Need Career Advice

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Hi everyone so I just resigned from my first real nursing job at a LTC rehab facility. It was just not the right environment for me for multiple reasons. A lot of the reasons why I left is because of the lack of quality training/orientation I received, the tremendous load of patients assigned to one nurse and the chaotic, disorganized and lack of management/team support from my other nurses. I felt like everyday I went in I was risking losing my license due to the unsafe practices and policies I saw being done at the facility. It was emotionally and physically draining the life out of me and was making me hate not being able to provide the nursing care I wanted. So the only option for me was to resign shortly after my 1 week of orientation period and I did feel a huge sign of relief listening to my heart. Now that I'm back to the job search I need your advice. I have read so many articles about LTC experiences people have gone through and reasons why they left and the exact feelings, complaints and issues other people have had is exactly what I experienced. I have learned that LTC is not the place for me but know what?? I do hold a masters level education as nurse and I did love working in primary care settings and home health because i had more time with my patients. I loved doing assessment care plans for my patients in home health and learning to diagnose, treat and prescribe in my msn program. I dont have a great foundation of RN experience and thought I should work on developing that but I truly want to be practicing as Nurse Practitioner. I have heard hospitals are more structured and organized chaos and you will have a smaller patient ratio than in LTC is that true? Training is a must for me without it I will not have the confidence or ability to practice independently. what do you guys advise?? Or has anyone else had similar LTC experience?

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Specializes in NICU, ICU, PICU, Academia.

Can you clarify what type of NP you are and why you refer to staff as 'my nurses'? Were you hired into an NP role? Or an RN role?

What is your previous RN experience?

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I was hired as a charge nurse (RN) for this LTC facility but I currently hold a ARNP (FNP) license with my RN license. I have little less than 2 years experience in home health doing insurance based/plan of care assessments and medication management. My primary care experience is from my clinical practicum i completed in my MSN program over 1 year (780 hours).

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Is there a particular reason you were pushing a medication cart as a charge RN at an LTC rehab facility when you have a FNP license in your back pocket? I quizzically await the answer.

The answer to this question could determine the type and quality of career advice that future respondents will provide.

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I was told throughout my MSN clinicals by preceptors that I need to work as a RN before I will be considered or be able to get hired as a NP. I thought a doctor would look at my work experience and see I do not have a foundation of RN experience behind my name and not consider hiring me. Therefore, with all the competition out there in my area (Florida) I wouldn't stand a chance getting hired compared to another NP new grad who worked as an RN for many years. The LTC place hired me as RN to get more nursing skills and foundation of RN experience .

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I have learned now that bedside nursing especially in LTC nursing home setting is not for me . I do want to practice as a FNP and am still looking for a place to hire me. I am willing to build on my rn experience in the meantime. I have not had one clinical experience in an office or with a doctor or NP that I would or could be considered for a job position. If I work in the hospital I would have sooner exposure to finding MDs and finding a specialty for me. Even if I work one year as an RN in a hospital get that experience and move into NP job when it comes?

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my curse for every nursing job now is that im over qualified and underqualified at the same time :( Can NP new graduates work in home health? I was contacted by some NP recruiting agency that will hire np new grads to do independent contractor work out in the community doing home health risk assessments...they pay per assessment and try to line it up in your area that you are willing to travel. Unfortunately they dont have any assessments needed in south florida for probably a month or so and said they'd keep me on their list. That is something I would be willing to do just to get some NP experience until i find a primary care office physician to hire me. Not sure exactly if i should research home health jobs for NP new grads?

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I don't mean to sound snarky but how in the world did you obtain any degree in nursing without knowing the answer to differing patient ratios in acute versus LTC? Lay people know this answer.

Be mindful of how naive you may across in interviews.

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I knew there would be a bigger patient ratio but I thought I would be able to adapt to it and manage that workload of patients but that plus how the place was run and the environment was not conducive to me. I know there is a smaller ratio of patients in a hospital. I saw easily 30 patients in primary care setting but that is different I know than working as an RN. I learned from my mistake and know now what environment is not for me.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I don't mean to sound snarky but how in the world did you obtain any degree in nursing without knowing the answer to differing patient ratios in acute versus LTC? Lay people know this answer.

Be mindful of how naive you may across in interviews.

OP you put the cart before the horse, getting your master's and no experience. Now you find yourself in the untenable position of being unqualified for most nursing positions. There is an order to things and jumping the fence to get ahead more quickly can burn.

Now you are in the position where you have to take any job you can and get any experience you are able to. You are not in any position to be picky, so don't. Get a job, get experience, and slowly you will get there.

There is no "fast lane" to experienced nursing, nor anyone's "dream job". And no one wants a nurse practicioner with little to no background and actual nursing experience as their primary care provider.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
OP you put the cart before the horse, getting your master's and no experience. Now you find yourself in the untenable position of being unqualified for most nursing positions. There is an order to things and jumping the fence to get ahead more quickly can burn.

Now you are in the position where you have to take any job you can and get any experience you are able to. You are not in any position to be picky, so don't. Get a job, get experience, and slowly you will get there.

There is no "fast lane" to experienced nursing, nor anyone's "dream job". And no one wants a nurse practicioner with little to no background and actual nursing experience as their primary care provider.

I agree. Unfortunately, the "fast track" didn't pay off and shame on any school that promotes this. Yes, you can put one foot in front of the other and get to where you want to be. Even though most LTCs are chaotic, not all of them are total pits. When I worked agency I ran away screaming from one after five shifts. The other two were quite doable. So maybe just keep looking.

Please don't take this as snark but do work on your written communication skills. When you tell me you have a master's degree in anything but don't use paragraphs or pay attention to sentence structure, there is a disconnect. This may be undermining you more than you know.

Good luck.

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