Need help deciding between ED nights or DOU days

username2008 · Jun 5, 2008

both #10 and 11 are supposed to be for the opposite hospitals above. sorry for the confusion.

Smackdown · Jun 5, 2008

I would choose Hospital #1. Switching back and forth between days and nights at Hospital #2 sounds like it would be killer on your body and mind. Plus, it sounds like that manager isn't telling you something about why there is such a high turnover of new RNs. I'm sure they aren't ONLY leaving because of the benefits.....something else is up.

Being able to start on days as a new grad is something unheard of in this area, usually you are forced to work for 2 or more years on night shift first. I would jump all over a day shift job.

I know that there are nurses who love night shift.....but I graduated a year ago and have been working nights for a year. It makes my sleep schedule all crazy and is depressing to be up all night long on my days off while trying to flip my schedule back. I would choose a job that I might not find as exciting as my current job if a day shift position was open, just for my own sanity.

**canoehead, BSN, RN** · Jun 5, 2008

You ACCEPTED both job offers but are only taking one?

Better make a good choice because you may burn your bridges with the other unit, possibly the whole hospital.

northshore08 · Jun 5, 2008

Congrats on having two great job offers right out of school!! :yeah:

There is a lot to be said for being in the department you want to be in, learning the kind of nursing you want to learn.

That said, here's some things to consider. The list stated that in the ED you will rotate shifts. Get more info on this; most EDs have multiple shifts that may start at 0700, 0900, 1000, 1200, 1500, or 1900. My current position says I must rotate, but after negotiation I was able to delete 7p from the mix, since they already had enough nurses on nights. Of course that could change. (And I have found that the 1500 shift is not that bad; this coming from a devoted day nurse.) Some EDs schedule 12hrs, 8hrs, and even as little as 4hr pieces to cover personnel needs. You will probably be training on days; 5 months should get you settled easily. And I may be flamed, but I think you are better off in a non-union atmosphere. You have enough to deal with learning the job without the extra political stuff that goes with unions. But I agree that a running turnover of new grads is a big red flag. And if the benefits issue is the real problem, you may find that you are paying that $700 (that was gonna be dues) for benefits over the year anyway. Is there any chance you could talk with any of the ED staff? Folks in other area EDs might know something.

Now, let's discuss the tele job. Days guaranteed is great, hands down. And if you are available for inhouse registry, you maybe can float to the ED someday and scope it out. It's good to train under nurses who have been there forever. Old heads hold a lot of knowledge and experience, but you may be getting that in the ED training as well, who knows? And how fast is that pt turnover? Is it a chest pain obs unit? If it's an observation unit, wonder what the patient acuity is like? At any rate, it seems this would be a gentler way into a nursing position, and give you a job with pay while you learned the ropes (of nursing and being part of a union.) Then you could check out the ED for a possible lateral transfer, but you would still be 10 miles away from home. How's the traffic for you? 7-10 miles would not be a consideration for me; I currently drive 30-40 minutes, and have never worked closer than a 20 minute drive from home.

Hmmmm >Guess it's ultimately up to you!

Enjoy your new grad status wherever you end up; don't be afraid to speak up and ask for help. Good luck with your choice!! :twocents:

jakeMIKY · Jun 5, 2008

What is in house registry?

HM2VikingRN, RN · Jun 5, 2008

Union dues are deductible off your taxes while health insurance premiums are not.

I would have 1 questions for both institutions:

1. What does the salary schedule look like?

I would take the tele job. The constantly rotating schedule of option 2 would get old real fast.

If the nurse manager is saying that turnover is driven by out of pocket benefit costs that would be a real red flag to me. Individual benefits can very easily cost 150$ plus per paycheck. You are looking at 3600/year for your health insurance.

In the union hospital you will pay maybe 50$ per paycheck. That is 1300/year. (Worst case). If you add the cost of your union dues to option 2 that still puts you at least 1600/year ahead of the ED hospital.

The union hospital probably has fixed shifts as a result of the contract. While bidding for shifts and schedules based on seniority has its share of issues under a seniority system everyone is treated equally and you don't have to worry about favoritism.

The pay rate is not comparable if you are expected to pay for your benefits in the nonunion hospital.

username2008 · Jun 5, 2008

in-house registry is like working overtime, or working a second part-time or per diem job at another hospital. so instead of picking up extra shifts at another hospital, you can work that at your current hospital, so it's in-house, and registry is like any other registry where you sign up if you want to work an extra shift a week or a pay period. i plan to do that and that $50/hr is very good incentive for me to work at hospital #1. both hospitals are 12 hour shifts. DOU's patient acuity is high and comprise of unstable cardiac patients, although they do get renal and other types of patients (except post heart surgery, which goes to CVDOU across the hall). the DOU patients mainly come from ICU or ED. as for hospital #2's variable shift in ED, i dont know the details as it can change anytime depending on their needs. also, i like to mention that i had rejected a night shift offer with hospital #1's ED before i even interviewed for the DOU position. the manager is very nice and didn't really ask me much during the interview (she knew i had rejected an offer with ED, and the ED director who interviewed me may have taken my rejection personally because she said she was "disappointed" in my rejection, so i'd prefer not to see her around the hospital if i were to decide on hospital #1. hospital #1's ED is a 12-bed level 2 but they claim to be expanding and there's an overflow unit upstairs, and their charting is not yet computerized). hospital 2's ED manager, however, grilled me during my interview and was direct and intimidating telling me how i will have to be on my feet for 12 hours and it's all stressful and the nurses are burnt out. of course, as a newbie, i expected to be intimidated, so i'm not sure i bought everything she said. she wanted to make sure that ED was what i really wanted before she gave me an offer. of course, during interviews an applicant (as was my case) will always tell the interviewer everything they want to hear. you will lie if you have to just to get an offer, because that is your goal during an interview: to get an offer. anyway, that's the full rundown. so far, it seems everyone would suggest i take the day shift with hospital #1. anyone in favor of a variable shift in ED? i have no problem working up till midnight, but my concern is after 3am and sleeping during days and switching this up back and forth. the only reason i rejected my first offer with hospital #1's ED is because it was nights. i figure with variable, i can get some days in, but someone told me that be worse than a straight night position? for those of you who work a variable shift, how was it for you?

northshore08 · Jun 5, 2008

Our calendar runs Sun to Sat. My variable schedule for the last four weeks looks like this:

week 1--mon 12-12 tues 12-12 sat 12-12

week 2--sun 12-12 mon 3-3 fri 10-10

week 3--mon 10-10 tues 3-3 wed 3-3 (i did this to myself b/c family was visiting; originally sched thurs 3-3, fri 3-3)

week 4--tues 7-7 wed 7-7 fri 7-7 (a-p)

I have a 4th grader; it kinda works out well since my husband can take him to school the mornings I have to sleep. I do need extra rest on the day after a 3-3, but I'm usually up and okay by noon. :yawn: I thought I would have issues bouncing back to 7a, but not so much.

We have a good scheduler that works with the staff closely. And we trade off frequently. But they have not scheduled me to follow a 10, 12, or a 3 with a 7a--not enough rest. If the scheduler does it, he gets teased terribly for it, and promptly changes the schedule.

The best things about later shifts are: no bad am traffic; a busy, fast working shift (it's over quickly); and you are frequently not involved in a lot of the day vs night politics because you work with both shifts. That is a big plus.

:specs:

northshore08 · Jun 5, 2008

After reading your last post more closely, I would lean toward the tele job, too.

My reasons are:

1. I think it's a better learning environment for a new grad. Everything you learn there can and will be used in later ED jobs.

2. Day shift.

3. Ability to watch the developing ED (in hosp #1)from a safe distance and see what happens. (Don't personalize the interview with that manager; if you do well in the DOU, she will be glad to have you, and things may have improved--expansion complete, bugs worked out of new computerized charting)

4. Too many unanswered questions with the ED in hosp #2.

About the computerized charting. At my last hospital ED we were the last department to go computerized, and it was horrible to have a hold pt. Since they had taught us how to chart in the computer during orientation, they expected us to remember (which we didn't.) I think it's a good thing to know the hospital's charting system, especially if it is different than the ED.

username2008 · Jun 9, 2008

northshore08, thank you for your feedback, as well as to the other two posters who suggested the day shift. after looking at your variable schedule more closely, it looks very doable, if not desirable, for me if that was my own schedule. my concern with a variable shift would be working something like this:

week 1: mon 7p-7a, tue 12p-12a, wed 7a-7p

week 2: mon 7p-7a, tue 7p-7a, wed 7p-7a

week 3: mon 7a-7p, tue 7a-7p, wed 7a-7p

week 4: mon 7p-7a, wed 7a-7p, fri 7p-7a

a schedule like this would totally screw up my sleep patterns and body in no time. that is what i'm afraid of and my manager hasn't yet answered my questions regarding that. so my impression is that i'm pretty much at their mercy. i'm just hoping i can get a schedule like yours and have more flexibility even though it's a variable shift. further, here are my reasons for ultimately choosing one hospital over the other:

hospital #1:

1. $50/hr for a 4th shift (overtime via in-house registry)

2. day shift

3. nice manager

4. low nurse turnover, high patient turnover

5. as a new nurse, the ED sounds scary and may be too much for a newbie like me and i'm not sure i know what i'm getting myself into if i go to the ED first (this fear is due to my intimidating interview with the ED manager at hospital #2, although she started out in the ED too and was grilled and intimidated but yet, no matter what her manager told her when she first started, she kept with it because this was what she wanted (looks to me like she gave me and her other new grads the same treatment that was given to her as a newbie), unlike my interview with the ED director with hospital #1, the night shift ED job that i previously rejected, who said that she didnt' believe new grads should start out there, even though the hospital does hire new grads to her ED, and when i asked her why the hospital does that, she answered "i don't know", but this is another story.)

hospital #2:

1. 18-week Versant Residency training (includes preceptor, mentor, debriefing and support groups, web-based training, etc.)

2. slightly closer to home so i won't have to drive through a portion of the freeway that is usually packed during morning rush hour

3. the ED is my first choice unit and i have little to no interest in inpatient medical telemetry (my future goal is to work in outpatient ambulatory care, preferably outside a hospital environment, such as a clinic, physician's office, outpatient surgery center, or even a prison or jail)

4. because of #3, i'd rather not waste my first year or two in inpatient medical telemetry and, instead, get started right away in ED (i know it won't be a total waste since i'll be learning things that can apply to the ED, but it won't be the same as actually working in the ED)

5. even though i gave a verbal agreement to stay 2 years, nothing is legally binding and i can leave after a year, after training, or whenever i feel marketable to apply to other area EDs

which do you (the reader) feel is the better rationale for selecting either hospital? both programs start in july, so i will make a final decision soon and should give them enough time (3 weeks) to find a replacement. i dont feel i'm burning any bridges like that one poster said because this is equivalent to resigning a position and giving 2 weeks notice. this is a business decision, nothing personal, so should not be taken personally. you do what's best for yourself and can't worry about screwing others (recruiter, manager) over (sure, the recruiter will have to start over, but that's part of their job). right??? this is my life we're talking about and i need to consider it carefully. also, i will go and see if i can talk to the ED nurses directly.