New Grad Indecision

[rnofsunshine, BSN]

Hi there! I could use a bit of advice as a new grad.

I shadowed a position in an LTAC today and was a bit disappointed, but it is the only job that has interviewed me since the end of April. My state was hit pretty hard with COVID-19, and I just got licensed middle of June. I was told LTAC could be a great learning experience, but I want to become an Acute Care NP within the next 5 years. Would LTAC give me enough experience for ACNP?

Furthermore, there is a new grad residency that I want to apply to as well which starts in September and new grads get to cycle through ICUs and choose which they like best and get a permanent FTE (0.9) position there. I love this idea but it starts so late and I feel a lot of pressure from my family just to get a job and stop being so "picky."

But when I was at the LTAC, it just didn't feel like me. I like being in a patient's room for 3+ hours because of their acuity. I didn't get a good feel of the LTAC patient's acuity, but I just feel pressure to say yes and stop being so picky.

So does LTAC give good experience or should I hope I get into the ICU residency?

~RN of Sunshine

[Hoshio, RN]

I've had almost all of my nursing experience in an LTAC and most of the patient's I've worked with are acute in different ways. Overall I've loved the experience of being able to see how far my patient's have been able to come.

A little background for you, I started working at this LTAC in 2016 as a nursing assistant on a cardio pulmonary floor. It was my first actual hospital job, up until that point I honestly associated "sick" with cough/ cold, not being who actually can't breath or have machine's keeping them alive kind of mind set. My floor had "stable" patients weaning from ventilators, recovering from acute episodes of heart failure, and some had LVADs - I even had patient's with Bivads (RVAD & LVAD). Obviously I was a CNA so I didn't comprehend much of the machinery, but it got me very comfortable with providing patient care, and the nurses who I worked with were always willing to teach, explain and demonstrate stuff to me. It was very beneficial while I was in nursing school, it defiantly made school a lot easier.

When I got my RN I switched to a different floor for a different environment & got hired onto the neuro & Traumatic brain injury unit. While there were no vents here, most of my patients were completely dependent for care and were going septic left & right. It really taught me how to prioritize & how to put clinical data & status together. Also it doesn't hurt that most of my patients were not alert enough to see how horridly my IV & skills were. After being on this floor for about two years I feel I've really developed my basic skills & am feel confident as a nurses that I'm starting to look into going to an ICU next - many of the RNs here go to an ICU after because we take so many patient's from the city nearby and they know just how much we do. Hell we had to take COVID+ patient's on ventilators at one point d/t the pandemic.

Long story short, LTAC is a great place in my opinion to start. It's a great place to master basic skills, see a lot of different patients, and plus it's a job. Now don't get me wrong I feel like at any LTAC, staffing sucks, the floor can be heavy, and the pay not be great, but I think the experience makes it all better at the end of the day.

Good luck!

[speedynurse, ADN, BSN, RN, EMT-P]

First - how badly do you need a job? Can you afford to go one month without a job to take on the residency?

I have never worked in LTACH but have actually heard it has some good critical care things in its own way.....vents, etc.

I tend to be inclined that a new grad needs a supportive residency and a lot of residencies are really wonderful at providing enough training with new grad classes, critical care classes, ACLS/PALS, in services, check-ins with the nurse educator....etc. You will learn a ton in the ICU (I am not an ICU nurse but have taken care of multiple ICU holds). However, ICU can be overwhelming for a new grad. Some love it and some are miserable and a lot depends on how supportive your environment is.

Anyway.....just my two cents from someone who has never worked in either unit LOL ?

[rnofsunshine, BSN]

For anyone wanting an update, I actually kept on waiting and waiting because no job felt right and got offered (and accepted) my dream job in NICU! Thank you all for your helpful words!

~ RN of Sunshine