New Grad Indecision

Lovethenurse2b25, ASN, BSN, CNA, LPN, RN · Jul 8, 2020

3 hours ago, rnofsunshine said:
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

LTACH offers great experience that you will not see in just one day of shadowing. A great nurse has experience is many areas of nursing. I would say to pray about it and explore the option that is suitable to your future career goals. You could also work in LTACH until the ICU residency opens up.

Sour Lemon · Jul 8, 2020

How competitive is the residency, and what's your plan if you're not selected for it? There are probably a lot of new graduates in your position, and they're probably waiting on the sidelines to apply as well.

I'm under the impression that there's a lot to learn in LTAC, but it would be shady to work for a few months and then quit. You'd probably still be on orientation. Who's funding you? Can you afford to wait it out?

rnofsunshine, BSN · Jul 8, 2020

8 minutes ago, Sour Lemon said:
How competitive is the residency, and what's your plan if you're not selected for it? There are probably a lot of new graduates in your position, and they're probably waiting on the sidelines to apply as well.
I'm under the impression that there's a lot to learn in LTAC, but it would be shady to work for a few months and then quit. You'd probably still be on orientation. Who's funding you? Can you afford to wait it out?

I honestly don’t know what I would do if I didn’t get the residency. They do it 3x a year, in Jan, June, and Sept. So I honestly don’t really know. It’s in a community hospital and in their June cohort they took 32 NGs. I’m not sure how competitive it is.

I definitely would not take the LTAC job only to leave and do the residency. The LTAC job starts only 2 weeks before the residency does, and I haven’t been officially offered the LTAC job yet. I can afford to wait it out as I’m living from home but I am getting married soon. Most is paid for but it would be nice just to have funds coming in to put aside.

I just honestly had not heard about LTAC before this position came up. I’ve been on a waiting list for a position at the hospital for 2 months and they told me about this one popping up. I spoke to a few nurses and they said night shift is a lot slower and I just really prefer to be busy, so in my mind there’s so much to monitor with ICU patients that nights would still be fairly busy. I’m not sure about other LTACs but this one the patients are usually trached with or without a ventilator, have wound vacs, and on dialysis, but not CVVH/CRRT, and no hemodynamics monitoring, ratio 1:4-5. I think when it was described to me it just sounded different than when I went, but it might just be me. Like I said, I only learned about it like a week ago.

Sour Lemon · Jul 8, 2020

Well, not having an actual offer simplifies things ...at least for now. There's no tough decision to make yet. I'd continue filling out applications elsewhere while you wait and think things over.

EDNURSE20, BSN · Jul 8, 2020

I agree with your family. Stop being picky and take the job. Any experience is better than none. Especially in This climate, where jobs are hard to come by. it’s very rare to start in ICU as a new grad too.

most new grad have all these big great plans, and most of them end up in areas they never considered/hated the ones they thought were for them. Be open minded, get some experience, you never know where it may lead you.

RNNPICU, BSN, RN · Jul 8, 2020

I don't know of any area where you would be in the patient's room for 3 + hours, you would never have time for everything else that needs to be done.

In the ICU you try and minimize the time in the room, you go in, do assessments, give meds, monitor and then let the patient rest. Yes, when the patient is really sick and there is a lot going on you can be in the room for that long, but that is pretty rare. Trust me, you really don't want to be in the room that long. Exceptions are teaching, cluster cares, etc. Remember you will likley have 2 patients in the ICU and with all of the charting, coordinating other services, checking meds, charting, assessments, charting, charting, you would not have those three hours.

Since you do not have an offer for the ICU I would take the LTAC. It is a job.

Good Luck in your future as a nurse

rnofsunshine, BSN · Jul 8, 2020

1 minute ago, RNNPICU said:
I don't know of any area where you would be in the patient's room for 3 + hours, you would never have time for everything else that needs to be done.
In the ICU you try and minimize the time in the room, you go in, do assessments, give meds, monitor and then let the patient rest. Yes, when the patient is really sick and there is a lot going on you can be in the room for that long, but that is pretty rare. Trust me, you really don't want to be in the room that long. Exceptions are teaching, cluster cares, etc. Remember you will likley have 2 patients in the ICU and with all of the charting, coordinating other services, checking meds, charting, assessments, charting, charting, you would not have those three hours.
Since you do not have an offer for the ICU I would take the LTAC. It is a job.
Good Luck in your future as a nurse

I had a clinical where we were in a patient’s room for 3 hours because it was shift change and the patient was really unstable.

I’m honestly just terrified of choosing a job and realizing that I hate it and becoming a nurse that complains about her job/doesn’t do it well, as I’ve seen so many times. It could just be my generation. I was up for a NICU, PICU, and Peds ER residency before they got canceled because of COVID, so honestly everything has been a disappointment after that.

RNNPICU, BSN, RN · Jul 8, 2020

Just now, rnofsunshine said:
I had a clinical where we were in a patient’s room for 3 hours because it was shift change and the patient was really unstable.
I’m honestly just terrified of choosing a job and realizing that I hate it and becoming a nurse that complains about her job/doesn’t do it well, as I’ve seen so many times. It could just be my generation. I was up for a NICU, PICU, and Peds ER residency before they got canceled because of COVID, so honestly everything has been a disappointment after that.

That scenario at shift change is the exception not the norm. You can also choose to hate or like something. If you have an offer, you obviously interviewed and applied for a reason. I realize it was a disappointment with the residency cancelation, but you do have another offer. If you really think abut it, even in a job you would like, there will be aspects that you can complain about, and people will complain too even if you think it is the best thing ever.

Take a chance, be open to all skills and patient management. You have the power to set your own tone about the job. If you go in with the idea that it is a great FIRST job, then you have won half of the battle

rnofsunshine, BSN · Jul 8, 2020

Just now, RNNPICU said:
That scenario at shift change is the exception not the norm. You can also choose to hate or like something. If you have an offer, you obviously interviewed and applied for a reason. I realize it was a disappointment with the residency cancelation, but you do have another offer. If you really think abut it, even in a job you would like, there will be aspects that you can complain about, and people will complain too even if you think it is the best thing ever.
Take a chance, be open to all skills and patient management. You have the power to set your own tone about the job. If you go in with the idea that it is a great FIRST job, then you have won half of the battle

That’s the whole thing — I didn’t apply to the LTAC job. I applied to a residency program at a larger hospital and they asked me my 3 ideal units and said they would contact me when a position was available there (cardiac stepdown, neurology, and oncology), but they called me about LTAC instead and I interviewed on the phone because it sounded different than when I visited the unit. I’m not sure if I explained that well enough before.

RNNPICU, BSN, RN · Jul 8, 2020

I still think that they must have thought enough of you to offer something you didn't apply for. That means they likely think you are a good candidate for their hospital and want you as an employee and this was the best match given your experience, interview, etc.

This isn't a downgrade, or something that makes you less than something, this is a job that someone thought you would be a good fit. Working in LTAC is not a sub nursing job. Although I only have ICU experience I have worked with those who work in LTAC type facilities and there is a lot of different patient management and is a challenge in itself. Nurses work in so many different settings, nurses are needed in all settings. Think about this, what if the ICU turns out to be a disaster of a unit?

rnofsunshine, BSN · Jul 8, 2020

Just now, RNNPICU said:
I still think that they must have thought enough of you to offer something you didn't apply for. That means they likely think you are a good candidate for their hospital and want you as an employee and this was the best match given your experience, interview, etc.

I thought that too! But I asked the HR person and it turns out it’s the only unit in the whole hospital that has open positions.

Either way, I appreciate your input.