New Grad:Leave new'ish acute care perinatal for (unexpected) dream PH maternal-child job?

[estoquodes]

Hi PHN's! I'm facing a bit of a dilemma, and wanted to get some input from those who have been working in public health, and/or have transitioned from acute care to public health.

Around January/February this year I interviewed for two very different nursing positions as a new grad nurse, but both maternal-child health related (my passion): One in a very well known hospital system, within their new grad residency program. The hospital is about 1 1/2 hour - 2-hour commute from my home. The other position was/is in public health and with an MIECHV (maternal, infant and early childhood home visiting) program that is headquartered in my immediate community. The MIECHV role really is my dream job.

While the interview process for both positions happened within the same couple of months, the hiring process did not. Due to state budget issues, the MIECHV program experienced a hiring freeze around the time when I anticipated hearing whether or not I got the job. Long story short, I was told there was no definitive time on when hiring would resume for that role (darn and blast), and in my mind I wrote the position off.

Luckily and thankfully, I received an offer of employment with the new grad residency program. I accepted the acute care offer quite happily, and feeling quite lucky actually to have been chosen given how competitive the program is. I figured that I would complete the residency, and then look for employment closer to home after that first year - and/or hopefully the public health/MIECHV position would be out of its hiring freeze by then.

Of course, it's never that easy. Right before the July 4th weekend (so, almost 5 months after my interview) I received a phone call from the nurse supervisor of the MIECHV program saying that they were resuming hiring, and wanted to offer me employment. I was thrilled, and also - Murphy's Law.

I have spoken with the nursing supervisor and they are aware I am employed. They have graciously given me time to make a choice, because I have to consider not just what I want but also the position of my current employer (ethical dilemma's abound).

The only reason I would even consider leaving my current job so soon after being hired is because these MIECHV positions don't come around often. Well, not in my area at least. They are looking to fill positions now - and historically, once filled, they remain filled for years and years until nurses leave. There really may not be another opportunity to work in this dream job of mine for years. Certainly, anything is possible - but historically that's not usually the case.

I have been in my current position for almost 4 months, and I'm still in my probationary period. The only thing I can (and do) complain about is my commute - but the program itself is robust, and while very different from public health, it's maternal-child health related and I feel thoroughly supported as a new grad.

But here is my dream job calling me (literally) - very similar pay, slightly better schedule (and by better, I just mean more consistent), similar level of benefits and pension, fantastic nurses, lots of transition support. The big plus (as trite as it sounds) is that it's close to home. But oh, the timing!

I am a second-career nurse, and older (well, relative to my graduating class ). I do already have an idea of where I'd like my nursing career to go – and most of my goals lead me to public health work. But, if I leave inpatient for public health so early in my career - will I be doing myself a disservice? Should I stick with this acute care role for the year, and get that experience under my belt - will that make me a better public health MIECHV nurse, should there be an opportunity later on? Is it common to leave jobs in nursing so quickly? Or will my name be on some 'RN Naughty' list for eternity? Am I allowed to even take a dream job so soon in my career? I paid my dues in my first career, working my way up from the bottom - isn't that what I should do now? (...My therapist would tell me, "Stop with the should's!", and my Millennial friends would tell me I deserve to follow my bliss. But as someone straddling Gen X and Gen Y, I'm so conflicted: I very much want to grab this dream opportunity but at the same time I feel that I need to strap on some potato sacks for shoes and walk 15 miles in the snow to work because...work ethic!)

I have quit jobs in my life. Touch wood, I've always handled those situations well and (except for one ill-advised period of cringeworthy ignorance in my very early 20s) have not burned bridges. But I've really never been as invested in my career as I am with nursing - being a nurse means a great deal to me and I don't want to mis-step so early on in my career. And, I already know - nursing is a small world.

Yes, this is a dream job. And yes, if I were talking to a friend I'd probably tell them to follow their passion (or something like that). But it's different when the shoe is on the other foot. I'm thoroughly conflicted. Reading Robert Frost and thinking about taking the road less traveled is not helping either - it's just making me nauseous.

Forgive the lengthy post. I wanted to provide as much information as I could. I look forward to your responses/advice/musings/doses of reality/face palms of disbelief.

Cheers!

Ps. I have cross posted this in OB Specialty aswell.

[Everline]

I'm an "older" nurse and this is my second career. I wanted to be in public health from the time I was in nursing school, but I had the idea that I needed to do my time as a hospital floor nurse. I took a job in a new grad residency program. I had a lot of support and lots of learning opportunities there, but I found that floor/bedside nursing was not for me. I was very unhappy. At about the 7 or 8 month mark, I received a job offer to work in a community clinic. I accepted, gave proper notice and never regretted leaving the hospital. I am currently a public health nurse in a health department and intend on staying in this specialty for the length of my career in one capacity or another.

Firstly, you have look at your future goals. When I was working my first job in a hospital, I had a preceptor encourage me to think about where I want to be in a couple of years and make my decisions accordingly. What is your goal ultimately? For instance, I am not interested in working in acute care or doing floor nursing in the future so I am not worried about how I will get back into acute care or similar concerns. When I was thinking about leaving the hospital job, I realized that I was more likely to regret not taking the new opportunity than I was to regret leaving the job I had at the time. I also had an idea of where I wanted to be and the kind of nurse I wanted to be— and moving away from the hospital was definitely a move in the right direction for me. That being said, I did learn a lot working in acute care, and it is because I worked in acute care, even for less than a year, that other doors opened up for me.

If you decide to leave your current job, just make sure you have a written offer letter from the place you are going. Best wishes, whatever you decide. And congrats for gaining employment in the specialty that is your passion!

[estoquodes]

Hi Everline! Thanks for your wisdom and encouragement. I'd say our experiences are similar. I also have this underlying belief that I need to do floor nursing first - I think it comes from beliefs impressed on me by some instructors and preceptors in my nursing program. But, honestly, bedside never really fit. I actually really do enjoy my current job, and in just a few months my knowledge and skills has grown exponentially (more so than I thought possible, actually). I just don't find the work fulfilling, and while I know not every job is going to tick every box, I have been around long enough to know that if it doesn't feel right, it's not sustainable forever. I just thought I would complete the program and have that year of experience under my belt before moving on. So, this turn of events, while wonderful, is posing a number of challenges - personally and professionally. :)

I have written my short and long term goals, and they don't involve going back to bedside nursing or having years of acute care experience. I see myself in public health long term - working with the mother-child population and on maternal health programs and projects in the community.

Given that you also left fairly shortly after starting your acute care job, how did you approach it with your supervisor? How did you explain why you were leaving so soon? Did you even need to go into a lot of detail?

[oceanblue52]

Everline expressed pretty much exactly what I was going to say. If this is your dream job and you are confident that bedside is not for you, I say go for it! As far as resigning, you don't need to give a lot of detail. You can always say something personal came up, or you've found a different opportunity. Do expect though that you might be placed on a "do not rehire list." Make sure you have things squared away with the new job (public health jobs sometimes take awhile to get everything lined up), and give proper notice. Congrats and good luck! Keep us posted.

[estoquodes]

The "do not rehire" list is what scares me. Thanks very much for your insight, oceanblue52.

[SiwanRN]

Sometimes you just know that a particular nursing environment isn't going to do it for you. Oceanblue and Everline have laid it out pretty well, I think. Having additional acute care experience certainly won't hurt you in public health, and the knowledge base you build in your acute care position (either what you have so far or or what you have yet to gain if you stay longer) will only serve to broaden your perspectives when you get into a public health position. That said, you do bring up a very valid point about timing. In many public health settings jobs only open if someone retires or dies - the openings are not as plentiful as acute care positions, and if you have a job offer in hand that is very positive indeed. If you have no intention of ever returning to acute care, I wouldn't be overly concerned about only having several months experience in hospital nursing before transitioning to public health. However, if you want to leave the door open to return to hospital nursing in the future, it would probably be ideal to get a least a year in before transitioning out of the hospital. If you do make the switch, be sure to review the policies and procedures for job termination at your current position and give whatever amount of notice they require, and speak positively about the time you've had there and what you've learned with your coworkers and current supervisor. Don't burn a bridge.

I wish you the best of luck, whatever you decide, and do come back and let us know what you chose!

[Apple-Core, ASN, BSN, RN]

Please don't flame me ...... can somebody please explain what is "public health nursing" as opposed to "bedside" (I can pretty much figure it out, of course, but would like to here the professional definition).

Thanks!

[Everline]

Given that you also left fairly shortly after starting your acute care job, how did you approach it with your supervisor? How did you explain why you were leaving so soon? Did you even need to go into a lot of detail?

I didn't explain much, actually. I wrote a resignation letter that was short, sweet and to the point. Basically I said I was giving two week notice, but did not give a reason for leaving. I said how grateful I was for the opportunity to work there and that sort of thing. Wished the hospital continued success, etc. It was a short paragraph. I did have a talk with the nurse manager on my last day. I didn't give her any details but I do think I said I was going to a position that would move me toward my future goals as a nurse. I was sure to let her know how helpful everyone had been and that I'd had a positive experience working there. She told me I was welcome to return in the future. So that was a good thing to hear...not because I was planning on coming back. But I didn't want future employers to call and hear that I was not eligible for rehire.

Find out the HR requirements for leaving a job, how much notice they expect and any info about resigning from a residency position. Then perhaps add that to your considerations. I would have left the hospital even if it would have resulted in me being ineligible for rehire. It was just better that I didn't have to.

[DowntheRiver]

In my area, public health nursing jobs are falling out of favor to essentially public health workers, kinda like CNAs/UAPs. What nurses once did now unlicensed personnel do. It is all about cost, and nurses are expensive, even though the majority of us take a pay cut to go into public health. Mine was about $8,000, I think?

In the current political climate, I think its hard doing PHN. Budgets are tight, and for me my probationary period was a year with a HD/state job.

Will this job require wear/tear on your personal vehicle? Make sure you account for that when factoring salary. I was using my personal vehicle for my PHN job and the miles add up. I did get reimbursed for mileage but it wasn't worth it.

[AssociateDegree]

One thing you might want to check out is how the MIECHV job is funded. If it's a grant-funded position, I would not leave your current job, given that you are still in a new grad residency program. Grants expire and may not get re-funded. This has happened a number of times where I live (Ohio), specifically in maternal/infant home visit programs. If you lose the PH position and don't have a lot of hospital experience, it could be difficult to get hired in the future. Just my 2 cents...

[SiwanRN]

One thing you might want to check out is how the MIECHV job is funded. If it's a grant-funded position, I would not leave your current job, given that you are still in a new grad residency program. Grants expire and may not get re-funded. This has happened a number of times where I live (Ohio), specifically in maternal/infant home visit programs. If you lose the PH position and don't have a lot of hospital experience, it could be difficult to get hired in the future. Just my 2 cents...

That is a very good point and probably something that should factor into your decision.

[estoquodes]

Thanks for that advice. I appreciate the perspective.