New Grad RN, BSN wants to know if working in SNF is a dead end?

[FutureFlightRN]

Hello Nurses!

I graduated in December 2009 with my BSN, got my RN in February, and I have been job hunting for six months with only one panel interview at Stanford Hospital & Clinics and no job offers so far. I currently work part-time as a caregiver for a staffing agency. My client lives in a skilled nursing facility and I have been presented an opportunity to work at this SNF as an RN. But, I have had two hospitals tell me, "Whatever you do, do not work in a nursing home" and "If you ever want to work at _________ Hospital, you must have at least one year experience as an RN from a different hospital."

This makes me feel that working at a SNF could be a career ender for a New Grad RN, BSN. What do you think?

Your thoughts and wisdom are very appreciated! :-)

[shockable_rhythm]

If it is a good opportunity take it. SNF is a valid field. I know quite a few nurses who started out in LTC/SNF and later moved on to work in a hospital. Hospitals are saying they want acute care experience now, but when the nursing market opens up again the hospitals will hire you:twocents:

[graykitty]

All of the posts on this thread are encouraging. Can anyone clarify something for me? I'm a new RN grad with no hospital experience behind me either. At a job fair I attended recently, I spoke with a Nurse Mgr in a hospital rehab dept about working there, full time, eves/nights. This hospital is an acute care hospital with a rehab department, same floor as med-surg. She explained that this would be a good starting job for me & would allow me to get my nursing skills down first before going to any other area. Since she stated that, "all of the pt's in the rehab dept are stable - they must be, in order to handle 3-4 hrs of rehab per day. If they become unstable, they get sent back to surgery, etc." I now have an interview set up for this position. If I'm only working with stable patients, what kind of nursing skills am I going to learn here, besides time management, organization, & psychosocial? Within 6 months to 1 yr, if I want to move to med-surg in the same hospital, will I have cut my own throat? Will I experience overwhelming stress because I've "lost" everything learned in school?Do I take the rehab job if offerred and keep looking for med-surg? Or should I turn down a rehab job and wait for a med-surg job to become available? That seems scary to me. I'd be losing all of my nursing knowledge from school if I sat around for 8 mos-1 yr.

I'm so confused and I don't want to make a decision that may come back to haunt me. Of course, I may love rehab nursing, fall in love with my patients, and decide to stay for years. Any advice?

[JenniferSews]

I work in a SNF, which in theory is a step down from that unit. But I can promise you that "stable" is a relative term in healthcare these days. I have had many healthy patients who had stable courses and transitioned to home as planned. Sometimes we asked each other why they were even in our facility.

I have also had patients who should have been stable but weren't. In the last week I have had some apparently stable patients turn critical very quickly. You must react quickly since you can't just call the rapid response team or wait for the doc. 911 is my only backup, and I need to identify a problem early! In this setting you need really good instincts and good assessment skills. We don't have a doctor on hand and if you're going to call someone in the night or on the weekend you'd better be very sure about your assessment and be prepared to defend your position.

I have done lots of wound care, peritoneal dialysis, started IVs, inserted catheters, managed trachs, g-tubes, and a ton more. A lot of what I do every day might be done by another discipline in the hospital. When the peritoneal dialysis wasn't working right, it was me that had to troubleshoot it and solve the issues myself. I'm not losing skills, that's for sure! I'm learning skills I probably never would have learned otherwise. If you turn down an opportunity and sat around waiting for the right moment, you may well end up with nothing.

[nurse1109]

TO MINDYKOZ:

I recently started working on an acute rehab unit in a hospital. I transferred there from PACU. My pacu experience gave me some critical care, abc, and quick assessment skills but since you only keep your pt for about an hr I had a limited set of skills. I was a new grad when I started in PACU and decided to do prn work at a nursing home on their skilled rehab unit to learn additional skills and med pass, dressing changes, treatments. ARU is a great place to start. I am learning better time management, I attend care-plan meetings with the physician, discharge planner and therapist. While the patients are stable I still have to give blood, have pt's on IVs, manage hypoglycemia, they are always getting labs and x-rays, some develop dvts or pneumonia. The nurses I work with have worked on this unit a very long time and say the pts are moved from med-surg much sooner than in the past. Since health care is insurance, money driven I think this will be the current trend. I don't think there is any "skill" that a pt may need that we won't provide, the pt just needs to have the physical stamina to meet 3hr/day therapy requirements. Good luck to you! It is hard to know what to do when you first graduate but I think any experience as counts towards building your resume :)

[nurse1109]

Having worked LTC before I do not think it is a dead-end job. Most ECF's have large skilled rehab units because that is where reimbursement is. Patients are dc'd from the hospital much sooner than they were in the past. Almost every week at the nursing home I worked for there was at least 1 emergency situation. This requires and builds your assessment skills. Working with the elderly can be very rewarding. As an RN after some experience you will have management opportunities as well such as Assistant DON, staff development, admissions/marketing, and MDS. Eventually you may even work your way up to DON. I have a friend who is a DON and recently got a corporate job as a regional manager with her ASN. I myself would not be opposed to going back to an ECF one day. Good luck! First jobs can be hard, your 1st job may not be what you had in mind and its difficult to know what you will and won't like until you try it. I hope this helps :)