New Grad Trying to Make a Decision

"nursy", RN · Nov 12, 2019

If you read enough posts on here, you will quickly find that a lot of nurses are getting burned out with bedside nursing. I would take the clinic job in a heartbeat, especially if it helps you with your decision to go back to school. There are too many variable in the future for you to worry about possible reentry to bedside down the road. If you end up wanting to go back to bedside, you can always find a way to make it happen, especially once you've graduated with a BSN.

allnurses Guide · Nov 12, 2019

What is it about a hospital job that you want so badly?

You will not be eligible for residencies at this point. Generally speaking those are open to individuals who are new grads with no experience. Some will take people who are in the first year after graduation, but after that it becomes pretty difficult to land a residency position.

Being in both a residency and in school can be pretty difficult, but if you want to be in the hospital, you basically have until one year after your graduation with a nursing degree to secure one. If you are still in that time period, you should get as aggressive as you can about landing one, including being willing to move. Getting your BSN unfortunately will not reset the clock on this. Generally speaking, you have one shot at being eligible for residencies.

Olga · Nov 12, 2019

Hi jennsrn,

I feel the same way! I am a new RN and I accepted this job at LTC because no hospitals will take me without BSN. I absolutely HATE it and I already put my 2 week notice, and I can't wait for the last day at that place. I have 30+ residents and while I got faster at popping pills, I can see how dangerous this is. There should be a law about save ratios! The other day there was a real emergency, the one that if we didn't see what happened the patient would die (bleeding). And I constantly think now that this was just luck. CNAs were serving trays so they walked in the room. I was on the other end of the floor. Another 5 minutes.... And do we all respond to the call bells within 5 minutes, no. When I say there should be another nurse to help with meds, administration says "oh..but you only have 32 patients, so it shouldn't be to bad, other floors have 47". I work at sub-acute rehab floor, where I have family members there every day and resident who DEFINITELY need more time spend with them. Some of them I see only twice - when I do rounds and when I give meds.

I am also working on my BSN online and spend at the LTC almost 2 months, I saw what it is from the beginning but I hoped to get at least some experience there. Now I just hope nobody dies on my shift so I can leave that place with my license.

stockmanjr, BSN · Nov 12, 2019

4 hours ago, Nurse SMS said:
What is it about a hospital job that you want so badly?
You will not be eligible for residencies at this point. Generally speaking those are open to individuals who are new grads with no experience. Some will take people who are in the first year after graduation, but after that it becomes pretty difficult to land a residency position.
Being in both a residency and in school can be pretty difficult, but if you want to be in the hospital, you basically have until one year after your graduation with a nursing degree to secure one. If you are still in that time period, you should get as aggressive as you can about landing one, including being willing to move. Getting your BSN unfortunately will not reset the clock on this. Generally speaking, you have one shot at being eligible for residencies.

That really varies as there are fellowships that will take nurses who are transferring to a new area of care. The problem of course is that many HR folks look down on LTC like we've discussed before. It's interesting I have a friend who has a cushy corporate office nursing job and is complaining she's bored. She's thinking about taking an LTC job as no hospital seems to want her with her direct entry MSN.

allnurses Guide · Nov 12, 2019

2 minutes ago, stockmanjr said:
That really varies as there are fellowships that will take nurses who are transferring to a new area of care. The problem of course is that many HR folks look down on LTC like we've discussed before. It's interesting I have a friend who has a cushy corporate office nursing job and is complaining she's bored. She's thinking about taking an LTC job as no hospital seems to want her with her direct entry MSN.

We have a robust fellowship program here at my hospital. Its so popular though that internal candidates take all the slots.

You are right, direct entry MSN is at a huge disadvantage if they never worked in acute care. I can understand that one. They have no experience but want more money and its a given they will move on as soon as they possibly can. I don't fully understand why LTACH experience gets snubbed.

stockmanjr, BSN · Nov 12, 2019

Just now, Nurse SMS said:
We have a robust fellowship program here at my hospital. Its so popular though that internal candidates take all the slots.
You are right, direct entry MSN is at a huge disadvantage if they never worked in acute care. I can understand that one. They have no experience but want more money and its a given they will move on as soon as they possibly can. I don't fully understand why LTACH experience gets snubbed.

I don't either but this seems to be the trend. The only way around is to work LTACH Tele or Vent it seems. A few of my classmates moved on from LTACH but it was either they did it super quickly like less than 6 months so they were considered a new grad or years and years of working tele.

jennsrn · Nov 13, 2019

@Nurse SMS

It's actually not about "wanting a hospital job so badly", it's me being a new RN grad who is concerned about how her current decisions with job offers may affect her future opportunities. I currently work in LTC/SNF, in which I hear from multiple sources, that once you're in LTC, it's difficult to transition to acute care/hospital setting. In my state, a lot of hospitals offer BSN graduates residency programs. While yes I may be an Associate's degree RN with experience, once I graduate with my BSN, I may be able to transition into a hospital setting. I don't know which state you live in, but it may work differently in other areas. I'm looking for opinions on whether it's a bad idea to start out in another setting, or if I should attempt to find my way in to a hospital while I'm seven months out of college, and considered a "new grad". I have applied for a hospital position, but have yet to hear back. I am only three months into my LTC job, but what my fear is, is making the same mistake twice. The transition from student to RN is difficult and tough, I'm sure you've been there, so I don't know if its my nerves that is holding me back, or if it's truly the fact that bedside nursing is not for me, and that maybe a more administrative, or office-based RN job is better suited for me. As mentioned in my post, I was offered a RN office job at a multi-specialty practice with great hours, yet the pay didn't even come close to what I'm making now, nor what I'd be making in the hospital. I'm looking for insight/opinions on whether taking a position like this can totally prevent me from transitioning back into acute care in the future. It's not that I "want a hospital job badly", it's the "what ifs", and the potential regret. I think it's just me having anxiety on taking that leap as a new nurse and jumping into the hospital setting, and the fear of the unknown.

jennsrn · Nov 13, 2019

@Olga

It's very overwhelming! And the RNs at my facility seem to forget what it was like to be a new nurse, on their first job, and it's frustrating. I work with an RN that is a year older than me, and has maybe 2 years of experience as a nurse, and I feel like she looks down upon me, and it's frustrating. They call me out on certain things, and while I accept any constructive criticism I receive, especially as a new nurse, I'm beginning to think I'm just being targeted and bullied. It's very "clicky" at my facility, and I feel out of place, and I feel like everything I do/attempt to do, it's WRONG. I know learning and experience comes with time, and that most "experience" comes with working on the job, but I just feel so unsupported in my current environment, that learning is not even a possibility. The ONLY thing that's keeping me there is the $. I make $11 more than what any other facility was willing to pay me, so that's a big difference. But I've stuck it out for three months now, and I'm at the point where the money doesn't even matter, it's my sanity and happiness that does, and if I have to take a big pay cut for a job that is 10x less stress, I am willing! I am seven months as an RN, and if I'm already this stressed being a nurse, then something needs to change! This will be my career for years and years down the road, and I need to be at least content with my job, where I feel like I am learning, gaining knowledge, and feeling supported. I don't feel any of that at my current job. I feel like a robot. Passing medications, putting in orders, providing treatments, documenting. I don't even have time to think about what it is I'm really doing! Not enough time to adequately assess my patient, not enough time to catch on to things that are out of the ordinary. And if there's something wrong with the patient, I usually miss what it is, because I am SO overwhelmed with knowing I need to accomplish so much in the eight hours before I can go home, and I end up feeling stupid that I missed the signs.

For example, I had a resident that was being sent out to the hospital for SOB. Usually when a patient has a respiratory issue, you would hold food, etc. Well dinner trays came, and he began eating. He was on 2L O2 of course, but the EMT was yelling and ripping apart the staff on how a patient with a respiratory issue shouldn't be eating. AND that's something I learned in nursing school, so I should have known that. But I was in the middle of 5pm med pass and it completely slipped my mind. I feel embarrassed. I could only imagine what my RN supervisors were thinking. It's just difficult juggling the tasks that LTC demands, and since you work in it, I'm sure you can relate. Taking care of 25-30 residents as a new nurse is extremely OVERWHELMING, and having to do it all in 8 hours is even more crazy. I'm looking into finding a new job. An office setting, outpatient dialysis, and even looking into hospital positions. Maybe something else with a little less demand, so I can go back to school. I think that if we can develop some skills from LTC (time management, prioritization), it will help us in ANY other nursing setting we choose to go into. Many people have told me LTC is a whole different level, and if we can somewhat handle that, we can handle almost anything else.

**CommunityRNBSN, BSN, RN** · Nov 13, 2019

20 hours ago, jennsrn said:
It's not that I "want a hospital job badly", it's the "what ifs", and the potential regret. I think it's just me having anxiety on taking that leap as a new nurse and jumping into the hospital setting, and the fear of the unknown.

This fear of “If I take a non-hospital job I’ll never get back into the hospital” seems to be widespread and unfounded, in my experience. Most of the nurses I know (I’m a new grad but now that I’m working, I’m obviously surrounded by nurses) have really bounced around from inpatient, outpatient, SNF, etc. My very first preceptor for example, started in an OBGYN clinic, 8-5 job, then got tired of it after a couple years and changed to med-surge, where I met her. (Different state, because she moved for family, so it’s not like it was within the same hospital system or anything.). I realize I’ve just given you one anecdote, but from my experience, people don’t have a hard time “getting in” with a hospital once they have a little bit of experience (if they are actually a good nurse, and a good employee) whether that experience is directly related or not. I think you should take the job you want to take, and rest in the knowledge that you can do a different job later if your circumstances change.

Olga · Nov 14, 2019

jennsrn

Nobody is looking down on me just because everybody else are new as well... I get no criticism of any kind because I'm on my own 90% of the time. And I quickly learned that even if people act very confident it doesn't mean they know what they doing. I feel like this is very bad and I got bad habits that I'm not even aware of.

20 hours ago, jennsrn said:
But I've stuck it out for three months now, and I'm at the point where the money doesn't even matter, it's my sanity and happiness that does

Oh, yes. I lasted for 2 months only. and I feel exactly the same. I am as well ready to take a cut.

20 hours ago, jennsrn said:
I feel like a robot. Passing medications, putting in orders, providing treatments, documenting.

Exactly! I even feel like there is no reason for anyone to go through RN school just to pop those pills out blister pack. This is all I do. I try to be a nurse in a very simple way, like I address DM control and make suggestions or BP control... "Oh, this resident is always low, I feel like meds need to be revised." Or " The sugar is high, I think we need to put a sliding scale" This is the most critical thinking I've done (this is not a critical thinking even)... I feel like this is very primitive and "not a rocket science". So I'm scared that I will feel very inadequate if I get a hospital job.

20 hours ago, jennsrn said:
but the EMT was yelling and ripping apart the staff on how a patient with a respiratory issue shouldn't be eating.

First of all, if someone is yelling at the professional setting and especially in front of the patients that already says a lot. I would ignore that. No, I would cut him off.

Second, in my facility - "do your best, however you can".... I honestly do not remember such a rule about SOB, that pt shouldn't be eating. All I can think about is encouraging smaller, more frequent meals. If resident was on O2 and wanted to eat and was able to do so, what is the reason he can't? The SOB wasn't that bad if he was eating. The EMTs worried about intubation and possible aspiration on stomach contents? Was this COPD or something else? Was any treatments given? Nebulizer?

I might be embarrassing myself by asking those questions((

James36, LPN, RN · Nov 15, 2019

I would take the office job TODAY, and walk away from the LTC with my license still in good standing!! It will work with your school schedule and you will gain good experience. You are a new nurse, and more pay will come with more time and experience. This will not prevent you from working bedside in the future. Good luck!