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New grads & Job Offer: When to settle

Posted

Specializes in CDU, cardiac telemetry, med-surg. Has 5 years experience.

Settle with....

  1. 1. Settle with....

    • 6
      Take the plasma center offer!
    • 9
      Take the LTC offer!
    • 5
      Keep looking!

20 members have participated

I know what everyone will say. I'm a new grad with a couple of job offers...take it! Take them both! But hear me out when I say it's not that simple.

I am very fortunate to be in a position where I can financially finish my BSN (Dec 2015) without working at the same time. But I don't want to delay my career, or lose my knowledge and skills.

My goal in school was to get into critical care in a hospital. After graduation, that goal has been downgraded to just getting into a hospital. I have applied to non-hospital positions too and have had an offer from a plasma donation center and a LTC.

I am very unsure about what to do. I am worried about the LTC because of the lack of training, high patient volume per nurse, and because I don't enjoy the environment. I'd be worried that a plasma center or clinic would not give me the experience that would make me marketable to hospitals in the future.

I totally understand the argument for taking any job that gives me any kind of experience, but I'm not convinced that employers regard "experience" in such broad terms. For HR, it's a buyers market. They can specify that candidates must have several years of experience in a very specific specialty. It seemed like med/surg use to require some kind of general nursing experience. Now med/surg requires 1-2 years of med/surg experience! I worry that sticking it out for a year in LTC would only qualify me for, well...... some other LTC. With office/clinics, I worry I will be even less marketable in terms of my skills, or lack thereof.

I know that I am lucky to be in a situation where I feel that I can choose, but there's a flip side to choice. I only have myself to blame if I make the wrong one.

I appreciate your input!

Edited by JustAdmitToObs

Not sure how it is in your part of the country, but where I am it seems that the only new grads that get jobs in hositals are those with connections somehow. So do some research with your connections and the two facilities.

Check in with any preceptor or NM who will remember you from a clinical. Ask if they would consider you for a position that opens on the unit based on how awesome you were in clinical (don't say it that way though! LOL). This will give you a feel for what other options you may have.

Another question-will hospitals in your area hire ADNs? Where I am, they only hire BSNs. If it's that way where you are, you may not get a hospital job until you complete your BSN.

Finally, are either the plasma center or the LTC affiliated with a hospital? If so, then your experience there will get you a foot in the door and could open up job possibilities in the future. If the LTC regularly takes admissions from hospital XYZ, the docs from that hospital will round on those patients and get to know you. If the plasma center is located in the basement of a hospital, you will get a chance to network.

After you do the research, your choice will become clear. I would definitely take one or the other to get that steady paycheck and some sort of experience!

JustAdmitToObs

Specializes in CDU, cardiac telemetry, med-surg. Has 5 years experience.

Most hospitals don't take ADNs however, I have connections with a small local hospital through volunteer work and clinicals. Despite having plenty of friends in the hospital and contacting the unit managers, as you said, I have not had success in getting in. Unfortunately, neither the plasma center or LTC are hospital affiliated. I definitely feel that the plasma center is not going to provide me with the right experience and it's looking for some for to stay long term. I'm very worried risking my license based on the staffing and lack of training at the LTC. We never did clinical rotations in an LTC so I'm not sure if I'm overreacting about how tough it is.

I still think that I can have a chance at getting into the hospital that I have contacts at, it's just up to timing of when they post the few and far between RN I positions.

RunBabyRN

Specializes in L&D, infusion, urology. Has 2 years experience.

I finally bit the bullet and applied to ONE SNF and got hired. I think that going into critical care, it might actually be good experience for you. It's a lot of juggling, but you learn a lot about dementia versus delirium, strokes, TBI, heart failure, hospice, UTIs and a lot of other stuff that's very relevant in CC. While it may not count as acute care experience, keeping your skills up and brushing up on those areas will serve you well when you DO get into critical care. Plus, you'll see where your patients go when they leave your care in the hospital, so you'll know what they need set up upon discharge.

Do your research on SNFs in the area. I was very selective about where I applied, and I asked about patient ratios and training. If I didn't feel comfortable, I wouldn't have taken it. I have been training since 9/2, and my first shift on my own is 9/28. I am training like crazy in the meantime. Advocate for yourself and your patients, protect yourself and your patients, and refuse to work anywhere that isn't safe.

Nothing says that taking one of these jobs means you stop looking elsewhere, either. I am still applying like crazy.

JustAdmitToObs

Specializes in CDU, cardiac telemetry, med-surg. Has 5 years experience.

RunBaby, you have a nice training time period. The SNF I may be accepting an offer from has only 5 days of training before I'm on my own with an average of 20 residents assigned to my care.

RunBaby, you have a nice training time period. The SNF I may be accepting an offer from has only 5 days of training before I'm on my own with an average of 20 residents assigned to my care.

Yes RunBabyRN was very fortunate with the training. I worked in a SNF as my first job as well and got two weeks of training. I know one person who recently got 4 days training as a new grad. Are they going to put you in a LTC wing or sub acute wing? You can always try and ask for more time by saying you don't feel ready. I worked on a LTC wing but trained on the acute wing. My nurse to patient ratio was 1:30. Once you get a routine down its not so bad.

JustAdmitToObs

Specializes in CDU, cardiac telemetry, med-surg. Has 5 years experience.

Yes RunBabyRN was very fortunate with the training. I worked in a SNF as my first job as well and got two weeks of training. I know one person who recently got 4 days training as a new grad. Are they going to put you in a LTC wing or sub acute wing? You can always try and ask for more time by saying you don't feel ready. I worked on a LTC wing but trained on the acute wing. My nurse to patient ratio was 1:30. Once you get a routine down its not so bad.

The SNF has a rehab side and a LTC side. I have a feeling I would be on the LTC side. What confuses me is that I have a friend from school who just started at a LTC, and she reports that it is easy, even boring! And she is not someone who sails through things without a care.

I'm sure it really depends on the facility. SNF's have a high staff turnover because of the high workload. If your looking for boring you could try your friends place. You will learn more on a acute wing however. The LTC wings can be boring because they become routine for the most part(same meds, blood sugar checks and treatments). You have to worry about falls and skin tears since they are usually older. Admissions are less frequent on an LTC wing as long as they are mostly full. You also get to know the LTC people better since they are always there.

estrellaCR, BSN, RN

Specializes in OB, Pediatrics, Maternal/Child Health. Has 2 years experience.

Depends how you look at it...I work in a hospital in acute care but i had a clinical at an LTC/rehab center and i enjoyed working with the older adults...most of them had dementia. Some were able to hold a conversation some where not , however u felt you were making a difference in their lives. Besides, dealing with falls and skin tears are great skills that if you want to work in hospital at some point will definitely be a plus. In acute care, you have patients that may be in the hospital for months of even years (usually elderly patients) and falls and skin tears are big issues to care for and prevent.

RunBabyRN

Specializes in L&D, infusion, urology. Has 2 years experience.

Yes RunBabyRN was very fortunate with the training. I worked in a SNF as my first job as well and got two weeks of training. I know one person who recently got 4 days training as a new grad. Are they going to put you in a LTC wing or sub acute wing? You can always try and ask for more time by saying you don't feel ready. I worked on a LTC wing but trained on the acute wing. My nurse to patient ratio was 1:30. Once you get a routine down its not so bad.

The training was something I asked about when I interviewed. I refuse to work at a SNF that throws you on the floor way before you're ready. My first shift is coming Sunday, and I still don't feel ready, but I think that's a normal feeling... Or at least, that's what I tell myself. :)

The more acute wing is where I have seen those patients that I listed above. On the LTC side, we still have hospice and a few things that pertain to ICU, but as fridgelight said, it's more about falls, skin tears, insulin/glucose checks and dementia. Both sides, you have pressure ulcers, though I saw more people with them on the rehab wing (recovering from them, not getting them).

Our patient ratios vary from 1:16-1:30, depending on the shift/acuity.

vintagemother, ADN, CNA, LVN, RN

Specializes in Med-Surg, Psych, Geri, LTC, Tele.

If the LTC is a SNF, rather than an ALF, you will get to use more of your "nursing skills" so to speak. Such as tube feeds and complex tx. That's the advice I was given anyhow.

I work in LTC psych though and love my job. (-:

I think your first job should be in a field you really want to be in. Start applying for residencies now...all over the country. Unless you are dead set on not moving from where you currently live. If that is your situation, you will have a difficult time if you are in an area where they don't tend to hire new grads.

But my advice to everyone...and I do mean everyone, is to be in a first job you want and be willing to move. For 94% of people, you CAN move to a new state/city for a first job, get experience, and then move back to your "home town" if that's where you want to be. To me, saying, "I have $XX,XXX in student loans! I can't move!" is a cop out. If you want something bad enough, you make it work.

Nursing is my third career. I just graduated. I have massive loan debt, but I will go where the job I want is. No, I don't have lots of money in savings or a trust fund. I'm a realist and optimist. (Being a widow does this to you.) Settling for something you won't be happy with is never a good option.

Best of luck to you in this journey.