New RN; Advice Needed about Jobs (Unique SNF or L&D)

Published

Hi everyone, I'm a long time lurker on this board and need some advice for a conflicting situation that I'm in! I apologize for the long post in advance, but I wanted to provide some background info on what I'm going through.

So I'm a recent BSN grad, passed the NCLEX in September and have been applying for jobs since then. All throughout school I always wanted to become an L&D nurse, women's health is a huge passion of mine and I completed my senior practicum on a postpartum floor, which I loved, interviewed for, and had several nurses on the floor vouch for me to their manager. But the hospital I worked at ran into major budget issues -- and their HR dept. is a disaster -- so they won't be hosting a new grad residency until sometime next year. So now, unfortunately, I'm currently job searching during the 'off-season' of new grad residencies which has resulted in little to no L&D/Mother-baby residencies available for the remainder of the year in my city (PNW).

On Monday, however, I was scheduled for an interview for an L&D residency in a hospital that's about a 30 minute commute from my house. The residency would begin in late January. Awesome, I was very excited about this!

However, that morning, I had also put an application in for a RN job at a large non-profit hospital's center for HIV/AIDS patients -- it was the first organization of it's kind in the nation. The job is for their inpatient hospice/SNF unit catered to end-of-life care of HIV/AIDS patients and co-morbidities related to their disease (heart failure, liver disease, kidney failure, cancers, etc.) as well as a small handful of patients with ALS and Huntington's Disease. Within 30 minutes of my application, I was called by the DON and after a little chat she invited me to stop by and tour the facility. I really like the DON, she had worked there for ~15yrs, was passionate about their work, and seemed to get along really well with the nurses. I spent about an hour and a half there, she toured me through the inpatient and outpatient unit (which the RNs are trained for both) and then ultimately offered me a job on the spot. I was definitely shocked, especially since I've been incessantly applying for jobs for almost 2 months now, and have had little success until this point - I've only had one interview two weeks ago for a Med/Surge unit that I STILL haven't been called back about and, frankly, didn't really get a good impression of. With the SNF I'd be working with a CNA to care for 8-9 patients on the inpatient unit. There are 35 pts total in the entire inpatient unit, the outpatient unit serves another 330 patients; I'd working four 8hr shifts to begin and then could transfer to three 12s/wk during the day or night. Pay is $31.30/hr w/ differentials for nights and full benefits (competitive/on par for the 3 other hospitals in the area).

I let the DON know that I was really interested in the job but I have an interview scheduled on the 20th for the L&D job. She knows that my interests up to this point have been firmly rooted in mother-baby but that my passion for patient advocacy and treating patients with dark pasts with dignity and respect would make me a good fit for the SNF. So she encouraged me to go to the L&D interview and let her know. This has given me a week to really think about what to do if I also get the L&D job.

SO here's my thoughts on the situation:

  • I have no car; I live in a very bike friendly city and am a bike commuter to save on costs/convenience of getting exercise while not stressing about traffic and the terror of parking in the city. The L&D job would absolutely require me getting a car. The SNF is a 15 minute bike ride from my house.
  • I'm interested in both L&D and serving patients in need, so while the SNF satisfies caring for a unique pt population (some were homeless, many are LGBTQ, some have a history of drug addiction, etc.) it doesn't involve mother-babies. And the L&D job would be in a hospital that's located in a very high-income, not very diverse area -- two extremely large tech companies have HQs there. So... opposite patient population.
  • The L&D gig would require me to wait until late Jan. to start the residency (~12 wks of training). I can begin training at the SNF in the next few weeks (4-6wks of training). I have student loans that I would like to get paid off in a year, so being able to begin working ASAP is a plus.
  • I don't think the SNF would be a long-term career for me, I would like to spend two years there minimum but I believe that I would ultimately end up going back to women's health within the next 5 years. My goal is to earn my DNP/CNM within the next 10 years and work for lower-income women in need of obstetric care. So while this experience may satisfy the 'patients in need' aspect, it won't give me much experience in women's health. But I do think I could find fulfillment in this work.
  • I've heard that SNFs allow you to learn at a slower pace than a new grad residency, this isn't entirely a big factor in my decision. While I know I have A LOT to learn, I know that I will be successful in a residency. I'm a quick learner and my L&D and senior practicum preceptor's feedback included that, as a student, I was already on par with new grad residents.

Finally, my question would be:

I understand that working in SNF or hospice often times isn't seen as acute care experience and can have the reputation of 'bottle-necking' one's career. But as this one is very unique -- these patients are diverse in age and background, and there are specialized skills needed to care for them. However, this definitely isn't a Med-Surge, ICU, or trauma floor and there are skills that I would gain from an acute hospital floor that I wouldn't from the SNF. Would this be harmful to reaching my career goals? Does anyone have any experience transferring from a SNF/hospice center to a different specialty, specifically mother-baby?

Up Vote Up Vote ×

I personally would be salivating at a chance to work with the population in a potential SNF job...but that's just me. It would likely offer some great experience, but it's hard to know what you would be walking into since it's a new unit opening up. Other people can probably offer better feedback, but can you go back and talk with the DON to make sure the specifics are clewr about what is expected?

L&D is also a great field, and I could see this being a good opportunity if you have a full preceptorship and can arrange to get a car. It really depends on if you are wanting to be this specialized, or wanting to get a broader community scope to start as a new grad. And the working environments of course, which you can get a feel for through the interview.

Up Vote Up Vote ×

I think in this case you want to look for "fit" which in the case of a new nurse you want to know how supportive your manager and coworkers will be. If you want to be in L&D and/or CNM in the future I don't think the SNF job will limit you. Being able to bike to work is a plus for your first job and would let you save up for a few years to buy a car versus spending savings now or getting a loan. Good luck!

Up Vote Up Vote ×
Specializes in Critical Care, Education.

Just wanted to provide some relevant info - the "HIV/AIDS specialty facility is not unique nor groundbreaking. They were common in most metro areas until the late 80's/early 90's, when reimbursement patterns changed and this patient population was accepted more readily into other facilities. Based on the fact that US healthcare "trends" follow the money - the stability of any specialty-only facility may be iffy.

It's intriguing to me that OP is expressing interest in two specialty areas that are polar opposites - end of life & beginning of life. I haven't run across many nurses that have the same patterns of interest. I do agree with PPs who are encouraging OP to make a decision based upon current logistics (e.g., bike transportation).

Up Vote Up Vote ×
Specializes in SCRN.

It looks like the SNF job makes more sense right now- they offered the job already, you can bike to work, and start right now. The L&D is farther, you have to wait until January, and you are only INTERVIEWING at this point.

That being said, I do see some red flags : the DON offered the job on the spot, which means there is high turnover, and short staffing going on. She's been there 15 years, great, but sounds pretty desperate. Do not believe the workflow description she gave - caring for 8-9 patients in SNF is a very light patient load. You stated the total number on inpatient unit is 35, and according to 8-9 patient split, they need 4 nurses to run the unit. Did I mention it sounds like they're short -staffed? Exactly.

If you must work now, go for the SNF job, see for yourself, and if you get L&D for January, just go work there. You will make up your mind very fast at that point. Just curious - how do you ride a bike to work when it's raining?

Up Vote Up Vote ×

@helen09

Those are very good points...

Some of my hesitation does come from the fact that they offered me the job so quickly, but the DON has been really supportive in giving me over a week to think about it. So my guess is even if they're desperate, they're not so desperate in pressuring me to decide ASAP. Yeah, the unit is set up to be split in quarters. I think right now they're hiring three nurses (2 RNs and one charge), and I think two are in the pipeline to starting soon on nights. I'm sure that they really need people, but from my walk through I could tell that there were 4 RNs (and several CNAs) throughout the unit, so I think they're only down a few people. They also have a float RN and a few part-time nurses on hand, it's a pretty big organization that's managed by and connected to a larger hospital in the area.

I guess I could also work both... I don't think it would be very good for my reputation to leave a job after 3ish months but if the working environment is bad then it would be in my best interest to change.

And biking isn't too bad in the rain! I just go a little bit slower, wear some type of eyewear and have a good jacket. I'm going to invest in rain pants as well -- which is basically all you need to survive the rain. Most of the time it's just a drizzle so it's not terrible.

Up Vote Up Vote ×
+ Join the Discussion