Should I accept a SNF position as a new grad even though this is not the field I want?

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Hi everyone,

I am a new grad nurse who graduated Dec 2017. I was offered an RN position at a SNF with starting pay $44/hr in the Bay Area, CA. Full benefits and 401K. However the average RN to patient ratio is 1:16. The patients non-acute and I was told that the position was mostly passing meds, occasionally IV, and other very low key skills. The orientation period is only 4 days.

I have not heard back at all from any other places that I have applied to and the only interviews that I have managed to get were from LTC/SNF. So far, this position sounds the best.

Should I accept this job even though I know for sure that once I enter the job I would already be looking for other jobs on the side (L&D or more acute positions)?

In TX you would have 1:34, 2 CNA's, three if you are lucky. I believe the ratio's, lack there of are different.

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Yeah you should take it. You can always move to a better position & $44 an hour beats $0 an hour

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1:16? That's not LTC. You're going to be getting 2 day post ops, exacerbations and infusions. $44/HR is not good pay for the Bay Area, Sacramento and other affordable areas of Northern Ca start their newbies in the $50s. (Maybe not LTC/rehab).

HOWEVER, it is experience with a near acute patient population. If you knock it out of the park for a year, you'll be more marketable than you are now 1 yr out of school with no experience.

Think of it as a paid internship meets boot camp. Good investment!

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Hi everyone,

I am a new grad nurse who graduated Dec 2017. I was offered an RN position at a SNF with starting pay $44/hr in the Bay Area, CA. Full benefits and 401K. However the average RN to patient ratio is 1:16. The patients non-acute and I was told that the position was mostly passing meds, occasionally IV, and other very low key skills. The orientation period is only 4 days.

I have not heard back at all from any other places that I have applied to and the only interviews that I have managed to get were from LTC/SNF. So far, this position sounds the best.

Should I accept this job even though I know for sure that once I enter the job I would already be looking for other jobs on the side (L&D or more acute positions)?

Take it! Stay for at least two years, even though you THINK this isn't where you want to be. Until you actually start doing the job and until you start to become competent, you probably won't know for sure whether you like the job or even like nursing. The first year is going to be pretty awful even if you get your dream job right off the bat. The transition from student to nurse is a rough one, and you have so very much to learn. Believe it or not, you can learn most of the "skills" you need to further your nursing career right there in the SNF. After a couple of years, when you've worked out how to be a nurse and became competent at it, you'll have also worked out what you do and don't like most about your job and will have both a better handle on where you really want to work and some transferrable skills.

So yes, accept the job unless you have a sugar daddy who is willing to support you!

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Yes! Once you start working there you will discover how many skills you get to perfect while learning how to manage time and assess patient status. You won't have to spend time passing meds (SNFs usually have designated med nurses), so that leaves more time to perfect your direct care skills. You will encounter different types of central lines on which you will do dressing changes and infusions, perform tube feedings, assess wounds and learn about dressing changes, become versed in all different kinds of surgical procedures, devices, and diseases, you will learn how to communicate with physicians, learn how to delegate, learn how to manage time, how to prioritize...the list goes on and on. As an RN in a SNF you get more opportunity to develop management-type skills that you would as a new grad on a med-surf floor or in a clinic. Go for it!

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Specializes in EMS, LTC, Sub-acute Rehab.

...the average RN to patient ratio is 1:16. The patients non-acute and I was told that the position was mostly passing meds, occasionally IV, and other very low key skills. The orientation period is only 4 days.

Ratios where I've work range from 1:25-48 in my state.

Non-acute can become emergent real quick with Geriatric patients think AMS r/t UTI, URI, fluid/electrolyte imbalance, falls, multiple system organ failure, and of course death (expected or otherwise).

Passing 9-13 different medications per Pt, isn't as easy as it sounds. Drops, patches, insulins, and critical meds all have a time window. It might be possible to do it to State regulation with 16 Pts. I've never had less than 25 Pts. I don't know.

Getting an IV in an 80lbs, 80yo, dehydrated former smoker is always fun and ease, especially when they are combative and demented.

Lots of quick and dirty triage/ focused assessments to figure out who's having an MI vs gas/reflux (think Elderly Urgent Care but they never leave the facility alive). Wound/ dsg changes, feed tubes, traches, vents, CPAPs, neb tx, caths and finger sticks. Yeah all of that is 'very low skill' stuff.

I'd request to remain on orientation until you feel comfortable. The LTC has lots of moving parts where I work. I did my orientation in 4 days but it was really a sink or swim environment. I've seen plenty of seasoned and new nurses that couldn't make it. So if it doesn't work out, it wasn't really for you.

You will learn time management, long term effects of disease/aging process, and how to practice medicine with very minimal physician involvement (you'll become an expert at writing orders). Best of luck!

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If the ratio is really 1:16, I'm guessing there is a mix of rehab patients in there, most likely all rehab. I doubt very much it wiould be 16 LTC residents. With rehab you'll have a smaller load than a LTC unit, because rehab patients will have more labs and vital signs to monitor, more wound care, more physician's orders to carry out, etc. Really, most of your patients will be at an acuity level just below hospital med-surg floor.

There is much less of all that with LTC patients, so the ratio there edges up toward 30:1

Either way this sounds like a decent facility, at least based on what you can expect in the SNF world.

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Hi everyone!

First of all, I want to thank you all for your wonderful comments and advice. Here's an update:

Yesterday I called back my interviewer (director of nursing) telling him that I would like to advance in my application. I gave him my references and he said he would get back to me by 5pm. But I did not receive any calls nor emails yesterday. I plan on calling him later today to find out the status of my application but I'm worried that he might have filled the position.

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Ratios where I've work range from 1:25-48 in my state.

Non-acute can become emergent real quick with Geriatric patients think AMS r/t UTI, URI, fluid/electrolyte imbalance, falls, multiple system organ failure, and of course death (expected or otherwise).

Passing 9-13 different medications per Pt, isn't as easy as it sounds. Drops, patches, insulins, and critical meds all have a time window. It might be possible to do it to State regulation with 16 Pts. I've never had less than 25 Pts. I don't know.

Getting an IV in an 80lbs, 80yo, dehydrated former smoker is always fun and ease, especially when they are combative and demented.

Lots of quick and dirty triage/ focused assessments to figure out who's having an MI vs gas/reflux (think Elderly Urgent Care but they never leave the facility alive). Wound/ dsg changes, feed tubes, traches, vents, CPAPs, neb tx, caths and finger sticks. Yeah all of that is 'very low skill' stuff.

I'd request to remain on orientation until you feel comfortable. The LTC has lots of moving parts where I work. I did my orientation in 4 days but it was really a sink or swim environment. I've seen plenty of seasoned and new nurses that couldn't make it. So if it doesn't work out, it wasn't really for you.

You will learn time management, long term effects of disease/aging process, and how to practice medicine with very minimal physician involvement (you'll become an expert at writing orders). Best of luck!

Thanks for your wise advice! As a new nurse there are many skills that I am frankly not good at and I agree that I would learn a lot from this job, especially since they're moving forward with my application. Do you have any advice for those skills that you have listed above, such as passing 9-13 meds per patient with 16 patients? Or trying to stick an 80 yro, dehydrated woman? Thank you.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

I was in LTC for five years and it was great experience before moving in the acute care environment. And 1:16, depending on acuity, is great. I was 1:30 on days and sometimes 1:60 on nights. Don't let people convince you that LTC nurses don't use their nursing skills. You need them just as much as in any environment. I had a non-verbal quadriplegic and I was able to catch that she was sick (septic) just by the look in her eyes. You don't take vital signs on every patient every shift, so you get good at assessments. Good luck!

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Yes. You should take it. The alternative is to be unemployed and do no skills for $0 per hour.

THIS was the best advice posted to this thread!! this is all that needs to be said.

Good luck to you!

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I am also a new grad in the bay area, and came from out of state. I am only getting SNF interviews as well. I am wondering if you ever got this position and if so, how is it going? I'm curious, what facility was this?!

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