Outpatient Clinic vs. Bedside Nursing

[Ruth725]

Hello fellow nurses,

I am a new graduate nurse and have been offered positions in a :

1) Full Time M-F 7am-4pm Outpatient Clinic, no contract

and

2) Full Time New Graduate program at a community hospital, in their med-surg/telemetry float pool with a varied schedule, 2 year contract

My question is trying to decide on the specialty clinic that will allow me to maintain a sane schedule and advance in this specialty, or opt for a hospital where I can meet people and get a thorough training but most likely night shift hours?

Another biggie is that I am currently also doing my BSN online, and the hospital would pay approx $10 more an hour than the clinic.

Any tips or advice would be much appreciated!

[guest464345]

It totally depends on your personal goals and your individual situation - it's hard to give advice without knowing you.

If your biggest dream is to become an ICU nurse in the future, it doesn't make sense to take a clinic position. On the other hand, if you love the clinic specialty and want normal-people hours, it doesn't make sense to work in a hospital. If it's absolutely critical that you make as much money as possible right now, you need the job with the highest salary. Maybe one of these jobs has tuition reimbursement for your BSN and the other doesn't. In this forum most people will tell you to get that one year of hospital experience, but that doesn't apply to every single situation.

One thing I will point out: a 2-year new grad contract is a bad sign, especially if there is some financial punishment for bailing out early. It is a guarantee that they can't get experienced nurses there - something is wrong with the patient ratios, the hours, the pay, the work environment or all of the above. If for some reason you feel you have to go that route (is this an HCA hospital? Read the many posts about StaRN and HCA as a warning), read your contract very carefully and be prepared to pay the price if it's worse than you imagined.

[Queen Tiye, RN]

10 hours ago, laflaca said:

It totally depends on your personal goals and your individual situation - it's hard to give advice without knowing you.

If your biggest dream is to become an ICU nurse in the future, it doesn't make sense to take a clinic position. On the other hand, if you love the clinic specialty and want normal-people hours, it doesn't make sense to work in a hospital. If it's absolutely critical that you make as much money as possible right now, you need the job with the highest salary. Maybe one of these jobs has tuition reimbursement for your BSN and the other doesn't. In this forum most people will tell you to get that one year of hospital experience, but that doesn't apply to every single situation.

One thing I will point out: a 2-year new grad contract is a bad sign, especially if there is some financial punishment for bailing out early. It is a guarantee that they can't get experienced nurses there - something is wrong with the patient ratios, the hours, the pay, the work environment or all of the above. If for some reason you feel you have to go that route (is this an HCA hospital? Read the many posts about StaRN and HCA as a warning), read your contract very carefully and be prepared to pay the price if it's worse than you imagined.

I don’t know if the two year sign on bonus means it’s a hospital in bad shape. I worked in an awesome academic institution that has sign on bonuses. My view is that they get cheap labor from people new in the field and once residency is over the pay is immediately increased plus review for a raise every six months.

[Wuzzie]

In my neck of the woods the 2 yr contracts came about because hospitals were tired of pouring money into residency programs only to have the new grad nurses bail the second they completed them for other jobs they thought were better. They want something in return for their investment as any business would.

To the OP. After many, many years working bedside I switched to an ambulatory clinic. I do not advise it for new grads. There is much to learn about being a nurse that is best learned bedside. The opportunities are much more varied and abundant than what you will find in a clinic. You will be able to hone those nascent nursing skills of yours (such as IVs and assessments) in a way that will be unlikely to happen in the ambulatory setting. In clinics good time management is an absolute must and will be expected of you from the start. We experimented with a new grad residency in ambulatory and it was a dismal failure, not because of the program or the new grads but because it simply was too difficult a start for them. Admittedly our clinic is not easy with multiple, very sick patients and high expectations of the nursing staff but still, they had tons of support and still couldn’t do it.

The other issue is that if you start in a clinic the likelihood of you ever being able to go into acute care is very low. Some people are able to return but to have zero experience at all will not work in your favor.

[LibraSunCNM, BSN, MSN, CNM]

A red flag for me is a new grad program that has you joining a float pool---unless I'm misunderstanding how you described it. New grads need the stability of a single unit, IMO. Between that description and a 2 year contract requirement, I'd be leery. However, I agree with the others that clinic positions as a new grad *can* pigeon-hole you for the future.

[llg, PhD, RN]

Some float pools are designed for new grads -- and they can be a great opportunity. And it sounds like the one mentioned in the OP might be such a float pool. I worked in a hospital that had such a program. New grads were oriented to a small group of units that were very similar to each other -- learning a core set of skills that could be applied. As the new grads worked on this small cluster of units, they usually "found a home" and were allowed to "transfer" into the unit where they had found the best fit for them.

Because this was a planned program, included appropriate classes and preceptors, it worked very well. It helped the units with variable staffing needs -- and helped the new grads explore a few different units as they transitioned from student to professional and find the best fit before they committed to one single unit. That made for smoother transitions and less turnover.

Ruth725, I recommend looking at the details of the hospital float job. If it looks good, I would recommend that. Once you go to outpatient, it will be very difficult to get a good inpatient job later. Getting inpatient experience will give you the best experience for a wider variety of long-term career options.

[Hoosier_RN, MSN]

A 2 year contract isn't necessarily an indication of a bad employer. some are tired of pumping resources into orienting new nurses, to have them begin NP (or other MSN program) studies at 2-3 months (or less) into orientation. it helps them to insure a ROI

Like others have said, your desired outcome is what you should look at. Something to think about though: if you choose the clinic, and it doesn't work out, you most likely will not qualify for the residency as you're not considered a new grad once you have experience of any kind, regardless of how little that experience may be.

Good luck with your choice!

[CommunityRNBSN, BSN, RN]

What do you want to do long-term? I knew I didn’t want to work in a hospital. Therefore, I took an outpatient job right out of nursing school, and it was definitely the right choice. But when you picture yourself in 10 years, do you see yourself standing bedside handling a lot of ICU equipment, keeping people alive? Or do you see yourself in an office, educating your patients who can walk in, talk to you, and breathe on their own? I think that will give you some guidance.

[greytRNtobe]

Go for the hospital graduate program. It is SO HARD to get into these programs and without them, you will have a hard time getting a job in a hospital ever again. When I got out of school, there were few programs available and you had to know someone to either get a job in a hospital or get one of 15 spots (that had 500+ applicants). Community nursing jobs, while not always easy to get, are easier to get. You are young and will find out where you fit in, what you like more, and create a working life.

[Ruth725]

Hello everyone, I appreciate all the advice given. I decided to take the hospital job and once I did I felt very relieved and excited about this opportunity!

Thank you so much for responding to my post!

[Hoosier_RN, MSN]

16 hours ago, Ruth725 said:

Hello everyone, I appreciate all the advice given. I decided to take the hospital job and once I did I felt very relieved and excited about this opportunity!

Thank you so much for responding to my post!

Let us know how it goes