PCU or ER as a new grad

[sour]

I got offered a position in both PCU and the ER as a new grad. "Feel lucky that you got options as a new grad."
Well no, not really. I'm lost. I've worked in my hospital for 12 years as a unit assistant and recently graduated the nursing program. I went through 3 interviews (Neuro, medical, surgical) and didn't land the jobs. We just went through a RIF (Reduction in force) and my unit aassistant job is getting cut. After HR learned I'm a new grad, I got an interview on a unit that a position hasn't even been posted (PCU). Prior to getting asked to come in for an interview, another hospital called me to ask if I'm still interested in working for their ER (trauma lvl 3). I accepted.
After PCU's interview, they offered me a job as well. I love cardiac as much as I love emergency nursing. To be honest, I feel so much guilt if I decline the PCU Job.

ER: Full-time, benefitted, 55 minute drive, grave yard

PCU: supplemental (full time in 6 months) 5 minute drive, grave yard.

Each pays the same.
How do I choose? I really want the ER, But I don't know if I can't live with the guilt of declining pcu after they went out of their way to open up a position for me. ?

[JKL33]

8 hours ago, sour said:

The plan is to orient me for 12 weeks, working side by side with another nurse. I'd be working three 12's a week. Along with that, I'll be sent to classes for any certifications I need like cardiac monitoring for nurses, sheath pulls, LVAD.

Well that's something. Doesn't sound too awful if it turns out to be what they say. I'd keep putting out apps and have a pretty low threshold for entertaining any other FT offers you may get, and a low tolerance for shenanigans during orientation (such as not really having you work closely with a mentor and trying to give you your own assignment instead). In your favor, I don't think it would look as bad to leave a supplemental position...it's pretty easy to explain and most people will understand your need to look for FT work.

Good luck....maybe it'll work out great. ??

[myoglobin, ASN, BSN, MSN]

As someone who has commuted an hour each way for the last decade I would still gravitate towards ER (if it is a reasonable unit with safe staffing) for the following reasons.

a. It is full time from the start.

b. There are few units with more consistent demand than ER. If you can survive the first year you will have the ability to work as a "travel RN" and make well over 100K in places like California.

c. I might even consider getting a hotel room for the "middle night or two nights" if you do three in a row. Of course cost might be an issue, but there are probably people on websites like Airbnb or Roomies.com that would give you an awesome deal if you did that arrangement long term.

[optimis]

I’m an ER nurse, so I’m a little biased towards the ER job. Lots of my coworkers have an hour commute. Does it suck? Yes. Are they used to it? Also yes.

You have been at that other hospital for TWELVE years and they haven’t given you a FT offer AND they are obviously working on cutting down...I wouldn’t necessarily trust them to make sure I got enough hours every week. Loyalty doesn’t pay the bills.

[Dani_Mila, BSN, RN]

OP what did you choose?

[sour]

3 hours ago, Dani_Mila said:

OP what did you choose?

PCU. Zero regrets. I received a full-time job right at the end of my 90 day orientation. 5 minute commute to work. I work with a great team and a great manager. I’m glad I went with PCU.

[sour]

1 minute ago, sour said:

PCU. Zero regrets. I received a full-time job right at the end of my 90 day orientation. 5 minute commute to work. I work with a great team and a great manager. I’m glad I went with PCU.

And the pay for PCU turned out to be $16 more an hour 

[Dani_Mila, BSN, RN]

3 hours ago, sour said:

PCU. Zero regrets. I received a full-time job right at the end of my 90 day orientation. 5 minute commute to work. I work with a great team and a great manager. I’m glad I went with PCU.

Sounds great! That's what I'm looking for. Hoping the PCU job offer I got will have a good team and great manager like yours! 12 weeks of orientation sounds like the way to go. Was there a steep learning curve? I'm transitioning from LTC to acute care and I think it will be a huge step. Do you have any advice?

[sour]

6 hours ago, Dani_Mila said:

Sounds great! That's what I'm looking for. Hoping the PCU job offer I got will have a good team and great manager like yours! 12 weeks of orientation sounds like the way to go. Was there a steep learning curve? I'm transitioning from LTC to acute care and I think it will be a huge step. Do you have any advice?

Yay congratulations! Our PCU has a lot of post open heart surgery patients that require a lot of assistance in movement. I’ve oriented a few new grads and my biggest advice is

a) run don’t walk between tasks. The busiest time is start of shift until after first med pass. If a call light goes off next door (your other patient) and you aren’t in the middle of an important task like dressing change or med pass- pause with your current patient and go see what your other patient needs. If it’s not urgent tell them you’ll be back in a certain time frame. If it’s urgent, ask for assistance if you’re unable to help them with their immediate need. But don’t choose catching up on charting over helping your own patient. Everyone notices the nurse that walks slow, doesn’t respond to call lights while everyone else answers them and it’s exhausting and annoying. 
 

b) be humble. Don’t ever say “I know”. Read the material provided for you and study it day and night. You won’t have time to learn while orienting. We like to quiz our new grads (based on their learning schedule) “what is important about pulling an IJ” “what is important to check and chart on a TAVR patient?” If the RN tries to educate you on something you already know, just listen. We had a new grad that would say “I know” and when they were questioned “what can you tell me about this procedure” they would deflect and say “oh I don’t remember.” The new grad was dangerous and was fired during 12 week orientation. 
 

c)ask questions but know when. During a rapid response event, probably not the best time to ask “so what is the reasoning for pushing bicarbonate” when everyone is running around doing actions trying to prevent a code. 

d) if you’re unsure about something, even slightly, clarify/ask for help. “Hey I know I did this dressing change a couple times but I don’t feel comfortable doing it tonight alone because this patient now has chest tubes, can you supervise me?” We are happy to assist rather than “can you do this for me because I don’t know how to.”
 

e) when you start getting in the hang of things or have time and witness overwhelmed nurses, help with answering their call lights. Like if a RN is in an iso room, go see what the patient needs. If pain meds, ask RN If you can give it to the patient. 
 

f) don’t sit at the main nurses station when charting unless your preceptor tells you to. Sometimes I’d find an empty room, away from distraction, and chart in silence. Or if you have an impulsive patient that is a safety risk, camp out with your WOW and a chair in front of their room to respond quicker.

LTAC’s are very busy and you’re coming with a lot of great experience. Some things might be the same, but some might be very different. Accept the style of the new place and within policy, you can adapt to your own after orientation. 

You will always learn something new everyday you work. 2 years in and I still go “oooo what?? I didn’t know that! Thanks for showing me.” 

 

again congratulations and good luck! Feel free to ask me anything if you have questions ?
 

 

[Dani_Mila, BSN, RN]

6 hours ago, sour said:

Yay congratulations! Our PCU has a lot of post open heart surgery patients that require a lot of assistance in movement. I’ve oriented a few new grads and my biggest advice is

a) run don’t walk between tasks. The busiest time is start of shift until after first med pass. If a call light goes off next door (your other patient) and you aren’t in the middle of an important task like dressing change or med pass- pause with your current patient and go see what your other patient needs. If it’s not urgent tell them you’ll be back in a certain time frame. If it’s urgent, ask for assistance if you’re unable to help them with their immediate need. But don’t choose catching up on charting over helping your own patient. Everyone notices the nurse that walks slow, doesn’t respond to call lights while everyone else answers them and it’s exhausting and annoying. 
 

b) be humble. Don’t ever say “I know”. Read the material provided for you and study it day and night. You won’t have time to learn while orienting. We like to quiz our new grads (based on their learning schedule) “what is important about pulling an IJ” “what is important to check and chart on a TAVR patient?” If the RN tries to educate you on something you already know, just listen. We had a new grad that would say “I know” and when they were questioned “what can you tell me about this procedure” they would deflect and say “oh I don’t remember.” The new grad was dangerous and was fired during 12 week orientation. 
 

c)ask questions but know when. During a rapid response event, probably not the best time to ask “so what is the reasoning for pushing bicarbonate” when everyone is running around doing actions trying to prevent a code. 

d) if you’re unsure about something, even slightly, clarify/ask for help. “Hey I know I did this dressing change a couple times but I don’t feel comfortable doing it tonight alone because this patient now has chest tubes, can you supervise me?” We are happy to assist rather than “can you do this for me because I don’t know how to.”
 

e) when you start getting in the hang of things or have time and witness overwhelmed nurses, help with answering their call lights. Like if a RN is in an iso room, go see what the patient needs. If pain meds, ask RN If you can give it to the patient. 
 

f) don’t sit at the main nurses station when charting unless your preceptor tells you to. Sometimes I’d find an empty room, away from distraction, and chart in silence. Or if you have an impulsive patient that is a safety risk, camp out with your WOW and a chair in front of their room to respond quicker.

LTAC’s are very busy and you’re coming with a lot of great experience. Some things might be the same, but some might be very different. Accept the style of the new place and within policy, you can adapt to your own after orientation. 

You will always learn something new everyday you work. 2 years in and I still go “oooo what?? I didn’t know that! Thanks for showing me.” 

 

again congratulations and good luck! Feel free to ask me anything if you have questions ?
 

 

Thank you so much for all the advice!! I am already stressed out reading all of that! LOL but I am willing to learn. That is what the NM told me that she does not like people sitting down. So, I expect I will be on my feet at all times!! Your advice are very much appreciated and I will definitely use it as some guide. I'll definitely ask you if I have more questions!! Thank you!!