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Please Help me decide

Specializes in ED, Cardiac-step down, tele, med surg.

I am torn between two opportunities and need to make a choice by Monday. I have offerred a job in another state in a small town rural hospital in there ER. I think it's a level V ER. There's a lot of sub acute patients there, all other acute patients are transferred out to a larger hospital. I'd get lots of experience there, however. Plus they are nice and invested in my learning. Where I currently live I just started an on call position in a SNF locally and work another on call job locally doing flu shots and health screenings. I'm a "new grad" with some recent acute care experience in a residency program, it wasn't paid. My family and friends are here. The out of state position is full time, I would have to stay there most of the time, and not commute back, because the sallary is low. My goal is to work in acute care, probably in CA, no particular specilty in mind yet. What experience do you think would get me to my goal, the experience in the rural hospital or the SNF? The SNF could lead to more full time SNF work and I know some nurse have gotten into hospitals after SNF. Any advice is greatly appreciated.

OnlybyHisgraceRN, ASN, RN

Specializes in LTC and School Health.

I would move and do the ER. More experience, more opportunities. Just get up and go! Sounds exciting.

Ruas61, BSN, RN

Has 38 years experience. Specializes in MDS/ UR.

How small a community is it? If is real rural- you may come in as an outsider unless you fit their mold. Did this once, it was tough. Of course, time are different now.

Double-Helix, BSN, RN

Has 9 years experience. Specializes in PICU, Sedation/Radiology, PACU.

The rural ER would be considered "acute-care" or "inpatient" experience, which is what almost all hospitals will want from an applicant. SNF- full time or not- is not considered acute-care or inpatient, so it will not be as beneficial.

Take the ER job. Short term sacrifice for long term gain.

celtchick68

Specializes in Emergent pre-hospital care as a medic.

The ER position without a doubt. Acute care settings will enhance and improve your assessment skills with a wide variety of patients: infants, peds, adults, geriatrics as well as a variety of illnesses and traumas.

luvmy2angels

Has 22 years experience. Specializes in Geriatrics.

I agree, ER position without a doubt!

canesdukegirl, BSN, RN

Has 14 years experience. Specializes in Trauma Surgery, Nursing Management.

Take the ER job! You will be introduced to so many new experiences, and you will undoubtedly grow and blossom in a rural ER setting.

You will learn a completely new skill set and will be exposed to a plethora of illnesses and injuries. You will also learn how to quickly triage patients and how "disaster teams" are set up.

You just had a goldmine of learning/experience dropped on your lap, Amy! Go for it, and let us know how you are doing.

amzyRN

Specializes in ED, Cardiac-step down, tele, med surg.

The town is very small, I think only 1200 people. I think the hospital is like a 25 bed unit. Being this small, do you still think I will learn enough to transfer to a larger hospital at a later time?

MPKH, BSN, RN

Has 10 years experience.

Yes you will. I am working in a rural hospital as my first job after grad and I am learning and seeing so much. Definitely go for it! The city will always be there for you but a job opportunity won't.

NO50FRANNY

Has 14 years experience. Specializes in Emergency, Haematology/Oncology.

ED, without reservation.

Definately Emergency, you will be amazed how much there is to learn. Rural positions offer the opportunity to practise without the backup of monstrous tertiary technology, the art of assessment and stabilisation with limited resources, and the gift of seeing EVERYTHING. I would take it without hesitation, have done it myself and was the greatest experience of my nursing career, and my town was even smaller. Good luck.

sauconyrunner

Has 11 years experience. Specializes in Emergency.

Do not do the SNF. You will gain great experience in a small rural ER because all sorts of crud will come in there before it is transferred out. You will learn HUGE amounts. Plus you can use the time to simply get all those pesky certifications out of the way, ACLS, PALS, CEN, TNCC, possibly even CCRN. I worked as a traveler in 2 hospitals with 6 inpatient beds (Critical access hospitals) I got experience there with: toxic ingestions (children eating mushrooms in the yard), a day when 3 anaphylactic reactions all came in within 30 mins of each other (2 nurses on only, ED packed...in a large ED you would have so many people you might not even know there were 3), major trauma, lots of cardiac and stroke...as well as the usual kidney stones, kids with fevers etc...

really this is a no brainer given your goal to work in acute care. Going to a SNF does not forward that goal in any way, shape or form.

dandk1997RN, MSN, RN

Has 4 years experience. Specializes in Cardiology.

Definitely the ED position!

amzyRN

Specializes in ED, Cardiac-step down, tele, med surg.

One thing I forgot to mention is that I am married and my spouse cannot relocate and I would have to commute back from time to time and the job is full time. I also have a grandma that partly depends on me to help her with things. Maybe I can talk to the DON and explain this to her.

One thing I forgot to mention is that I am married and my spouse cannot relocate and I would have to commute back from time to time and the job is full time. I also have a grandma that partly depends on me to help her with things. Maybe I can talk to the DON and explain this to her.

Now you're talking about personal rather than career issues. It's hard for anyone else to climb into your head, or know all the details of your personal situation. As far as the professional considerations are concerned, there seems to be unanimity among those who have knowledge and experience in nursing.

amzyRN

Specializes in ED, Cardiac-step down, tele, med surg.

Yes you are right, there are personal issues at hand. I just wanted to know that in fact it was a career booster (as I had suspected) and that I would learn more in the rural setting. Now I have to see if I can balance my personal life to allow me pursue what I am truly passionate about.

sauconyrunner

Has 11 years experience. Specializes in Emergency.

I would think after your orientation period, you may be able to work something out where you work 3 days say M,T,W and then have T,F,S,S,M,Tu,W off and work TH, fr, sat, and so on. Of course it wouldnt always be that perfect, but It sounds like this hospital wants to work with you. DO they have self scheduling?

amzyRN

Specializes in ED, Cardiac-step down, tele, med surg.

I'm not sure if they have self scheduling or not, but I would be doing 8 hour shifts, 40 hours a week. They might be open to me doing more than 40hrs per week and then at the end of the month doing less. I will have to ask about that.

sauconyrunner

Has 11 years experience. Specializes in Emergency.

Oooh ask about 12 hr shifts.

amzyRN

Specializes in ED, Cardiac-step down, tele, med surg.

I have another area of concern. I've read some things about new grads in the ED, and it's not always a good idea for many. I thought that this being a rural ED and I think a level V trauma center, wouldn't be so overwhelming. But I've come across a couple posts that say that new grads in a rural critical access hospital might not mix. I am worried about moving several states away and not being able to handle the greater autonomy. They want me to be able to rotate to do Charge after orientation, which they initially said would be 4 weeks. I aked the DON about an extension and she said they woud extend it until I felt comfortable, but I would feel stressed if I was taking a long time. My plan is to talk to the DON re extending the orientation to 12 weeks, but I don't think I would feel comfortable as a Charge nurse. Anyway, if you have any more thoughts on the matter, pass them along. Thanks.

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