I am a new grad nurse and I am really struggling with how to choose my very first nursing job. So far, the majority of nurses I have asked said they chose their job because it was the only offer they had at the time, however, that is not my situation. I currently have four offers (2 different med surg floors, a neuro floor, and a cardiac floor) and still have a few more interviews left. The med surg, neuro, and cardiac offers are at a bigger hospital about an hour away from me with a typical nurse-patient ratio of 1:6. The other med surg offer is at a small hospital (59 beds total) about 30 minutes away from me with a typical nurse-patient ratio of 1:4. I have had clinicals in both of these hospitals and shadowed on all the potential floors and truly enjoyed them all.
I know there are pros and cons to any choice but I'm still struggling with deciding how to pick which one would be the "right fit" because I honestly feel like I could see myself in all of the positions. I could really use some advice about how to go about picking my very first position and things to be mindful of when choosing the hospital. How did you guys decide on your first position? Any advice would be SUPER HELPFUL!
Congratulations on graduating and having multiple offers!
I'd pick bigger hospital because at bigger hospital you'll get to see alot and gain more experience. With that experience, you can also transfer to ICU. My commute is an hour long and I love the hospital I work at. If you don't have any other obligations, then I'd pick the bigger hospital.
Are any of the hospitals teaching hospitals? I really enjoy the environment of a teaching hospital. You could really pick up a lot of information from sticking close to the attending and residents while they are making rounds. It is a great learning experience and you are free to ask any questions to the attendings once you get to know them. Most of the doctors are there because they LOVE to teach.
In the beginning, you're learning how to be a nurse. Take the 1:4 ratio, and really develop a nursing foundation with a solid bedrock. True, you won't be exposed to as much as in a larger, more acute hospital, but you will be building your nursing practive without the pressure to take shortcuts to get everything done for 6 patients. And if your colleagues also have 6 patients, they're not going to have much extra time to help you out. You have your whole career in front of you to move to higher acuity, if that's what you decide you want.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
On 3/31/2019 at 6:01 PM, jazij14 said:
@TAKOO01 Thank you! It has certainly been a pleasant surprise but also overwhelming considering this is my first step in this new chapter. My only concern with the smaller hospital was that I wouldn't gain as much experience or see as much diversity my first year compared to the bigger city. Do you happen to have experience with or input about small rural hospitals compared to bigger cities?
Actually, you might get a more well-rounded experience at a smaller hospital. Big hospitals have everyone working their specialty units and usually have an IV team to do starts. Much easier to get stuck in a rut.
At a smaller hospital you'll do a little more of everything and end up with a broader experience. The smaller ratio and shorter commute would seal it for me.
Specializes in Surgical Specialty Clinic - Ambulatory Care.
I tell all new grads this:
1) Never take your first job somewhere they are offering bonuses and a contracted time to stay....it’s a trap and one you can choose to put yourself in when you are more knowledgeable about nursing.
2) New grads should have a 12 week orientation. As close as you can get to that would be best.
3) If your chosen floor doesn’t have a clinical educator that is only dedicated to the educator role (like clinical educator/floor manager is unacceptable) then I would be worried.
4) What kind of life do you see for yourself when you are 40? Do you think that being an NP is in your future or are you looking for something Monday - Friday 9-5 by then? If you think NP or furthering your education and going up the ladder are for you, do the neuro or cardiac stuff. Neurosugical is more in demand, then cardiac, the medsurg.
The bigger hospital would likely be way more interesting for you with lots more opportunities for using your different nursing skills. Bigger hospitals have lots of different programs for their employees; like education, social programs, volunteering, one hospital I worked for had there own store where u could order lots of home furnishings and stuff at discounts. I had several offers when I first graduated. I used Facebook and others to actually talk with nurses who worked there and found that one hospital was often under staffed or out of supplies so I went with the other because I didn’t want to have to “improvise “ before I knew what was what. I had a wonderful time at that hospital. I worked there almost 5 years before I just wanted to do something else. It was a quick 5 years!!
Do you happen to have experience with or input about small rural hospitals compared to biggercities?
No, Im sorry. Im a big city gal with no experience in rural areas?.
Youre at the start of your career, so I dont think you can go wrong, whatever you choose. If you go big and dont like it, you can always switch to the rural hospital after a reasonable time (and vice versa).
I would pick the smaller hospital closer to home, you'll learn more. Bigger hospitals you tend to have specialty floors where your patients are very specific. An example is the neuro floor, if you like neuro patients and seeing what type of injuries affect patient function, then this is for you, but that is ALL you will see there. In a smaller hospital the med/surg floor tends to be a catch all of everything. True, you won't see many extraventricular drains put in at the bedside, but unless that is your thing ..... I currently work in a 100 bed hospital, 3 floors, yet we do cardiac surgery, and neurosurgery, so hospital size isn't always an indicator of what you will be exposed to.
At my hospital, we usually aim for 5 patients each (day shift, med-surg). Some days, I only have four; other days I have six. There is a huge difference in my day when I have 4 vs 6 patients.
On days I have four patients, I have time to read notes in their charts. I can speak to doctors intelligently because I actually know what's going on with my patients. I have time to put together different elements and form a better clinical picture. I do patient teaching - good patient teaching with teach backs and return demonstrations. My charting is done in real time, and my pain reassessments are actually done (and in the computer) within the hour. I touch base with PT, OT, case management. I know the discharge plan.
On days I have six patients, I'm reacting. There's no time to plan; it's just a constant shuffle of priorities. I'm going from task to task, passing meds, doing dressing changes, trying to stay on top of orders as they come in. If everyone is stable and nothing goes wrong, I can manage. But when something unexpected comes up, it throws everything out of balance because I there is simply no time cushion to absorb the extra attention I need to give my patient with the problem.
There are days I get to the end of my shift, and tell the oncoming nurse, "this is a game of telephone. I'm going to tell you what the previous nurse told me and what happened with the patient today, but I have not verified any of the patient's PMH, looked up any imaging results, etc."
For me, there's no contest between a job that gives me time to think about the patient's big picture, and a job where I'm going to be running here and there, and just trying to keep everyone safe until the next shift.
gravy94, BSN
27 Posts
Congratulations on graduating and having multiple offers!
I'd pick bigger hospital because at bigger hospital you'll get to see alot and gain more experience. With that experience, you can also transfer to ICU. My commute is an hour long and I love the hospital I work at. If you don't have any other obligations, then I'd pick the bigger hospital.