PLEASE HELP!!

How many patients do the staff nurses usually have? Safety is where I would start. No matter how much you enjoy a specific area, if they have staffing concerns and no plan for addressing it except to give you extra patients, you'll eventually hate it.

Ask about the nurse/patient ratios.

Ask if they use an acuity tool.

In addition to nurse/patient ratio's, ask what the CNA/PCT's to patient ratio is.

Small community hospital vs Large Medical Center. These are VERY different places. I began my career at the former. I was already employed there as a unit secretary and CNA, and like you mention, it was the only place that even responded to my resume.

It was a wonderful place to begin my career. Since I already worked there, I knew the system, where supplies were and many of my co workers, making my role transition much less stressful. As this was a small hospital, staff new each other fairly well- including inter departmentally. In my situation, people were (mostly) friendly and were genuinely invested in helping you succeed. This was a med/surg/tele floor that mainly focused on medical vs surgical management. We were 10 min away from multiple major, world renowned medical centers so anything "interesting" from a cardiac perspective went there. HOWEVER- as we were small- there was NO dedicated code team. Every day an ICU RN was assigned to codes, and an RT and DOC would show up along with RN's from other floors who could be spared for a few minutes. RN's on the floor were left to run the code until they arrived. This may sound awful but it really wasn't. Our floor was connected to the ICU so that RN was there very fast. As the hospital wasn't big, it did not take that long for others to arrive. Since we ran codes so often, it wasn't that bad (in hindsight, it was better run than many that I've seen in other places). The RN knew the patient well and had their labs available, instead of the code team not knowing anything. We also got to know rhythms well, what to do about it and understood how to follow the algorithms. In general, we had a high comfort level with codes.

Now, I have since worked at two major medical centers. The experience is much different. In regards to codes, there is a code team. If you work on a tele floor you should (though in some places it isn't a requirement - which I think is insane) have ACLS and technically understand what to do. However, you may have monitor tech's and therefore never really have a great understanding of rhythms and then the code team. This leads to a lot of anxiety as the RN when a code happens (in my opinion) because you never get the experience of really participating and understanding what is happening.

Having said that, in a major medical center you will have more opportunity to see rare/interesting cases as well as more complex patients. There are also many more departments to change into if you don't like the floor you are on or you are just interested in something new. So generally speaking, you have more choices and possibly more opportunity for advancement.

In short- and based ONLY on my experience- starting in a community hospital taught me how to be a nurse (and on less complex patients). When I moved and went to a major medical center (which is far more impersonal) I had a lot more opportunity to grow.

Maybe you can ask some RN's you may know what their thoughts are. In particular, can you ask your old clinical instructors? They may have more inside information about these facilities that will help you make your choice.