Questions about a recent offer (med/surg)

[TheCommuter, BSN, RN]

Thanks in advance for any feedback that you might have to offer. This post is long and requires patience.

As some of you know, I am a newer RN who has 4+ years of experience as an LVN. I have never worked at an acute care hospital in my life. All of my nursing experience is in long term care, rehab, and psych. However, I have been attempting to land an acute care hospital position since earning my RN license to build a fund of knowledge, skills, and experience. I should also mention that my clinical rotations were substandard while in school.

I recently interviewed for a night shift med/surg position at a small regional hospital located in a town 30 miles away from my home. I live in a very large city with more than 500,000 people and numerous hospitals, but the job market has tightened within the past couple of years, so getting into an acute care hospital has been elusive. The hospital that offered the job is in a small town away from the greater metropolitan area.

I am currently working PRN at a small rehab hospital in the city where I reside, but I have always gotten a full-time schedule of three to four 12-hour shifts per week since I started working there. Keep in mind that I have never worked in an acute care hospital in my life, so my skills are almost nonexistent. I know how to operate IV pumps, but have only had one successful IV stick. I know how to perform wound care, suture removal, staple removal, bladder scans, G-tube feedings, PICC line care, CPM machines, finger stick blood sugars, medication administration, etc. I can insert foleys, but I am not proficient at this skill. I have never administered blood. You know where I'm headed...

Anyway, the small-town hospital offered me one week of classroom orientation plus one week of orienting on the floor before being cut loose to work on my own. They also discussed making me a night charge nurse in a couple of months. I was very upfront about my lack of skills, but the nurse manager stated, "Orientation is a time to learn paperwork. You'll be fine once you know where to find supplies."

I will have anywhere from 6 to 8 patients at night with no CNA or tech most of the time. This is a med/surg floor, but it also receives overflow from oncology.

In addition, my idea of a charge nurse is a highly-skilled resource who is knowledgeable about policies, procedures, running a floor, leading a group of nurses, and so forth. I think that I would be inappropriate in this role without some experience.

Any comments, questions, feedback, or advice? I personally think that the orientation being offered is too short for a nurse like myself who has never worked in an acute care hospital.

[classicdame, MSN, EdD]

in some situations the charge nurse is the RN, delegating to LVN's. I believe this job would be stressful for you since you lack confidence in your skills. I also believe if you had the confidence, the skills will come. So it comes down to what YOU think you can or want to do.

[gonzo1, ASN, RN]

There are a lot of red flags here. The orientation isn't long enough even for an experienced nurse and definately not long enough for a charge position. You are right about the experience a charge nurse needs.

Who would be on that floor with you at night. Another nurse, how many. Would there be enough help to even run a code if someone goes south.

Sounds like you would be leaving a good job for something very uncertain. Maybe you can find someone from that hospital to talk to and get some info about what it is like to work there.

You could be getting into either a very bad, or very good situation.

I have always enjoyed your posts and found you to be very well grounded. I would trust your instincts on this.

[TheCommuter, BSN, RN]

I should also mention that the small-town hospital is offering $10 per hour less than my current workplace. I currently earn $36 hourly at the rehab hospital in addition to $6 shift differential for night shift, which adds up to $42 per hour.

The smallish hospital is offering $26 hourly with a $3 shift diff for nights.

I am single with no children and can definitely afford the cut in pay, but I don't want more stress for significantly less money.

[Orange Tree]

I think I would stay put. The pay cut is a deal breaker. If you were a new grad taking a pay cut to move from an accounting job to a nursing job, I would say go for it....but you do have nursing experience and you're probably worth more $ than you think you are.

[Up2nogood RN, RN]

It's tempting to get into acute care but that's a sizable decrease in pay plus you'll have an hour drive (round trip) each day you work with a crappy orientation. Sounds like they just need some hot bodies and/or having issues on the noc shift. If i were you personally would stay where I'm at until a decent offer was made closer to home.

[beachgirl01]

I personally wouldn't take the job...I think that's way too little orientation, and 6-8 patients with no tech or HUC would be really rough, I think.

[carluvscats]

The lack of orientation time tells us that this hospital has a "sink or swim" mentality with its staff ~ are you up for that? It will be an incredible amount of stress, at least until you get your bearings. It is probably doable but only if you have amazingly supportive co-workers...... co-workers that will, in effect, be teaching you.... only to turn around and have you be charge over them. Could get dicey.

No matter, I agree with some of the other posters; the money would be a deal-breaker for me. That's quite a cut. If it were me, I'd keep casually applying to other places and keep your current job.

As an aside, I agree with Orange Tree.... you are probably worth more than what you are giving yourself credit for. IV sticks come with practice, as do other skills. I wouldn't worry with such things until you have to.

Good luck! :)

[SuesquatchRN, BSN, RN]

It's a no go, TC. The pay and responsibility indicate to me that they can neither attract nor retain experienced personnel and you would be too much on your own.

You do have a lot of skill and knowledge, BTW. Clinically. You just don't know it yet - but being alone on a floor with acutely ill people and no resources is no way to find out how much you do actually know.

[General E. Speaking, RN, RN]

I agree. IV sticks come with practice so don't sweat it! It is a skill you can easily pick up. I wouldn't go either. Too much of a pay cut. Too little orientation. If you want to branch into acute care, perhaps you could find a PRN position to get your feet wet? I realize this will be difficult because sporadic shifts here and there would be challenging to gain skills but maybe if it were the right place with a good orientation....

[RNlvn]

I would say no to the hospital. The drive its only 30miles but it'll wear on you over time, orientation umm if thats what you wanna call it, and the pay cut. I work at a rehab facility and we constantly have a lot patients that require skills so maybe you can volunteer to do other nurses skill assignments such as foleys, IVs and blood to become more proficient.

[OttawaRPN]

For all the reasons everyone else stated --- Just Say No.