Questions about a recent offer (med/surg)

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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.

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

I agree with this.

Specializes in RN, BSN, CHDN.

NO do not take it I dont think it will serve you well!

You do not want to drop your salary, that is a large drop. I dropped mine $8 an hour to move to OH and no matter how people tell me it is cheaper to live here I cannot make ends meet as I did before!

I'd prefer more orientation, that may be negotiable.

As for charge nurse duties after a few months, the charge nurse IS a resource, but that's more about good judgement than actual skills (which can be learned pretty easily.) I think once you get into an acute care job, you'll realize you know more than you think you do. That you've already developed some good nursing spidey senses that will tingle when something is wrong.

As for is THIS job the one for you? That's going to take you weighing the pros and cons. How badly do you want to get into acute care? Could this job get you enough experience to make you more attractive to another hospital even if it's not the place you want to stay forever? How do YOU feel about a commute? And as for the pay cut, are you comparing apples to apples? You said your current job is prn, so are you making $10/hr more without benefits, but will get benefits with this job?

Good luck with whatever you decide!

Another vote for staying put. Too many red flags as others have already mentioned AND it's a big pay cut and long commute. It sounds like you already know by the sound of your post. Since you currently have stable employment, I'd hold out for a better offer at on a more supportive unit.

Specializes in Hospice.

My question to you is what area of nursing do you want to focus on? Nursing offers great diversity in career options, there's not one particular skill set that makes one a great nurse. If you enjoy the population that you currently work with, then it might be worth it to stay where you are. If you feel like it's time for a change, then maybe the job offer is the way to go.

I'm a fairly recent RN grad. I really wanted to get a job in a hospital setting, particularly ER or Critical Care. I got an offer that is an hour drive from my house in an clinic setting. I accepted the offer with a little hesistancy. Much to my surprise, I discovered I love my job. The orientation is very comprehensive, not rushed. I'm not bored, but not overwhelmed either. I enjoy working with one patient at a time, I've learned alot looking further into topics to answer patient's questions. The hours are consistent, and will allow me to pursue further education. The pay is less than what the hospital would pay, but the benefits are very good. I really don't mind the drive. Now I'm grateful that I don't work in a hospital. While I may not be getting the same skill set that I'd be getting in the hospital, I still feel like I'm acquiring a good skill set.

Specializes in Hospice / Psych / RNAC.

I have to agree with the one who said that there are multiple red flags here. I would stay where you are. At the new hospital since it's on the out skirts in their med/surg will probably not have anything challenging because the more acute ones get sent to the big city so..............why go? Oh yes maybe a true challenge here or there but along with the pay cut and the short orientation plus the patient load and being the charge as well Hmmmmm...........way too many red flags. Plus when ever did the hospitals abide by patient ratio numbers they quote. Expect a couple more than they told you just to be sure. Also nights are a different animal altogether when they are 8's.

You say the pay cut won't matter but really when it all comes down to it you are being paid what they deem your worth. You will definitely see a difference in your pay checks and it will effect you mentally even if you say it will not. And if they can't pay their nurses what the nurses are suppose to get I wonder how they pay out for supplies and the short cuts that will be in place. I don't know about this one........I would wait for a better offer and in the meantime look around where you are and see that I bet they really do appreciate you. This one falls under the grass is greener on the other side but the grass isn't.

I can't give advice on the job duties part of this discussion, but I do think you should put pen to paper with regard to the drive issue. I never truly realized how expensive it is to have an hour commute until I started driving 2 hours a day. I don't know your mileage but if you figure an hour is maybe 50 miles that's 100 miles per day. I'm assuming you'll work 5 days per week for 50 weeks per year. 500 miles per week equals 25,000 miles per year just to an from work. Now apply the federal mileage reimbursement rate to this which is supposed to give you an idea of how much per mile the average person has in gas and maintenance costs and you've got $11,250 in expense on top of your hourly wage pay cut.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
I can't give advice on the job duties part of this discussion, but I do think you should put pen to paper with regard to the drive issue. I never truly realized how expensive it is to have an hour commute until I started driving 2 hours a day. I don't know your mileage but if you figure an hour is maybe 50 miles that's 100 miles per day. I'm assuming you'll work 5 days per week for 50 weeks per year. 500 miles per week equals 25,000 miles per year just to an from work. Now apply the federal mileage reimbursement rate to this which is supposed to give you an idea of how much per mile the average person has in gas and maintenance costs and you've got $11,250 in expense on top of your hourly wage pay cut.
The small-town regional hospital is located exactly 32 miles from my driveway. It takes me 40 to 45 minutes to get there in clear weather, assuming that there's a moderate amount of traffic.

In addition, the hours will be three 12-hour night shifts per week from 7pm to 7:30am. I wouldn't accept an 8-hour a day, five-days-per week job unless I was about to become homeless or my body couldn't physically handle 12-hour shifts anymore.

Specializes in floor to ICU.

As for charge nurse duties after a few months, the charge nurse IS a resource, but that's more about good judgement than actual skills (which can be learned pretty easily.) I think once you get into an acute care job, you'll realize you know more than you think you do. That you've already developed some good nursing spidey senses that will tingle when something is wrong.

This is so true, Commuter! We can tell from your posts that you are an astute nurse who would be totally capable of handling sticky situations with your great spidey senses!

Specializes in Emergency, Trauma, Critical Care.

Commuter, I'm like you, I was an LVN with about 4 years experience and became an RN. I did get the chance to go straight into the ICU, I had about 4 months of orientation, they did not short change me because they knew this was a new role. I'm now taking another job in a different facility, but still ICU, and they are giving me about a month orientation.

The fact that this is a new field, I would not take it without efficient orientation. You still would probably not be proficient with IV's at the end of orientation, but it would at least give you enough exposure to feel more competent in doing your job. I still am horrible at IV's but we hardly ever do it in ICU.

I say don't take the job, because of the lack of orientation, as well as the fact they want you to do charge nurse fairly soon. The charge's that I have always worked with have a minimum of 10 years experience and are an excellent wealth of information, it wouldn't be fair to you or the nurses you work with.

I hope you find something soon!

Specializes in LTC.

That is way to little orientation and way too many patients with no help.

If you have a position you can tolerate I'd hang on to it for now and let the experience accrue while you apply to hospitals close to home who are willing to give you the training you need.

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