Residency program vs Rehab job

calivianya, BSN, RN · Jul 10, 2015

I would normally advise people to take the residency program, but holy heck that pay is low! That's just unacceptable and a little demeaning IMO. I made more than that as a nurse extern the summer between my junior and senior years.

You may have more trouble finding acute care if you take the rehab job, but I personally could not take that residency because that pay would be a blow to my dignity. It sounds like the rehab job will allow you to learn and grow your practice just fine because you will be using a lot of your skills.

kariace · Jul 10, 2015

Wow this is a tough decision... I personally would choose the hospital job because as you've stated above it will help you build your job skills (if you planning on working in acute care when you move.) Also why is the pay so low? Is it because it's cheap to live in Massachusetts? Where I live at new grades are started of at $28 or more in a residency program with $25 being the lowest...

Also if you do choose the hospital job for the 8 months I would also work SNF PRN for the last months before you move to get that 1 year of experience..

NurseIndependa · Jul 10, 2015

I am all about residency programs & know Mass General is an exceptional hospital, but I would not accept the spot for such low pay.

mlowell20 · Jul 10, 2015

It's incredibly expensive to live in Massachusetts! They're basically taking advantage of the New Grads because it's one of the best hospitals in the northeast so people would do anything to have them on their resume. They're switching their computer systems over so they need extra bodies while currently hired nurses are training on the new system which is why it's an 8 month program with no guarantee of a job at the end. It's a little insulting if you ask meâ€¦ but as a New Grad desperate for acute care experience I can't help but debate doing it!

mystory, BSN, RN · Jul 10, 2015

The $13/hour position is more than a little insulting. They are exploiting new grads and the poor economic climate for dirt cheap RN labor under the guise of a "residency." And without the guarantee of job placement? Shame on them. Please do not take this job and I implore other new grads to decline such offers.

mmc51264, BSN, MSN, RN · Jul 10, 2015

I started in LTC rehab and because it has been less than year since I graduated, I got my dream job on acute care after 10 months, in a new grad residency (ortho-which fit REALLY well with the rehab experience). Mass Gen is great, but that is less than the aides here make plus no guarantee of a job??? scary-if they don't keep you, how does that look for next job??? Tough spot to be in

llg, PhD, RN · Jul 10, 2015

The Mass. General residency will probably be better for your career in the long run -- but I understand that you would have to swallow your pride and bear some financial hardship to take it. If you can afford to do it, I would recommend the residency as an investment in your future -- like an additional 8 months of school.

Mass. General is at the forefront of an effort (emerging trend?) by hospitals to decrease their financial losses related to new grad transition issues. It is a major national problem and a painful problem to have to confront. Too many new grads have entered the RN job market with a thought of "I am going to work for a hospital for a year or so ... and then leave to do something else." And yet, as new grads, they require an extensive and expensive orientation program to help them transition to the role of a professional nurse. The schools are not producing new grads that are ready to work in today's complex acute care environments. That's just a sad fact.

So ... hospitals are becoming less willing to pay full professional salaries to these new grads who are not yet ready to fulfill the responsibilities of a staff nurse with no assurance that they will stay long enough to be worth the cost of their orientation. So hospitals are trying different strategies to deal with that reality. Some are simply not hiring as many new grads as they used to -- leading to the difficulties that new grads are having finding good jobs and "experienced required" on all job postings.

Others are offering residencies only to those who sign contracts to stay a certain length of time (requiring the RN to pay back some of the costs of her training if she leaves early.) And others are decreasing salaries for new grads until they have completed orientation. New medical school graduates have to spend a couple of years in low-paying residencies before they are allowed to practice independently. And that's the model that Mass. General is experimenting with. They have created a residency that is focused on educating the new graduate and nurturing him/her through the transition process -- but paying a low rate because the new RN is not expected to assume full RN responsibilities. It's an educational program and treated as such. The resident gets education and support that other new grads don't get -- but at a cost to the resident.

I like the concept -- but the pay is very low and "hard to swallow." I wished they paid a little more -- and then I could fully embrace it.

Libby1987 · Jul 10, 2015

I'm not an acute care nurse but I read over again how a year in rehab/LTC makes nurses trying to break into acute care ineligible for the new grad orientation programs.

calivianya, BSN, RN · Jul 10, 2015

They have created a residency that is focused on educating the new graduate and nurturing him/her through the transition process -- but paying a low rate because the new RN is not expected to assume full RN responsibilities.

That is very dependent on the new nurse's preceptor and her clinical opportunities in school. I took a full patient load my second day - charting, meds, assessments, and everything else. I was in a residency program, too, but I was doing exactly the same amount of work the other nurses were doing for 99% of the residency (just sort of watched the first few hours of my first day and was jumping in and charting by the afternoon, so there's my 1%) and I would have been furious to make such low pay for it.

Eight months is a really long time. The new grad will be taking a full patient load with full responsibilities way before the eight month mark. I could maybe understand lower pay for the first month, but paying so little for eight full months is just straight up greed and blatant disrespect for the nurses on the part of the hospital, IMO.

jdub6 · Jul 10, 2015

To PPs: I think the OP's 2nd opportunity sounds like a LTACH (long term acute care hospital) more than SNF. If so, that would encompass acute and critical care skills: pressors, vents, wounds, IVs of all sorts, etc.

Asomeone who competed a critical care residency at an academic medical center and then moved into the long term setting, I learned a lot from both and have found that you can definitely learn/maintain skills in both settings. You may have an issue if you move on after the long term job because unfortunately many hiring managers in acute facilities just don't understand what those jobs entail, they view it as "just a nursing home job." If you choose that job and later move on, you will need to be assertive about what you did there! This can also be very dependant on the repetition of the individual facility if you stay in the same local area, some are very well-known for taking high acuity patients and others not.

Honestly, I would say you'll get your skills either way. In my area, fair or not, the jobs at academic medical centers are definitely more highly valued by hiring managers when applying for other jobs, esp in hospitals. That said, given the huge pay difference with no guarantee of a job at the end, if the long term facility is in fact a long term ACUTE facility, and if it is relatively well known, I would give that position serious consideration. I would also ask Mass Gen what percent of their residents do get hired permanently, and how it is determined, do you have to apply/interview all over again and if so are you given any preference over other applicants, or is it just based on your evals while in the program?

mmc51264, BSN, MSN, RN · Jul 11, 2015

I'm not an acute care nurse but I read over again how a year in rehab/LTC makes nurses trying to break into acute care ineligible for the new grad orientation programs.

That's why I left at 10 months!! I got almost a year experience but was technically a new grad.