Starting out in ASC vs. inpatient setting

[kubelkabondy, ADN, RN]

As I'm about to graduate nursing school and considering a few job prospects in the OR, I'm wondering about starting out in same day surgery vs. inpatient. My current employer where I work as a CNA is a Level III trauma center. They have been good to me, and overall I like the culture of the organization, but I don't know much about the OR there since I work on the floor right now. However, I have been in touch with the OR manager and I know they are interested in me for the next residency cohort, although the application hasn't been posted yet.

My senior practicum site has also expressed interest in hiring me, but it's an ASC, 99% outpatient (there are a few beds). I also like the people there and culture of the organization, and I suspect the pay would be a little higher.

Although my current employer isn't Level I trauma, I would still get bigger/longer cases there as opposed to working in an outpatient setting. One thing I noticed in practicum was how fast the cases turn over in same day surgery, especially with certain services like endoscopy where you barely have time to finish charting on a case before it's time to head back to pre-op to bring in the next patient. 

Both places seem to have extensive and thorough training programs for new grads.

My question is: would I be putting myself at a disadvantage starting out in an outpatient setting? If I wanted to transition later in my career to a big hospital with big trauma cases, would lack of trauma experience render me useless? 

[RN_JuJu]

I think that if your main goal is to eventually transfer to a big hospital with big trauma cases, then you would be better off taking the hospital job! While the pay may be lower, the experience that you'd gather would be more valuable for your end goal. The thing with outpatient procedures is they tend to have lower acuity patients who are typically very stable. You wouldn't necessarily be building much critical thinking skills, in my opinion, if you go that route first. Additionally, it would definitely be harder for you to find a job later on at a big hospital if you ever wanted to go from outpatient to inpatient. That being said, if you started inpatient and wanted to transition out to outpatient, it would be much easier. I think sacrificing lower pay for better experience is worth it- especially as a new nurse. Plus, a lot of that "pay cut" could be made up by taking call.

Ultimately, I would interview for both and see which one seems like the better fit for you. I started off outpatient first and it took me a good TWO years to land an inpatient hospital job due to my experience being too specialized. So it's not impossible to go from outpatient to inpatient- just took slightly longer for me.  

[kubelkabondy, ADN, RN]

1 hour ago, RN_JuJu said:

I think that if your main goal is to eventually transfer to a big hospital with big trauma cases, then you would be better off taking the hospital job! While the pay may be lower, the experience that you'd gather would be more valuable for your end goal. The thing with outpatient procedures is they tend to have lower acuity patients who are typically very stable. You wouldn't necessarily be building much critical thinking skills, in my opinion, if you go that route first. Additionally, it would definitely be harder for you to find a job later on at a big hospital if you ever wanted to go from outpatient to inpatient. That being said, if you started inpatient and wanted to transition out to outpatient, it would be much easier. I think sacrificing lower pay for better experience is worth it- especially as a new nurse. Plus, a lot of that "pay cut" could be made up by taking call.

Ultimately, I would interview for both and see which one seems like the better fit for you. I started off outpatient first and it took me a good TWO years to land an inpatient hospital job due to my experience being too specialized. So it's not impossible to go from outpatient to inpatient- just took slightly longer for me.  

I think that right now I am leaning towards the hospital setting as you advised for the reasons that you stated. However, the ASC does have a few advantages. The biggest advantage that the ASC has going for it is that there would be no call, no weekends or holidays, and no nights. Also, when I did my practicum there, the RNs I worked with say it's a good place to work and the surgeons are much nicer than elsewhere. The ASC is also owned by a healthcare giant/HMO, so I feel like it would at least look better on my resume than a physician-owned surgery center that only specializes in a limited number of surgical services. However, they only have 9 ORs as opposed to the hospital which has over 20. 

I don't know if my ultimate goal is to work at a big hospital doing trauma cases, but I guess I'm worried I'd get a little bored at the ASC after a few years?

Thank you for weighing in!