Starting in a Nursing home vs. Starting in a Hospital

Concerto_in_C, BSN, RN · Sep 11, 2013

sunshyne17, ask for a position in sub-acute rehabilitation, not in a classic nursing home where the residents live and play bingo all day. That's not going to teach you enough marketable skills to impress recruiters in the future.

Sub-acute rehabilitation is like an extension of hospital care. They have interesting surgical cases (a lot of orthopedic cases such as joint replacements), surgical wounds that will teach you a bit about incision care, staples, steri-strips, etc, you will give IV antibiotics and get to start IV lines. It's very similar to a medical surgical unit and will teach you most skills you need in med-surg.

However, stay there for 1-2 years tops, no longer, because hospital recruiters can be prejudiced and they think nursing home nurses are poorly skilled (true for some, but not all). A recruiter told me if you stay in a nursing home setting 5 years or longer, most places will no longer consider you for acute care positions, unless you go back to nursing school or take refresher courses.

The industry does not like nursing home staff-this is an honest assessment based on what recruiters told me, and my own experience starting in sub-acute care and then trying to get out of there.

What I've seen happen is young LPNs getting a few years of experience in a nursing home, then getting a BSN, then immediately applying at local hospitals and generally getting offers. That seems to work well.

Good luck.

sunshyne17 · Sep 24, 2013

Concerto_in_C

Thank you so much for your comment! I didn't know of the "unspoken industry preferences," but I was afraid something like that would exist. That is why I made this post. I love the idea of geriatrics I just wanted a more hands on role. We shall see how this all plays out. I am praying I don't misstep here. This is a new career for me and I want longevity.

Concerto_in_C, BSN, RN · Sep 25, 2013

Good luck to you. Unfortunately the public at large (this includes many recruiters/human resources professionals) has a very naive and distorted view of nursing. This is shaped in part by the garbage shown on television screens (Grey's Anatomy, ER, General Hospital, etc.). Those shows tend to promote the trauma nurse/helicopter nurse/ICU nurse as the "elite". Can you imagine a Grey's Anatomy show set in a nursing home? "Come on, that's not real healthcare"-people would say.

It's good you like geriatrics. If that's what you want there are many places to go, and you will be very useful. Long-term care facilities have a very high nurse turnover rate. Any any point in time there must be a million openings out there...

Maddie86 · Sep 25, 2013

Hi! I am an RN, BSN. I started out my career 5 years ago in a LTC/Rehab facility. I have some attention issues and the hospital setting just didn't compliment me. I have made a career of it and am now certified in geriatrics and was recently promoted to a unit/nurse manager. After working for so long as a evening/PM supervisor and moving into management, it has come very easily to me because I understand it from the ground up. That being said, I regret very much not trying a med-surg unit first. My husband is also working on his second bachelor's-in nursing. I am very insistent with him that he begin in a large, preferably teaching or state hospital with a tried and true new grad program. I struggled on the hospital floor bc of very little clinical experience and thus weak clinical skills coming out of school. Just some thoughts for you. Hope it helps!

NurseNightOwl, BSN, RN · Sep 26, 2013

Hi! I am an RN BSN. I started out my career 5 years ago in a LTC/Rehab facility. I have some attention issues and the hospital setting just didn't compliment me. I have made a career of it and am now certified in geriatrics and was recently promoted to a unit/nurse manager. After working for so long as a evening/PM supervisor and moving into management, it has come very easily to me because I understand it from the ground up. That being said, I regret very much not trying a med-surg unit first. My husband is also working on his second bachelor's-in nursing. I am very insistent with him that he begin in a large, preferably teaching or state hospital with a tried and true new grad program. I struggled on the hospital floor bc of very little clinical experience and thus weak clinical skills coming out of school. Just some thoughts for you. Hope it helps![/quote']
I was also worried about working in the hospital environment bec of attention issues! But I've also always loved geri and I have wanted to work in the ltc environment for as long as I can remember.
To OP, I'm working 11-7 as the RN supervisor (also push the cart for my rehab hall), it's been 2 months and it's my 1st job out of school... it's definitely challenging, but I love it. The skills I'm learning/practicing are much more than what hospital nurses seem to think of LTC. I hope to work my way up to admin one day...

brithoover · Sep 26, 2013

I graduated knowing I wanted to work in peds but there were no jobs so I took a position in LTC thinking it was career suicide. I worked there a year and though I didn't gain any hospital skills I became much more confident as I was often charge nurse.

2.5 years later I am now in a pediatric hospital so LTC experience was worth it

Concerto_in_C, BSN, RN · Sep 26, 2013

I graduated knowing I wanted to work in peds but there were no jobs so I took a position in LTC thinking it was career suicide. I worked there a year and though I didn't gain any hospital skills I became much more confident as I was often charge nurse.
2.5 years later I am now in a pediatric hospital so LTC experience was worth it

Our young nurses get 1 year of med-surg experience and they get offers from everywhere. Crystal, one of my unit buddies, just got a peds job. Melissa got an ICU job at Loyola in Chicago. Med-surg seems to open all doors of opportunity. However, long-term care nurses are treated as stupid nurses. I managed to make the transition from long-term care to acute care, but the experience of talking to recruiters made me bitter and cynical about the industry and to some extent damaged my enthusiasm for the industry. I'm glad things worked out for you. Nursing homes are OK for a person who is genuinely interested in geriatrics, but that's very rare. The last time I met such a person I was in the nursing program and she was the geriatrics class instructor. Another word of caution: there are many ugly characters running those nursing homes. The DON of the rehab place I used to work is vulgar and unprofessional, uses 4-letter words when talking about her nurses, absolutely no class. That place is in Chicago suburbs and it's very pretty, it's not some hole in a ghetto but externally a nice facility.

sunshyne17 · Sep 27, 2013

I graduated knowing I wanted to work in peds but there were no jobs so I took a position in LTC thinking it was career suicide. I worked there a year and though I didn't gain any hospital skills I became much more confident as I was often charge nurse.
2.5 years later I am now in a pediatric hospital so LTC experience was worth it

Brithoover - so the LTC experience helped get you into peds?

brithoover · Sep 29, 2013

Brithoover - so the LTC experience helped get you into peds?

I wouldn't say it got me into peds. But it was a job when I couldn't find anything else. And it didn't "hurt" me like I thought it would

BrandonLPN, LPN · Sep 29, 2013

I see it as sleazy because the employers want a zero risk situation. The candidate is the only party that takes a huge risk by changing jobs because changing jobs in nursing is risky. A number of my colleagues have screwed themselves into the ground by quitting a reasonably good gig, and accepting an offer from a company that had problems. Some of those people later came back to us with their tails between their legs, they were fortunate our organization took them back...

I'm usually the last one to side with The Man, but why isn't it okay for facilities to refuse to hire new grads? It's safer for them to hire experienced nurses. Landing your first nursing job is your responsibility.

Plus, if it were just about money, new grads are a heck of a lot cheaper than experienced nurses.

Misskala · Sep 30, 2013

sunshyne17, ask for a position in sub-acute rehabilitation, not in a classic nursing home where the residents live and play bingo all day. That's not going to teach you enough marketable skills to impress recruiters in the future.
Sub-acute rehabilitation is like an extension of hospital care. They have interesting surgical cases (a lot of orthopedic cases such as joint replacements), surgical wounds that will teach you a bit about incision care, staples, steri-strips, etc, you will give IV antibiotics and get to start IV lines. It's very similar to a medical surgical unit and will teach you most skills you need in med-surg.
However, stay there for 1-2 years tops, no longer, because hospital recruiters can be prejudiced and they think nursing home nurses are poorly skilled (true for some, but not all). A recruiter told me if you stay in a nursing home setting 5 years or longer, most places will no longer consider you for acute care positions, unless you go back to nursing school or take refresher courses.
The industry does not like nursing home staff-this is an honest assessment based on what recruiters told me, and my own experience starting in sub-acute care and then trying to get out of there.
What I've seen happen is young LPNs getting a few years of experience in a nursing home, then getting a BSN, then immediately applying at local hospitals and generally getting offers. That seems to work well.
Good luck.

Hi! I was just offered a position with a sub-acute Rehab center. It's private and is very nice. The DON is also a WOCN and we clicked as I am interested in WOCN certification too.

Anyway, I am hoping to work this position (post-surgical pts, IV therapy, post-stroke pts...) while I do my online BSN program. I am planning on continuing to apply to hospital jobs as well. I hope this is a "transition job."

I have one year Med-Surg experience already....long story, I left this 1st position for a clinic and then was laid off after 7 weeks in that office as the previous nurse wanted her job back. So it has been difficult for me to get back into the hospitals as this termination looks bad on my resume. I am hoping being employed in direct patient care while I am applying for a hospital position will help my chances with HR. :)

I floated to the Rehab floor when I was working in the hospital. While you are not managing acute medical conditions, you still have direct patient contact, med administration, doctors orders, pt assessment, pt education, and pt admits and discharges to do. Not to mention working under facility guidelines, under Medicare guidelines, and being up to date on pt safety trends and protocals. While Rehab is not as extreme as my last Med-Surg floor, it is still WAY more hospital related than a doctor's office. It is hosptial-transferrable experience. :)

Yes, I am still worried this is career suicide though.

sbostonRN · Oct 6, 2013

I wanted to share with you my story because I started in Subacute/LTC and worked there for a year. I gained a lot of skills and was easily able to get this job weeks after passing the NCLEX. I don't know what would've happened if I had waited around for the perfect opportunity but I feel like I made the right decision in choosing that job because I gained a lot of valuable experience there. But the pay wasn't good and I truly wanted to work in acute care. So after a year, I got a job in LTAC (long term acute care). Here, I care for patients on multiple IVs, wound vacs, we do in-house dialysis. Pretty sick patients! I've been there for 16 months and just got my dream job in an acute care hospital on a medical floor. While I only have my ADN, I am working towards my BSN, which I think helped me land this job.

I know several other ADN grads who worked in nursing homes too, who moved into LTAC after a few years of experience. They seem to do a lot better working in the LTAC environment than the straight-up new grads we get.