Starting off in primary care or waiting for other opportunities

[nli122093]

I am located in Boston, graduated with my BSN and took my NCLEX in July. My ultimate goal at the moment is to work in an ER. Since my licensure I've applied to numerous jobs around Boston and have been looking at different opportunity.

The job market is extremely competitive and I have had no luck with hospitals. I understand that my chances would be increased if I looked elsewhere or relocated but at the moment that is not something I can do.

Recently I interview and was offered a job to work in a community health center doing primary care. From my understanding they do a lot of phone triage and case management. While they do see patients and perform nursing tasks (such as straight cath, wound dressings, ect...) a majority of the time is spent behind the phone.

I also understand that as a new grad rn it is very non traditional to start off here. I know that I should start in med/surg and that I won't be as effective doing phone triage without experience.

I am worried that if I take this job it won't help me find jobs in the future (particularly hospital jobs) due to the lack of skill set, which would impede my ultimate goal of working in an ER.

Thats why I am wondering if I should decline the job and wait for a med/surg opportunity? The problem here is I don't know how long it will be until I find another job opportunity.

On the flip side should I take this job and work for a year and try to find another job in the future? The problem here is that I've heard the longer away you are from the hospital the harder it is to find a job.

[CrunchRN, ADN, RN]

I started out in office nursing and now I work in research at a university and it is great. Go for it. It is what you make of it.

[Ddestiny, BSN, RN]

I think a lot of new nurses focus on the hands on tasks that you mentioned without giving as much weight to triage. Phone triage is a whole new beast. I started off in Primary Care where I would trade back and forth with another nurse; 2 days I'd do phone triage and 2 days I'd room and assess patients. The physician I worked for taught me a lot about critical thinking, being detail-oriented, and assertive (things that many new grads do not possess). I learned a lot and am extremely grateful for the experience I received. After 3 years I moved and started working in a hospital and the skills I learned in primary care are still being used everyday. I have background on some things that other nurses don't if they've always worked in the hospital. I think of primary care as the "med/surg" of the outpatient world -- you see a lot of different things, but with the added benefit of seeing how it all pans out over time.

As said above, it is what you make it.

The hands-on tasks that I didn't use in primary care came back to me after I started working at the hospital, plus I learned many more. I don't know anything about the job market in Boston, but my general recommendation is that having any job (even if it's not in your preferred specialty) is better than no job. You're going to learn a TON no matter where you go.

Good luck with your decision.

[SHGR, MSN, RN, CNS]

You are correct that new grads are infrequently offered these types of positions. I worked in a primary care clinic and did similar work to what you describe- and it was wonderful. You hone your assessment and communication skills on phone triage, believe me. The skill set you will develop- de-escalation, prioritization, communication, psych, diabetes, case management and resource utilization- will be an asset if/when you decide to move on (and probably insert IVs and the occasional cath). Don't focus on the specific "tasks". Think big picture. Another major plus is regular hours.

We had nurses move on to the ED or other settings if they wanted. I'd still be there if my situation hadn't changed (I didn't leave due to being unhappy there) after 11 years. Shadow at least one-two days if you are not sure.