Starting at small IHS hospital limit future employment?

[rucana]

I am a new BSN grad with multiple offers but am most excited about a job offer with an IHS hospital. I was wondering if anybody has any insight into gaining employment after working in a ~40 bed IHS hospital. My family lives in a major city with a very competitive nursing market (at least for new grads) so I may end up moving there to be closer to them after a few years with IHS.

I don't know anything about obtaining employment as an experienced nurse so I just want to make sure that this decision won't be a hindrance when applying for jobs in the future.

Is it difficult to gain employment at a large hospital after working at a small rural hospital?

[ToothFairy(5)]

I don't think it will affect future employment as long as you do a good job and have good references. Maybe a per diem in another area of nursing for a year or two just to make yourself more marketable? I would think the biggest impact is having those references though and a clean work record.

[chrisrn24]

Not to my knowledge. I know a girl who did that and moved and got a job at a major urban hospital.

[Pepper The Cat, BSN, RN]

I started in a small hospital. I think that is where I learned to think on my feet and trust my instincts. When there is not a doctor in house 24/7, you quickly learn when to panic and when not to. I learned how to trust my gut. I also learned how to assess without a lot of fancy equipment that bigger hospitals had.

This has made me into the nurse that when I say to a doctor, "you need to see this pt now" they k ow that is urgent, not just a CYA.

40 beds is much larger than the facility in which I started...

and tiny compared to the one in which I now work.

By all means, you can step up and out of a smaller facility into a larger one.

Small places can be a good place to start because the acuity is *usually* lower and the pace is often much slower... *until* they're not... and then you realize how easy the RNs in the big facilities have it by having myriad docs, RTs, pharmacists, and other RNs around when the fecal matter impacts the rotary ventilator.