Struggling with tough decisions after school

[FatsWaller, BSN, RN]

So first I understand in the end only I can make the decision but I thought it would be good to get some opinions.

A little background, I'm from Southern California, where competition is ridiculous for everything. I left my family and my girlfriend of 5 years to go to an accelerated nursing school in Kentucky. I graduate in May. I know there is no way I will get a job in California. There's just too much competition and almost every job posting says *No new grads. If you do get a job and that's a big if, then it's generally in med-surg for 6 months to a year and then you work your way up to ICU. With that said, here in Kentucky (Louisville to be exact) nursing jobs are plentiful and they seek out new grads. I already have a job lined up in the CVICU of a large downtown hospital /heart and lung center. I also was offered an ER position at University of Louisville hospital's trauma 1 center. I love ER, especially coming from an EMT and firefighting background, but my overall goal of going to CRNA school or maybe NP school requires ICU. The CVICU in the heart hospital will give me an insane amount of experience in ECMO, VADs, Hemodynamics, ArticSun, the list goes on as these are very ill patients. The ER job will also be great, it's a trauma 1 center downtown that sees everything and is constantly full. Also because there are 3 other main hospitals in 2 city blocks, the ER here tends to not get low acuity cases, as they are sent to the other hospitals. Because the ER hospital and the CVICU hospital are owned by the same overseeing company, I am in the midst of trying to take the best of both worlds and work CVICU full time with PRN or part time ER.

My dilemma comes from what to do. Should I stay CVICU or do ER, or should I try to get both. I also am stuck on whether to stay in Kentucky. Obviously jobs and opportunity are knocking on the door and if I could do 1 year here, then I should be able to get a job back in California with the experience. But that means changing my 1 year plan away from family and the girlfriend (who expects a ring any day), to two years, putting a strain on an already hard situation.

So Recap;

Stay in Kentucky and choose between

CVICU or ER?

Try Both?

But away from family, friends and partner

OR

Move back to California,

Struggle to get a job and most likely in med-surg,

Wait a year or two to move to an ICU

Be with family, friends, partner

Thanks for any insight or help!

[NICU Guy, BSN, RN]

First, you can not work full-time at Jewish (I assume) and part-time or prn at U of L trauma center. Your paycheck from both hospitals would come from KentuckyOne, which means if you work over 8 hrs in ER, it would put you in overtime. The same as me working full-time at Kosair and working prn at Norton. They are both owned by Norton.

I would stay in Louisville for 1-2 yrs either CVICU or ER and then start applying to hospitals in California. That way you have a job (and gaining experience) while looking for a job in California. Even if you were fortunate to find a job now in California, what would be the odds that you would get an ER or ICU position?

[FatsWaller, BSN, RN]

@Guy in Babyland

True that, plus apparently my application for RN licensure in California would take 3 months alone. Their website says they are currently processing applications from November 16-30^th, there are just too many people in that state. The odds that I would land an ICU or ER job are basically non existent, they don't hire new grads really for those positions, and if I could it would be at a small community hospital where the ICU would most likely be a step down at a main hospital.

I think I misspoke, I meant see if I could get PRN at UofL or heck maybe even Jewish. I only thought of it because I know of some people who do the same, or who at Jewish work full time in ICU and PRN in the ER. I know it puts you at overtime but it seems the hospitals are constantly short and calling people in anyways, at least that's what the CVICU nurses told me.

In my clinicals it seems Kentuckyone is much more apt to facilitate overtime then did Norton. That's just my experience with hearing what nurses complain about.

Thanks for the advice though. It does seem that with ICU under my belt, my options and room for growth are much higher. But my passion is in the emergency setting, so it's a very hard decision. That coupled with the choice to relocate is also hard.

[Zyprexa_Ho]

Can you try at least moving to a state that is closer to California? I'm not sure how the competition is there, but what about Arizona or Nevada?

[Duttygal86, BSN, RN]

What about rural California? I'm out of state too and looking into the Central Valley when I graduate next year so my daughter can get in-state tuition in the UC system. I've done a lot of research and there are some jobs to be had for new grads they just ARE NOT in LA, SD, SF or Sacramento. Also, LV hires new grads as well, it might be worth a shot to apply at St. Rose Dominican in Las Vegas (they have the best new grad pay & orientation).

I think after a year it won't matter anyways, but will your relationship survive another year (or more? Your opportiunities in KY sound great, but life is about more than work; and this is coming from a die hard work-a-holic with 2 jobs in nursing school.

[CSTtoRN]

First, you can not work full-time at Jewish (I assume) and part-time or prn at U of L trauma center. Your paycheck from both hospitals would come from KentuckyOne, which means if you work over 8 hrs in ER, it would put you in overtime. The same as me working full-time at Kosair and working prn at Norton. They are both owned by Norton.

I would stay in Louisville for 1-2 yrs either CVICU or ER and then start applying to hospitals in California. That way you have a job (and gaining experience) while looking for a job in California. Even if you were fortunate to find a job now in California, what would be the odds that you would get an ER or ICU position?

I don't know if you know this is a policy for this specific hospital system but where I work you can work F/T in one department and PRN or P/T in another because they are different cost centers. You can also do this at a different entity owned by the same company (work F/T at one and PRN or P/T at another)

[AliNajaCat]

Everybody wants to go to CRNA or NP school. Theres no shortage of applicants, even with an EMS background with only 1-2 years of new grad work experience youll be way down the list behind people with 8-12 or more years in ICU or other work. This is why all the new grads who plan on CRNA or NP school often end up doing something else, and, find out they love it. If ER is your heart, stay there, get good experience then transfer to ICU if you still think you want to. Youll be more attractive to grad programs if you do this because youll be showing them you can stick to something. they see lots of folks who cant aeb their changing jobs every one to two years.