Torn between office RN and hospital

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I have been a RN for a little over 2 years now. I worked on a Med/Surg/Tele floor for a year and then did travel nursing for the 2nd year, which I absolutely loved ... well the travel aspect of it. I am starting to feel burnt out and so tired of hospital nursing. The patient ratios I have dealt with have left me feeling uncomfortable and unsafe. For example, I have had 1:9 patients on an evening shift and although I delivered safe care, I felt so uncomfortable taking on such large assignment. I really would love to get out of the hospital for at least a little while. I feel as if my mental health has been declining because I am so unhappy in hospital settings. I feel anxious before every shift. So I applied to a couple of family care office RN positions and am learning about them. I feel like I would be using a different kind of skills set and would enjoy working in a different of a setting. However my current nurse manager pulled me into her office, in summary, basically saying saying I am too young to go to an office, that I will lose all of my skills and will have difficulty going "up" from here. She says she made the mistake and hated it and doesn't want me to regret making this decision. Normally, I would go with my gut but she really made me think and now I'm having second thoughts. I just wanted someone else's opinion on being a nurse in an office. It would be a family care office. Do you enjoy office nursing? Do you feel like you would be able to go back to a hospital and be competent after working in an office? Do you feel as if you lost all of your skills?

Im just torn because there are different pros and cons. I would be taking a major pay cut and apparently "skill cut", but I feel like my happiness and mental health Is more important. But now I hope I don't regret my choice.

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Specializes in Clinical Research, Outpt Women's Health.

I never did hospital nursing even though I had offers. I have never regretted my decision. It may be boring sometimes, but I love having a normal life.

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Specializes in Critical care, Trauma.

Office nursing is its own specialty. A lot of what you do on a daily basis really depends upon the physician you work for. Some people confusing "office" with meaning it will be "slow" or "boring" but that was never my experience. Physicians, especially primary care doctors, take on a LOT of patients so you're not just managing the ones that come in for the day but also the ones that call the office for phone triage, medication issues, needing prior authorizations done for the new medication that the physician prescribed, etc. The doctor I worked for actually had TWO nurses because she was so busy during her 4 days in the office (we were usually there for 9-10 hrs each day). We took turns where I'd room patients and assist with procedures while the other nurses did "phone duty," prior authorizations, paper work, etc and then switched for the other two. I feel really lucky that had a doctor that wanted to grow her nurses to have critical thinking (both of us were new nurses when we first started) so we could manage a lot of issues without having to run to her each time. And even with her using fairly large appointment slot times (15-30 minutes.....the longest appt times utilized in our office. Others would have 5/10/15 minute appts) she would still have patients with multiple issues, "door handle problems" (where, as she's walking out the door, the patient would say "oh wait, while I'm here...." or unexpectedly complicated problems (i.e. told the receptionist they were coming in for diarrhea when it was really crippling new on-set anxiety) where she'd need to even pull the "phone" nurse into the mix to help keep the office flowing on time. There were rarely boring/slow moments....usually right before a holiday weekend.

Some things do get repetitious... but I think that they can anywhere. Flu/respiratory season got old pretty quick for me, but you see a lot of the same stuff in the hospital, just more advanced acuity.

As far as advancement goes....well, how far can a nurse really advance "even" in a hospital without increased education? Floor nurse --> charge nurse --> nursing supervisor....maybe house supervisor....? If you're not happy in your current setting I wouldn't say that means the whole hospital is not an option for you, there are specialties (or even just hospitals where the culture demands better ratios) where you will not get 1:9 ratios. Moving into outpatient care doesn't mean you can't go back to the hospital setting at some time in the future. The amazing thing about nursing is that there are so many options. Many people love outpatient nursing because of the very set schedules without weekends or holidays. You "pay" for that benefit in the form of a pay decrease, but it doesn't make you any less a nurse, highly trained within your own specialty. I've been out of the office for over 2 years so I know nothing about the new coding changes and I couldn't even begin to think of all of the various things I've forgotten about pediatric care, chronic disease management, acute sprains/strains/medium-acuity injuries, childhood vaccination schedules, etc. It's just a whole different world and there will be a learning curve no matter how much hospital experience you have.

To that point, I'm curious why your boss feels like she was somehow held back by working in an office.....when she's now an inpatient nurse manager. Again, there's not much higher up that one can go without additional education. Maybe she has more to her story or maybe she's trying to hold onto what little staff she has considering those awful ratios. Either way.... her story is her own, you only get to dictate yours. If you think it's time for a change, it's your decision to make.

Good luck with deciding.

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Specializes in Ambulatory Case Management, Clinic, Psychiatry.

Do you have any long term career goals? It's OK if you don't yet/aren't sure, but if you do- keep those in mind.

It really depends on your personality and what you are looking for in a job. I've worked n the hospital (psych, not med surg) and currently work in the office. PRos and cons to each.

I have become bored with the office setting, but every office is different. THere is definitely less stress overall and the stakes are usually lower (less chance of an error hurting someone). Since you have a couple years of med surg, if you're interested in the office position, go for it. I'd see if you could shadow first, too.

Just keep in mind that if you do want to go back to the hospital (and/or pursue something like OR, PACU, cath lab, whatever-- not just the floor), the longer you stay in the office, the more challenging it *may* be to transition back to the floor.

Good luck!

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These ratios are what is driving me frim acute care. I work on a tele unit with cardiac drips and have had up to 7 pts. 6 is our standard ratio. Why in the world are we taking patients on dobutamine drips when we have a med surg ratio?! This seems to be the trend with many hospitals, now. I am done, at some point in the new year I will be leaving hospital nursing for new ventures.

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OR, PACU, Endo, and Cath Lab have their own challenges. The hours can be brutal, as call is required. I have put in 38 hours one weekend due to my 48 hour weekend call requirement in PACU. After working 20 hours straight and having 5 year old lap appy at 2 am, the simple task of administering fentanyl to the child becomes incredibly dangerous. The call in endo, OR, and cath lab is even heavier than PACU. If you can deal with the long hours, it is much less back breaking than the floors!

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