Weighing 2 very different job offers

[newenglandrn44]

Hi everyone. First, I would like to thank you all for contributing to this forum. I have been reading for about 4 years, but this is my first post.

I am a new grad and have two job offers on the table as of today --both, I feel are great opportunities. However, they are both very different.

Ultimately, I would like to work in pediatrics -- so here is my dilemma. My first offer is in a pediatric long term care facilty where the patients are critically and/or chronically ill. Lots of vents, trachs, g-tubes, a few picc lines. The second is a med-surg oncology unit at a community hospital. There would be a ton of hands on learning at the latter job, as this hospital is lacking specialty teams such IV nurses etc..

Long-term I feel you can't go wrong with med-surg experience. However, I am unsure if it would be wise to pass up the peds opportunity since ultimately that's the population I want to work with. I don't know if the peds experience would compensate for the lack of acute-care experience should I apply next to a peds hospital, say in 2 years.

Both jobs are close to home and on the same shift. Compensation is remarkably comparable as well. Benefits are slightly better with the hospital position.

I would really appreciate any feedback you have to offer.

[caliotter3]

I would go with the hospital opportunity because the other job is more likely to be more "easily" available in the future. Acute care hospital experience is more difficult to obtain and always beneficial at the start of one's career.

[NotReady4PrimeTime, RN]

And I would go the other way. Peds LTC isn't anything like adult LTC. When I worked on an extended care unit, there were a lot of acute-care skills I used regularly. Trach-vent kiddos can change from totally stable to critically ill in the blink of an eye. Managing an artificial airway requires skills that easily transfer to the ICU. Assessing these kids is challenging. Kids with spinal cord injuries develop autonomic dysreflexia at the same rate as adults do - and it's acutely life-threatening. Recognizing it requires astute observation and treatment of it isn't for the faint-of-heart. These kids are often on a lengthy list of medications, many of which would not be commonly used in adult LTC; many will have seizure disorders. Time management and prioritization are also important in peds LTC because the kids need to have time for play and for learning. Plus, for a lot of these kids, their families are integral to their care so family-centered care will be very important. Generally speaking, if a nurse can do this job, they can do any job in pediatrics. Full stop.

[newenglandrn44]

Thank you both for the replies. On the surface I also figured I should scoop up the hospital job if offered. However, now I am wondering if I would be passing up my foot into the door in peds.

That was great perspective about the long term peds experience. It sounds very much like the facility I am looking at. My question would be, would the hospitals validate this experience, or would they see "long term" care and assume it's more akin to LTC for adults?

[caseyuptonurse]

Here's what I've seen in my experiences as a new grad. I work in a pediatric subacute LTC per diem, I worked there as an aide for three years as well. I also work for an acute rehab unit. Out of the two, they are totally different experiences. With pediatrics I am gaining peds experience, vent/trach skills, g-tube experience, and more. With the rehab (the one I work on is very acute and similar to med surg) I learned a lot of other basic skills that I learned in nursing school. I do a lot of wound care, cathing, IVs, manage PICCs, manage some drips, and more. I see more variation with rehab due to the acuity. With peds LTC I have seen a few patients go critical but I've seen it more in the rehab. Also, in our area from what I've noticed is the people who work in peds LTC seem to go to the Children's Hospitals rather than rehab nurses due to their experiences but then again maybe less nurses who already work with adults want to make that transition over to working with children. Overall they are both different experiences, and both of them will be great experience. Ultimately I don't think you will go wrong with either one that you choose. Maybe way out economic benefits, training, and social environments to make your decision as well. Does the LTC have a lot of turnover? That's one reason I could not stand being at the first peds LTC I was at as an aide, extremely short staffed. Good luck with whichever you choose!

[NotReady4PrimeTime, RN]

Very experienced pediatric managers would know peds LTC is different, but to ensure that your real work experience is accurately reflected you should describe it clearly on your application/resumé. You never know which word or phrase in there catches the manager's eye. People whose careers revolve around children (like me) will know that kids aren't small adults and that pretty much nothing about their care will be the same as care for adults. In my mind, it's easier to go from peds LTC to peds acute care than it is to go the other way.

[tknrosales]

I Went Through A Very similar situation recently, ultimately I chose the job offer that was geared towards my dream job, even though the other position was closer to home and had better benifits. I say chose where your heart belongs. Often oncology nurses tend to stay in oncology, it's as much a calling as peds nursing is. Don't go there just for skills experience, you won't be happy!

[newenglandrn44]

All of you are very kind to take the time to reply! The LTC does have decent turnover. The position I have been offered was to replace a nurse that was midway through orientation and decided it was not for her. Staffing ratios don't seem to be an issue as the nurse manager kept telling me there is no mandatory overtime and they are well staffed. I did get to talk to a "friend of a friend" that used to work there and stayed for years (but said it was because she was at the point in her career nearing retirement that she was happy there), she told me the new grads stay for a year and move on.

The med-surg unit is technically med-surg oncology but is predominantly a typical med surg unit with a few onc beds. A friend of mine from nursing school started orienting on the same unit and has been able to give decent insight.

Peds LTC offers a 3 month orientation. Hospital offers 8 weeks but I have heard the nurse manager sometimes tries to cut it short to get you on the floor sooner.

My my main concern is positioning myself the best way possible for an acute peds position.

[newenglandrn44]

I am not sure if this impacts any of your thoughts, but I should have mentioned before that I worked as a medical assistant for the last year at a Pedi Primary care office and in December started working per-diem as a nurse there. Would that be enough combined with med-surg to land me in peds down the line, or for those that suggested the peds LTC does that make a difference in your thoughts?

[Swellz]

I would think the LTC is more in line with building your skill set and knowledge base. If your concern is future employment in a hospital, I'd think a manager would rather hire someone with the peds LTC in their background than adult oncology experience.

[lorichka6]

I'm biased (b/c I'm a peds RN). Take the peds job :)

[newenglandrn44]

Thank you all so much!