Where are all the Acute care jobs??

[J&B-RN, BSN, MSN, RN, APRN, NP]

I just graduated with a dual AGACNP/FNP a few months ago and job hunting has been zero fun!! I did not enjoy family med and want to avoid that area of medicine completely but it seems like those are the only jobs available!! Everywhere that is acute care or hospital based wants 2-5 years of experience. I’ve had a couple interviews only to be lead on and the job ultimately given to “someone with more experience”. I live in Seattle but applying all over WA, OR, ID and northern Nevada. Where are the acute care jobs?? I just don’t want to be in a clinic full time. I wouldn’t mind something that did clinic, hospital rounding, and OR time! Dream job! but alas... I have no experience. Did anyone start out in family med or some other clinic (renal/GI seems to be in demand) and then transition to the hospital after a couple years? How are new grads getting acute care jobs these days??
If I were to start out in the clinics would it Be better to do family med or a speciality (like renal/GI/wound care) If I plan I transitioning to the acute care setting ASAP?
Any other new grads having the same issue?

[KatieMI, BSN, MSN, RN]

The situation depends on local market saturation but, overall, yes, hospital groups more frequently than not want experience. It is understandible as training of a new acute care provider is a big investment for them in terms of time and money and they want to minimize it.

The "dream job" as you describe it, with clinic, acute care and OR time, happens in reality only in narrow specialties such as Ortho or similar near-surgical fields. For the majority of these fields, PAs are frequently preferred over NPs due to their model of training and (State dependent) eligibility for independent practice and prescription privileges. Where I am, in specialties PAs mostly do assist in OR and NPs do clinic, with in house rounds split 50/50.

You can try nation-wide hospitalist groups like Sound physicians or Apogee which (for a whole range of very good reasons) have low attrition rate and therefore hire constantly and more friendly for new grads. These are not "dream jobs" by anyone's definition (they usually pay above the industry range but have brutal 7/7 schedule without PTO, not the best benefits and low level of independence, among other things) but if inpatient experience is only one thing you need, you'll get that. Or, as usual, there are jobs in rural critical access hospitals and private practices which include rounding in acute care and doing something else (office, SNF, hospice, etc) in between. Do that for a year or two and you'll fibd yourself a way more desirable candidate for acute care. Make sure, if you go private, that your "right" to spend X% of your time in acute care written in your contract.

[J&B-RN, BSN, MSN, RN, APRN, NP]

I haven’t tried sound or Apogee yet. I am really trying to avoid that brutal 7 on 7 off schedule. Been there done that as a bedside ICU nurse and it about killed me. I think I’d rather do family med then that schedule again!
I’ll start searching all the critical access hospitals in WA and OR and see what I can come up with. I’m sure I will find something but I think it’s going to take me longer then I anticipated. I was thinking 3-4 months but it’s looking more like 6-8 months by the time I actually start.
It’s just hard to go back to square one. I did this once before as a new grad RN. Had to do a year in a nursing home and a year on med/surg before I got my dream ICU job. Looks like it’s going to be the same process. I just need settle in for the ride.
Thanks for the advice!!