Which is a better learning experience for RN position?

[ErinDel]

Hi Everyone..

So i have been a nurse almost a year. I have been doing substitute school nursing which i like but it is not steady work. I have an opportunity for a part time position.

The first job is an Assisted living job two days a week working as a nurse care supervisor on a memory care floor with 19 patients. I will be giving meds and supervising the cnas with their duties. It is Sunday and Monday 7-2. it is two days of training then i am on my own. When i get used to the residents i will eventually have to take call over night as needed..

The second job is a group home experience as RN working two days a week total 10 hours per week. I would be in charge of Med administration and MAP training. I do not know what MAP is yet.. I would be the only RN there along with a case manager and day assistants to help with the young moms. There is 8 girls in the home, some are pregnant and others have babies already.

The first job is 26/hr at 14 hr per week, and the second is 35/hr at 10 hr per week. I am not sure which would be the better position to take. I do not have experience with either job.. I do plan to stay on as a sub nurse because i really like that.

Does anyone have any experience with either job situation, or any thoughts on which to take? I am stuck with what to do.. Both jobs do not have anymore hours to offer anytime soon. I do feel more in tune with the teen moms but there will be another nurse on duty at the assisted living facility. I wish i was offered more training because after two days i will be on my own at the ALF.

Thanks for listening and hope to hear some opinions.. i appreciate it:)

[Lev, MSN, RN, NP]

You know what...even if you take the assisted living position, you will still have experience with kids because of your substitute work...so if you want to get in to acute care, go for the assisted living job..can you take BOTH jobs and do school nursing 1 day a week? If pay is not a concern, doing overnight call is the only thing I wouldn't like with the assisted living job. What's involved with this call situation? Would you have to go in to work or just be available by phone?

[CiaMia, BSN, MSN, DNP, RN, APRN, NP]

I can answer about MAP training! I've been MAP certified since 2008. Basically it's a very - VERY - rudimentary training here in MA for staff members at state-funded residential programs/day programs (mostly serving folks who have developmental diagnoses or brain injuries, lots who come from the old institutions) to be able to administer PO/topical/optic/otic meds. It used to be run through the ARC.

There is a full 2-day training as far as I remember, run by an RN, then you take a competency multiple-choice quiz. You complete a transcription exercise ("You accompany Ann Annson to their provider at 1pm on 1/1/1990 and return to the program with a new prescription for FixItAll 500mg twice daily. The provider has discontinued DisNoWork 300mg once daily. It is now 4pm. Update the medication record to reflect the updated orders") where you add a new order to the med sheet and do the d/c.

THEN you sit 1:1 with the RN and administer tic-tacs to them (haha). You have to talk through your 5 rights, do 3 checks (HCP order to pharmacy label to med book; pharmacy label to med book - prep meds - pharmacy label to med book - administer med - some examining RNs want you to do a post-admin final check) and verbalize monitoring.

Having said all that, many of the people I used to work with (I was a program manager before nursing school) did NOT have English as their first language. Nigerian or Haitian Creole. There is no critical thinking and you don't necessarily have any idea what you're giving or what to be looking out for. I could tell MAP horror stories of walking onto a shift to find meds not refilled, random pills under the kitchen table, the list goes on..!

There is always a MAP consultant on-call (an RN) so that staff can reach a licensed provider. They have to call if they have questions about things like blanks the med book, meds not available, being outside the 1-hr window, etc. etc. MAP is kind of its own beast in terms of documentation and order requirements; some providers were REALLY good about writing orders in exactly the way we needed it so the pharmacy label was identical, but some didn't get it.

Hope that helps a bit!! PM me for more if you want!

[CiaMia, BSN, MSN, DNP, RN, APRN, NP]

Medication Administration Program (MAP) here's a link if you're interested!! I guess as the RN you would be training/examining the staff, overseeing the med books/HCP orders etc and maybe in the MAP-consultant on-call role?

[BSN-to-MSN, ADN, BSN, RN]

I had a similar situation after getting RN license. I worked as an LPN in the assisted living for a year, and after getting the RN degree, they would not increase my pay, so I had to go look for a new job... You're right, hospitals don't want a new ADN with no experience. I went to work at the nursing home full time while getting the BSN...

My advice would be, don't accept any position where you're the only nurse there ( if you need advice, who is there to consult?), or if you are supposed to be in charge of LPNs, or any kind of "supervisor". Get a job that has you providing direct patient care, not a nursing coordinator. New grads need experience, and buried in documents and papers is not it.

[BrandonLPN, LPN]

I know 'nursing home' can be a dirty word for a new grad RN, but if you're seeking a job that offers learning opportunities..... and hospitals aren't an option..... then skilled nursing facilities are likely your best bet. You'd likely be surprised at what you'll have the opportunity to learn as an RN in a nursing home. The vast majority of nursing homes these days have beds devoted solely to subacute and/or rehab patients who require close monitoring, complex treatments, careful discharge planning, lots of education, etc., etc.

No, no nursing home will provide the comprehensive experience that an acute med/surg unit would, but you'll get a far more "well rounded" experience in a skilled nursing home then you will in an assisted living facility or an adult group home. Being an RN in *those* settings is more exclusively an administrative or management sort of position. Great positions, but probably better suited to nurses who already have solid bedside experience.

And most nursing homes are happy to hire and train new grad RNs, and being ADN vs BSN is a non-issue in LTC.

And, before I come off as a LTC apologist, I will admit that some of the things you hear about nursing homes are true. They have far fewer resources (in every sense of the word) than hospitals. They are more likely to run short staffed. They are very, very task oriented. Many (not all, but many) have huge morale issues. There can be a stigma associated with being a LTC nurse.(but, to be fair, all bedside nursing positions that aren't acute care are looked down upon to some extent)

In spite of all that, I think LTC can be an excellent alternative for nurses who cannot find a job in the much tighter hospital job market.

[ErinDel, ASN, BSN, RN]

Hi lev, yes i could potentially take both jobs if i wanted. The call situation was not really explained well...it was said one week out of the month you take call from 10p to 7a. Specific duties were not said about it. So i called back and asked more about taking call and was told it would not be a requirement right now until i feel comfortable knowing the residents and i would want to take on the responsibility of taking call. I felt like the DON just tip toed around my question about it. I kind of feel that this facility needs a nurse stat to fill this position so she is willing to take anyone to fill it. I feel two days of training is not enough either and that i will be just thrown in to figure it out on my own. Im just stressed right now trying to figure this all out..

[ErinDel, ASN, BSN, RN]

Hi ciamia, thanks for the info! MAP training was not explained to me very well..i stil am confused with the duties of my role with it. I asked more about it and the woman i interviewed with said she is not familiar with it and i would have to figure it out on my own. I did not like that as i am not familiar with it. I felt like again i would be thrown into this role to figure things out for myself.. does the RN need to be MAP certified in order to work in the residential home?

[ErinDel, ASN, BSN, RN]

Thank you helen09 you are absolutely correct. I feel like i am running out of time finding the right job though...i have been a nurse for 10 months and nothing major has come along. I do not want to be inundated with tasks i cannot handle either, or my license on the line. I would honestly just stick to sub school nursing but it is not enough hours..i am lucky if i get called twice a month to work..

Thanks brandonlpn for your thoughts.. you are right about nursing homes. I did apply to a couple nursing homes and i was hired, but my offers were rescinded due to my back issue and m restriction to not being able to lift over 50 pounds on my own. So i am kind of stuck and limited to what positions i can take. I am still young and i cannot lift heavy things on my own. My goal was always acute care, but i realize that is a far fetched dream due to my limitations.

[kfynn589]

I work in Mass and understand you having a difficult time. Great news is you will be starting a BSN program in September. I do not know where in Mass you live, but I am very familiar (grew up and now work there from NH). I know that the smaller hospitals like Winchester and Melrose-Wakefield will hire ADN nursing who are enrolled in BSN programs. If you apply and do not hear back I HIGHLY recommend you finding the DON's email and contacting them that way or by phone. I work with a nurse who couldn't get a job when moving to Mass and so she emailed the DON her resume and stated how she applied to the hospital x amount of times and couldn't get an interview - the DON called her for a phone interview and she was hired!! Make sure you mention your BSN enrollment. I truly recommend this... if you do it please let me know how it works out for you!!!

[ErinDel, ASN, BSN, RN]

Thank you kfynn589 for the tip! I should try that.. i used to work at melrose Wakefield hospital. Right now i live on the northshore in MA. It may be hard getting that info though but maybe i could mail my resume and direct it to the DON.. it is great that it worked out for that person, they got lucky. Both hospitals are great to work for i hear. Thanks again!

[kfynn589]

If you can't get into a hospital look into working for a Kindred facility. My friend had worked there and she said it was an amazing experience. Not like a typical long term care, its sounds like it is a subacute, they have vented patients and stuff like that.. I think they give blood and all that jazz. You would learn a ton.. especially where you want to do OR or ICU.

[ErinDel, ASN, BSN, RN]

Thanks kfynn for all your help!