Which job offer to accept

[Dormi93, RN]

I am a new grad who has worked in critical care as a HUC/PCT for the past 4 years while in school. Unfortunately, my unit cannot hire a new grad at this time... so I have interviewed and been offered jobs on two very different units. Background: I am used to working nights and 12 hour shifts and that is my preference.

Job 1: OR circulator. Comes with a 12 week "classroom" and OR floor orientation and then I am on orientation for the rest of the first 6 months. It would be from 11am until 7pm and I would be the last nurse in the OR in the afternoon. Monday thru Friday scheduled with 1 night a week and 1 weekend a month on call req.

Job 2: floor nurse on an ortho/neuro floor that sees everything from hip replacements to seizures, and also takes medical overflows. 12 hour shifts from 7p-7a. They said they are budgeted to be staffed for 22 beds (they are a 35 or 36 bed unit). On nights there is 1 PCT and no PCTs on Sunday, I was told I would be expected to have usually about 6 patients. The orientation is similar with 10 weeks in the classroom and on the floor, and then I am only orienting on the floor for the rest of the first 12 weeks.

My long term goal is to work in critical care again (I have applied to 7 hospitals and been turned down to their ICUs) and one day possibly go for my AGNP.

Moneywise for both jobs I'd make more per hour on the floor due to night dif. But I'd probably make more money from on call in the OR (I have a friend in the OR and they get called in very often).

Which job would you choose (given that I prefer nights and 12 hour shifts strongly and don't mind working weekends or holidays).

[JKL33]

They said they are budgeted to be staffed for 22 beds (they are a 35 or 36 bed unit). On nights there is 1 PCT and no PCTs on Sunday, I was told I would be expected to have usually about 6 patients.

Well, the ortho floor would be excellent for building your general knowledge base. But there is obvious potential for it being downright brutal at night in this scenario you pose. That they said they are budgeted to staff 22 beds was a bit of a clever statement. In your four years working in the hospital, you may have heard that the money people despise open beds, and that nurses being "maxed out" is a ludicrous excuse for not filling beds - not acceptable at all. Secondly, 1 PCT for 22+ patients on an ortho floor (or practically any acute care floor) will make you cry real tears and come here to write about how you're second-guessing your decision to become a nurse.

So my advice is that you need more information about this ortho staffing.

Congrats on your two offers!

[Floatnurse137]

I think that OR might pigeonhole u but I could be wrong. I prob would do the floor and keep applying for ICU jobs. Congrats

[DowntheRiver]

OR is it's own speciality so to go with that job and have no intention of staying in that specialty is not what I would recommend. That is a lot of training just to most likely abandon that job after a year or two.

Neuro/Ortho would be ideal. Why on earth is there no PCT on Sunday?

[Dormi93, RN]

It's somewhat understandable, "Ortho Days" or planned ortho cases are Monday's and Wednesday's so they plan on having the unit mostly emptied out to prepare for the admissions on Monday. The unit manager I interviewed with stated that usually it's pretty dead Sunday night.

[SC_RNDude]

The ortho unit you described sounds like a nightmare.

[Dormi93, RN]

Yeah, it sounding like a very rough unit is the only thing holding me back. I don't mind being busy, but I don't want to be so busy I can't learn or be safe.

[amcnamara01]

One PCT for 22 patients most definitely unsafe, day or night shift. I came from an ICU that staffed the same way this ortho unit tries to staff. All on the premise that "we'll never actually be full, so we won't staff enough nurses like we're going to be full". And guess what? Our unit was full EVERY DAY FOR 2 YEARS.

I don't want to make assumptions about this hospital, because I'd like to think managers don't think like this. But it sounds like they may be taking advantage of your inexperience by painting the census as "not so bad."

[RNNPICU, BSN, RN]

No PCT on SUnday??? It sounds like the unit is likely understaffed, and that 6 patient load appears that it will likely be 8, also it sounds like there would not be much help on nights. Imagine this, it may take 15 minutes for just the assessment, introduction, etc. (not including meds or tuning or any other interruption. 15 X 8 = 2 hours. Now add in dressing changes, turning, meds, feeds, etc. . I would be leary. The OR job sounds really interesting, you would learn so much about procedures, processess, etc. I think working in an OR would help you more with a ICU goal as many of the post op sick patients go to the ICU.

[blackmamba123]

Hi and congratulations! Ok, I'm one of those who believes in people doing what they love. If you're not hard pressed for money and not looking to just get your foot in the door, I'd keep looking. Did the 7 ICU's that turned you down give you a reason? Just curious. OR is so different and so far from the shift you want to do. That ortho unit sounds like a mess. Have you considered IMCU? A step-down/tele unit would be helpful. Any unit called progressive care unit, tele unit, intermediate care unit or transitional care unit are all step down units. It's closest to what you want to do, you'd learn a lot, and after a year of experience you'd be a shoe-in for ICU.

[Dormi93, RN]

Did the 7 ICU's that turned you down give you a reason? Just curious. OR is so different and so far from the shift you want to do. That ortho unit sounds like a mess. Have you considered IMCU? A step-down/tele unit would be helpful. Any unit called progressive care unit, tele unit, intermediate care unit or transitional care unit are all step down units. It's closest to what you want to do, you'd learn a lot, and after a year of experience you'd be a shoe-in for ICU.

I wasn't given a reason besides the normal automatic turned down email, "thank you for your submission... sadly we are not pursuing you for employment.... best wishes..."

I'm not super pressed for money, but I don't think I could not work for very long, and I can't travel very far (about an hour to 1.5 hour commute time max since my SO lives with me and is still in school nearby). So idk if there are even any ICUs left.

I have also also applied to a few IMCU and other step down units but I haven't heard anything back either way.

[nocturnallife, ASN, RN]

I work in the OR as a Circulator. I would recommend getting experienced on the floor if ICU is your goal. If you don't care about relocating then I would suggest relocating somewhere for a year that will hire you in the ICU. I relocated after graduation to get experience and now that I'm back home I have several job offers!