working at a hospital or nursing home?

Daytonite, BSN, RN · Jul 6, 2006

hi, bamagrl! been awhile since you posted, i see! congratulations on completing nursing school! you have an important choice to make. do you have an idea of what kind of nursing you think you would like? let me first tell you that as a nursing home charge nurse (which is what you will probably be) you will have to polish up leadership and supervision skills. i've worked both hospital and nursing home and the nursing home is where i really had to learn those skills. you have to more closely supervise what the nursing assistants are doing in nursing homes as well as keep an observational eye out for the residents you are responsible for. you cannot expect cnas to have to degree of assessment skills that you possess. since nursing homes can utilize lpns just as easily (and cheaper) as charge nurses, you, as an rn, do not come cheap and they will most likely expect to get every drop of your worth out of you. if they have a medicare hall of patients, that is most likely where you will be assigned. it's a very stressful and rigorous group of patients to work. your chances of getting into a supervision or management position quickly are good if you show any skill at leadership. i can't tell you what your daily duties would be. you just have to ask. i've worked in nursing homes where i had 34 patients and ones where i had 50 patients. i've had to primarily pass all the medications and do the treatments for all those patients. it can be hard to do if you are the only one doing it. if there is help in the form of a treatment nurse or a medication aide things might be easier. you learn to organize when you have that much work to do. it is doable. after a few weeks you start to memorize the names of the patients and learn what their little quirks, likes and dislikes are which make a big difference in planning how to get your work done. do not expect any kind of a formal orientation from a nursing home that even comes close to what an acute hospital will offer. you may get only a couple of days where you are paired with another charge nurse and then you will be on your own. there will be other charge nurses that you will be able to ask questions of, but they are doing their own assignments too.

an acute hospital is going to give you a lot more time in orientation. the stress of the acute hospital is different from the nursing home. i would say that you will probably learn a lot more nursing procedures in the acute hospital. you will certainly have to learn about starting and managing ivs, something which you may not see very much in a nursing home. i have always suggested that new grads stay off of telemetry and stepdown units. they have high turnover rates and many hospitals will put new grads on these units in order to keep them staffed--they are looking out for themselves and not you, the new nurse. ideally, my first choice for a new grad would be a post-op surgical floor of some type such as general surgery or orthopedics. second choice would be general medicine. the reason is because these units, particularly surgery, tend to see the same types of patients on a regular basis so new grads have some chance at working where there is a regular routine going on in the unit as they are learning their new jobs. there isn't much of a regular routine with the patients on a telemetry/stepdown unit. nursing homes are pretty much all about regular routines!

now, in one area of the country where i lived, starting out in a nursing home was the kiss of death for any rn who wanted to ultimately work in the acute hospital. the acute hospitals would not hire anyone unless they were new graduates with good recommendations from their instructors or they were experienced nurses with acute hospital experience. i don't know that this isn't going on in the area where you live, but you might want to keep that in the back of your mind. a nursing home will always hire a nurse who comes to them with acute hospital experience. however, the reverse is not true--acute hospitals will not always hire a nurse who comes to them with only nursing home experience. also, if you have any aspirations of going into supervision or management it will be extremely hard in an acute hospital without an bsn these days. acute hospitals will often offer more money in tuition reimbursement, so if you are looking to go back to get a bsn consider this.

before you make any decision to hire on, ask for a salary quote and for a list of the benefits. ask about raises and how often they are given. find out how many holidays and weekends you'll have to work and how they are determined. find out how much you will have to pay toward any medical insurance benefit. find out if they have tuition reimbursement and how much it is.

i started out of nursing school working in a nursing home because of a salary problem that occurred with the acute hospital that originally hired me. it took me 3 years to get another acute hospital nursing job and i did it by a very unusual way, i think. i was lucky. over the years i've worked both kinds of nursing because i like both kinds although they are worlds apart.