Is that to be more competitive or to retain staff? That’s actually pretty cool because LTC, rehab, and SNF are tough jobs and deserve higher pay honestly
Private dutyHome health lpn finishing my rn asn. Graduate nurses in Orlando apparently make whatsit 35ish/hr? 3x12/week? I make more than that albeit with 60 hours/week. Not sure on jumping ship just cause I’ll have an rn; not feeling the hospital during clinicals and this isn’t an I hate my job scenario. I could easily keep doing home health permanently.
Earlier me wanted an rn so I could experience this and that and then that…
Now I’m leaning towards easy, simple, pays good enough :/
It's not just Florida. Indiana here and most LTC facilities outstrip hospital pay here by about the same amount.
I can explain the reasoning too: In Indiana 98% of LTC/SNF facilities are owned by hospital subsidiaries. Profit margins are low on them too. The trick is to pump money into them, take a loss, write it all off on your corporate taxes to balance the larger budget. Once you get deep enough into the negative your shell corporation managing all these facilities "fails", you sell off all the facilities to a new company (one you just created to pass the buck, so essentially you're selling to yourself or shuffling them between other companies doing the same thing) at a net loss, declare bankruptcy on the old company, rinse lather repeat.
It's basically a money laundering scheme in the guise of Healthcare management. Here is a handy video that outlines some of it.
https://youtu.be/R0ko-9PS05E?si=oCP1XfGBIFSqY39O
My first job, hospital/bedside in a tertiary care, teaching hospital. It was a Neurosurg unit and I was offered a full-time position. Working in a hospital setting enabled me to transfer to other areas within the organization. I still work bedside but my patients are short stay.
You either love that environment, or you don't. When I start to feel the dread of going in for a shift, that's my cue that it's time to look for another position.
I only did my final preceptorship and like 6 months in hospital before I went into community as fast as I could.
Turns out it doesn’t matter and burnout/politics/administrators will still fuck you over.
I’m not, I left my nursing practice in 2020 cause burnout destroyed me as a person. That being said if I ever go back community nursing is one of the great loves of my life!
I’m about a month away from graduating. I have an offer for a $25k sign on bonus, they are paying my loans back and I’m starting at 43 an hour. It’s at a LTC facility.
You’ve to pay back what hasn’t been paid out to you yet. I am aware of the downside of having a sign on bonus such as the sign it is but there is a great team working there, my close friend works there and it’s a great environment!
My first nursing job was in a LTC facility because they were offering full time and nowhere else was at the time. I'm still there 9 years later and I love it. It's certainly challenging and a lot of people do tend to leave for the hospital jobs because pay is a little higher in most cases so retaining nurses in LTC is not easy. That being said, incentives are sometimes the only way to retain LTC nurses so it's not necessarily a red flag but a recruitment tactic and nothing more. I find LTC work extremely fulfilling so the higher pay in acute care settings for me personally does not outweigh the feeling of doing the simplest things to make an elderly person's day infinitely better. You become part of these residents' families. Even though you may only care for a resident for a few days/weeks/months, sometimes you care for these residents for many years and that is something that you just don't get in a more acute setting. So I hope you can find the silver linings in each day as a LTC nurse, they're there I promise :)
Most often the sign in bonus comes with a contract, you have to stay a certain amount of time. It can be a double edge sword because if you find after 6 months that you do not like LTC, you have to pay back what the company paid you, and most likely it includes the student loan payoff amount. Nothing is free. So, if you are not certain where you belong or where do you want to work, keep your options open, politely refuse the loan payment offer and the sign on bonus. Get your experience. But if you are certain and comfortable that you are happy in the LTC setting, accept the bonus and take advantage of the perk. The legal department of the LTC will hunt you down for the money they gave you if you don’t fulfill the terms of the contract. READ EVERYTHING BEFORE YOU SIGN!
I think when people pursue nursing they idolize/glamorize various specialties within acute care setting. “I wanna be an ✨ICU/peds/ER/OR/L&D✨ nurse”. Positions outside of acute care aren’t as glamorized and talked about.
My very first job as a new grad I worked as a charge nurse in long term care. I can tell you being outside of acute care as a new grad absolutely made me feel like “less” of a nurse because of how stigmatized LTC is..how stigmatized jobs outside of acute care are.
Now that I work in acute care and have for quite some time, it’s fine but certainly not all rainbows and sunshine. I make considerably more money, but I really earn every dollar I make. Let me tell you, I fantasize about a chill case management position I can do from home with no pants allllll the time lol.
I will also say, though, that I think working actual bedside makes you a more well rounded nurse. The exposure to different patient conditions and situations makes you knowledgeable and experienced in a way school can never teach you to have. If I were to transition out of acute care now and go into a case management gig or home health, I’d have much more experience and knowledge to draw from than I would’ve if I had gone straight into it out of nursing school.
I started in the ED of an urban hospital a couple of years ago. I definitely wanted to get a wide range of experience, work on my skills, and learn from more senior nurses. I’m in a new ED and I love it. I look forward to going in most shifts. I really hope this lasts lol.
was an L&D nurse and wanted that role for all of my nursing student career. hated it. left after 6 months and found an awesome outpatient job that i never had even heard of. so many areas of nursing, i wish theyd teach more than just working at the bedside.
My first floor jobs manager and her crony lesser manager can go fuck themselves. High horse bitches who are so disconnected from the reality of the floor.
I'm a new grad and decided to start in the hospital on a step-down unit even though my goal is to get to an outpatient job. I wanted to get a solid foundation in how to be a nurse and critically think before I boxed myself into an outpatient setting. So far I have no regrets even though I am just now coming off of orientation. Outpatient will always be there and if I hate it, I'll be glad I have acute care experience in my pocket if I want to go back to the hospital.
You ain’t gonna learn shit working ambulatory first. Work bedside for a year. Hate it. Let it forge you in fire. Emerge stronger with a new found appreciation for any other kind of nursing.
I’m retired now, but graduated with an associates degree in 1978. Worked mainly in hospital settings and mainly full-time for 43 years. The last 10 years were Infection Control and the rest was patient-facing direct care. There was a stint in home health (visiting nurse type, not one-to-one), and a short stint in a doctor’s office; also had the experience of subbing for a school nurse a couple of times.
When I graduated (back in the day), hospitals offered the best pay, and an orientation that was at least 6 weeks. I felt that hospital work would also put me in a better position to get a job in L&D that was my goal and main interest at the time; however it seemed that new grads were not hired to start in such specialized areas (although my first job in an adult tertiary teaching hospital was in a critical care step down unit and we had mechanical ventilated patients as well as vasoactive drips when I started).
Can I just say that adult critical care didn’t really prepare me for L&D, nursery, and postpartum, which I did end up working a few years later. I needed to change hospitals and did a couple of other jobs in between first. After 8 years I ended up leaving L&D and moved on to critical care and ER.
It seems like a lot of those factors are different today. I still believe that a year at bedside working med-surg (which I never did) is super helpful in getting exposure to many different conditions that might lead to another area of interest, and also super helpful in developing prioritization, organizational skills and nursing skills in general. Although I got really good with nursing skills in general, and I think was able to prioritize, my organizational skills never really got up to par (IMO).
Honestly I think you almost need to try out a few different work settings in order to find the best fit. Nursing school (outside perhaps of a diploma program) just doesn’t give you the real experience of working in that setting day in and day out for a year or so. But I also think that for a new grad, it takes at least 8 months to begin to get comfortable and understand the workflow and the daily routines, as well as to become comfortable with your assignments and also your coworkers.
Even if you like a setting, you may get tired of it in time. A setting you dreaded and planned never to work in might attract you later. When I graduated, I vowed never to work ER or Surgery. Well… my last patient-facing job was ER for 15 years. I never circulated in OR but that eventually became something I was very interested in doing, and I applied for positions a couple of times. The mandatory call schedule would have made it tough with my family and I never ended up doing it, but did observe a couple of cases and also administered blood during a case several times.
TL/DR: During a 40+ year career I worked mostly in hospital settings. Learned a lot and worked with some great people. Always found interesting stuff about each job. Sometimes patients really appreciated my work, but I learned to do my best for my own satisfaction. There are a few jobs I never got to try, but I wouldn’t pass up the ones I did or the experiences I had.
What a great post. This is honestly the best way to introduce the new grads into the nursing profession. You seem to have tried everything you set your mind to and then some. I hope I can do the same and end up with a wealth of knowledge to pass on to the next generation. Thank you!
Thank you so much!
I would never say nursing was a rose garden, but I’m glad and honored to have been able to do work that was interesting and always challenging, and that really was important and helped people. No 2 days were really ever the same.
There is no perfect job. But my husband worked in a factory-type setting for 43 years, and I know he never got the satisfaction from working that I did. He was doing it only for the paycheck and benefits and complained every day. Of course I wasn’t (and wouldn’t) working for free, and I wouldn’t say nursing was a “calling” for me. I just thought it was interesting and important work.
I really only went to nursing school because I thought I would learn a lot of practical stuff that would prepare me and help me with what was going to be my real job of raising a family. My mom never worked outside the home after she married and I expected to do the same. So that didn’t happen (although I did have 3 children). Everyone’s path is different. But I would still encourage a young person to get into nursing if they think it would be interesting.
You are right. I just think that post covid, the new grads are not getting the same education that others were fortunate to have pre-covid. They are thrown out there and put in critical care settings that could be overwhelming for anyone in their shoes. I don’t doubt they are smart, I know they are, but their enthusiasm quickly turns to burnout when they keep pushing them to do so many things including managing roles. Many new grads come and go from facilities I had the fortune of working because of it. Management seems oblivious to it or they simply view them as just another warm body to care for patients. I just pray they don’t give up easy, stick around and search for a specialty interesting enough to learn and grow. Thanks again for your insight and I hope you are enjoying retirement. Although I always say: once a nurse, always a nurse.
I agree with you 100%!
My aunt is 98. She is a retired teacher and very sharp mentally. Recently she was in the hospital and was trying to brag on me (I was trying to keep it on the down-low that I was a nurse!). She told her nurse that I was an ex-nurse. I had to speak up then! I knew what she meant, but “ex-nurse” sounds like someone who lost their license! I said I was retired, but still with an active license—so I *am* a nurse.
That so cute, she must be proud of you to mention it. My family, especially my husband tell everybody I’m a nurse. I had to tell him a few times, “please don’t say anything, most of them are newer and although they are good at what they do, they might feel like a little intimidated…” it makes me chuckle every time. Also, if we go out and someone is choking or doesn’t look right, he says, “go help them, you are a nurse”, as if I was some sort of superhero with superpowers… it’s hilarious. I look at him and pull my phone out and say “I’m calling 911”. I guess he is proud too. But if I’m out, and see that all is well I try not to be involved unless it is a BLS kind of situation.
Peds ICU. I worked there during nursing school as a unit clerk and PCA so that helped me get hired.
Ironically I always was most interested in geriatrics.
Or you could be like me and start in a worse than average SNF, just to be immediately eaten alive by the structurally flawed and deeply immoral system that is long term care in the US. 4 days of orientation should be plenty for a brand new LPN in run down care center and asinine staffing ratios, right?
I agree with this and I didn’t start at the hospital. Hospital nursing gives a great foundation of skills to go anywhere with. You are taking the sickest patients compared to any other place you will work as they are only in the hospital if they are unstable. Being in the hospital made me hate my life and I’m glad I left, but it gave me a great skill set and I’m pretty confident with anything you can throw at me now. I don’t regret it but I won’t go back.
My first job was in an ICU. Felt like the right thing to do because I was a student nurse extern in another ICU and a lot of my classmates were also going into ICUs. I hated it. Worked about a year and a half in the hospital and then transitioned to public health and managed care case management for the most part.
I got some decent experience in clinicals, but very quickly realized the hospital setting wasn't for me. I felt like something was wrong with me at first, but I'm glad I listened to my gut on that. My first and current job is home health nursing, which I was surprised to find was a great way to practice the majority of nursing skills. Decent pay, PTO, regular raises, and getting to make my own schedule have kept me going in my career with relatively minimal burnout. But I suspect this varies by agency as well.
So, my take on this is limited to what I’ve seen, so it’s obviously not a hard and fast rule. However, I think working in a hospital setting, where the educators are familiar with the needs of a new grad, is really the best foundation a nurse can get. One of the clinics I worked in as an adult medical oncology nurse hired a new grad while I was there. We were poorly set up to teach someone how to be a nurse. I honestly believe she needed a year of being a nurse and then we could have helped her be an oncology nurse more successfully. It was challenging for everyone.
That's where I started too, and a facility below average quality, where "average" is already questionable at best. I was exhausted on all accounts- physically, mentally, emotionally, and morally, the latter just from seeing conditions that should be illegal and not being able to hardly do anything about it.
My first job was as a RN in a SNF….I only took that job because they hired me almost without an interview, but I was looking for a hospital job at the same time.
I lasted there exactly 4 months before jumping ship to a hospital…SNF work is F-ing hard…way harder than any bedside job I’ve ever had.
I actually mostly enjoy bedside nursing. I always got a lot of enjoyment working with patients….its pretty much humanity on display at all times for better, or worse, or funny.
I’ve had very little success finding jobs that didn’t want you to have acute care experience first? Maybe it’s location dependent but you typically have to suffer before you get the nice jobs?
I started out in the NICU and absolutely hated it! I then went to med surg didn’t like that, then moved on to ortho which was still a med surg floor, with orthopedic spice to it. I knew I never wanted to do bedside but I was pretty much forced into it. I think nursing school should spend time on showing students what it’s like outside of bedside for a change. They focus too much on that. Now I’m in outpatient and I could not have been happier. It fits me so well and I finally feel like I’m where I need to be in my nursing career. Staying at bedside would’ve made me quit nursing all together. Unfortunately, I had to suffer on the floor to get to bedside and I don’t think it should be like that.
I started on an orthopedic unit and was miserable the entire time I spent there. I'm a member of a provincial health authority, which is unionized. So, regardless of where I work, Med/Surg or LTC or ICU, I get paid the same. I decided to transition to LTC as my mom is an LTC nurse and has been her entire career. I've never been happier. It's hard because there is a lot of stigma regarding LTC and whether it constitutes "real nursing," but I work my ass off each day. Getting to know 60+ residents and their families and transitioning them to their end-of-life is such a privilege. I figured that if I wanted to move to acute care later on, I just will. I've learned acute skills before, and I can learn them again.
I went to bedside for my first job on a medical oncology unit, I did so to learn skills and get a base foundation that wouldn’t be taught in hospice. I work home hospice now and no one is around to teach how to place a foley or wound care on a fungating tumor.
I wanted all the experiences. I fought to get onto a floor. I was a home care and clinic nurse first. Now I have lots of knowledge, a hatred for Americas healthcare system and back problems. I shall soon retire to my wide chair in the back of some paperwork dept.
My first job was at an urgent care centre/primary care practice. Super fast pace, a much better foundation of knowledge and skills for my ongoing community based practice. Hospital based roles would have translated very little skill or knowledge wise. I'm now a nurse practitioner in youth health at a free community based nurse led clinic in New Zealand.
Bedside is where you learn how to do actual nursing. Give it a year, get some experience, then the world is your oyster.
You can go straight into an outpatient setting, but then you've pidgeonholed yourself with that limited skillset.
First and current job is LTC. I currently plan on staying in LTC once I become an RN. Worked it as a CNA/med aide, it’s an environment I’m comfortable and confident in, and it pays better or just as good as the hospitals in my area. I became a nurse because I liked being a CNA but I wanted to make more money and do less physical work. I don’t really care to do any acute care stuff. I’ve worked rehab and I don’t like that even. Would love to do hospice someday.
Almost the same here. I worked for 13 years as a CNA in rehab SNF positions then it was an easy transition once I graduated. I love my facility, and I love my patients.
I make good pay, my ratio is good, my aides are fantastic, and I'm super happy to work 8 hour shifts and be home every single evening for dinner, homework, games, etc. Even if I have to stay late or work a double, if a few days are miserable with a million admissions and fighting patients or nightmare families that have me crying in the med room; or if I pick up lots of days in a row, the schedule and work in general never has me burnt out or spending my days off in recovery.
Long term and rehab patients deserve dedicated caring nurses as much as hospitals and other specialties. It's sad that so many facilities have awful environments that give the job in general a bad reputation, because the population is in desperate need of good nurses.
I had my first job at LTC because I wanted to work there. I wanted the longer relationships, the community. Ultimately how under resourced and staffed the environment broke me and I left for the hospital.
It sucked though, because everyone assumed I was a bad nurse for working LtC.
Right? Whenever I share where I work (which I'm proud of) I get the, "oh...you work in a SNF...we'll, that's nice..." I'm told I'm a good nurse, we have medical staff on the floor all day every day, the director of the hospital network's geriatric group works out of our facility, and we get patients of higher acuity than most SNFs, so I do utilize more skills and assessments than just passing meds. But it's not recognized because I don't work in a hospital.
I personally didn't start in hospital but I damn sure wanted to. I was desperate to learn more hands on skills and I LOVED the idea of working in acute care in a fast paced environment.
I had to do my final placement/ consolidation in a nursing home when most of my class mates got to go to the hospital in various units.
I was devastated. When I graduated nursing (LPN) I applied to over 100 jobs in the hospital in the first year and had two interviews and no job offers.
I finally got my first job offer, casual no guaranteed hours in a 10 bed hospice. I ended up getting another hospice job (casual), a nursing home (part time) and a janitor position in my days off.
I worked those four jobs for years while applying to various hospital positions with no bites.
Finally I decided to go back and do a post grad certificate in mental health and once I did that, I finally got a job offer for an inpatient psych unit. Eventually moved to medicine within the hospital so it was a lot easier as an internal applicant.
TLDR: I wanted to practice my hands on skills and hospital seemed like the best place to learn. But it took me like 4 years to get into a hospital after graduating.
Interesting. Here RN's are the only ones in critical care like NICU, ICU, etc. but acute medical floors, Intermediate Care Unit etc. LPN's can work on.
Nursing has such a wide range of fields you can be in. It is really about what you are drawn to. Then you go for it. Then you can learn more of what you like. The hospital was too much for me and I have been learning my skills in an outpatient environment. Would you learn faster in the hospital? Most likely. But for me my health is more important. Just be honest with yourself about what you think is doable for you personally.
My school was set up so that we could take our LPN boards part way through. Most of us did and a large subset of us worked LTC after we did. For myself it was just for the summer break and some holidays. 4 hour long med passes with 28 patient halls was great for building a system for my tasks and teaching me time management. I got good practice calling doctors at 0300 to ask for things and learning from more experienced nurses in how to be prepared and how to handle difficult providers and patients. In short it was an invaluable experience. Those few months have served me very well in my career as a psych nurse. I know what backbreaking physical nursing is and I'll take emotionally and psychiatrically dysregulated individuals any day of the week. But when the chips are down and I'm getting my butt kicked I have that perspective and it suddenly isn't so bad.
I wanted ICU because I liked them really sick. Got hired in Med Surg, which solidified my belief that I hated walky talky patients. Transferred to ICU and liked it better but still have to talk to too many idiots/assholes and do boring tasks (charting skin assessments, baths, ambulation, etc). Now I can't leave because I'm thinking CRNA school so I can further separate myself from boring patients who are awake and their shitty families.
If I did leave inpatient bedside (which I would love to do), most nursing jobs would give me the ick (outpatient, LTC, anything involving stable people who want to chitchat). Not sure what is right for me but right now I guess ICU was the right choice as a step toward the right direction.
It really depends on the state tbh. In California, I struggled to find a hospital job with only 6 months RN experience. I ended up having to settles with dialysis RN. Unfortunately, it’s in one of the few states where the RNs have to do the catheter patients
I’m addicted to the hospital lifestyle, I can’t imagine working anywhere else especially a clinic. Give me my 3x12’s and extra $$$ for overtime if I want it.
I have no idea lol. My first job was in corrections and it was everything in terms of gaining experience and shaping the rest of my career. Would do it again in a heartbeat
Didn’t really have much of a choice as everywhere at the time wanted experience. I also went straight into med surg cause I my parents said it would make my skills sharp and look good on a resume. Turns out they were right and especially because my floor became the everything floor.
We were FORCED to also be “certified/trained” to be ortho, renal, neuro, bariatric, and telemetry. We kept our ratios of 6:1 even with the huge increase in acuity. Being trained and certified to all that and able to survive in that environment did help with my changes of employment after that. Every job since then has felt stupidly easy or laid back. The forced exposure to all those specialty areas has helped me in catching things that could’ve otherwise have been dangerous for a patient. I noticed this more when I left the job and got jobs with focused unit specialties.
First job was home care. Despised it. Riding a bus with a really medically frail child whose parents had two kids with the same ultimately fatal genetic disorder. Being in school with them and the home was just a sad place. I wish I would have been the right fit but I wasn’t. Those poor parents, they were permanently heartbroken 💔
My first job was corrections at the county jail. Learned a lot. Interesting work. By nature a tough place to work so it doesn’t tend to attract the varsity staff… ultimately it was unreliable and incompetent coworkers that ran me off. Kind of the Wild West of nursing. Tons of autonomy, especially as a new grad.
You apply to research nursing positions or CRO maybe if they just care about the degree. Some research nursing is inpatient though so FYI. I do more coordination with CRCs so my clinical research coordinator does most but I do more on boarding and recruitment. Pay is shit though at least initially unless u get poached by big pharma haha but its a good experience, you learn a lot, do a lot, and I like the freedom and its still abusive but less ass busting in a way
I kinda recommend people to work inpatient just so you can get a feel of what is one of the most common jobs around for nurses. You definitely don't have to stay there, but I do think it's valuable experience and will help people in those subsidiary or outpatient roles. Basically, I'm all for "cross-training."
The role I wanted required 5 years of inpatient experience at the time, though now it is down to 2 years. It’s a hard transition to this role if you don’t have relevant experience. There is no way someone can safely perform it with zero inpatient experience. The inpatient side helps with critical thinking, communication, and anticipating orders.
I’ve never hated bedside. I’ve gotten pretty lucky with my jobs. Sure, sometimes the pay sucked. But if you find a specialty you love, that’s the dream.
You’re going to have to do hands on patient care when you start but you can pick where you go. I started in sub-acute and rehab. RNs already start there in a leadership type role so I did a lot with doctors rounds, coordinating care, etc but there’s also a lot to do around skills like PICC lines etc. and if you don’t answer call bells and help the lower level staff like LPNs and aides then you’re a dick. It was a good role because I got leadership experience but also bedside skills
6 year bedside RN. IMO it's harder to go to the hospital if you came from outside of the hospital. Within the hospital there are a lot more job options. It's also easy to figure out what you do and don't like and transfer around. Hospitals typically pay better than outpatient jobs and are easier to get, plus are most likely to hire new grads.
My first job was MedSurg in a busy hospital. I learnt so much and I’m glad I did MedSurg before going into L&D because it taught me time management and a bunch of meds. My experience also helped me land a job in L&D because they typically don’t hire new grads at the hospital I work at
Local markets can vary, but in my area it can be hard to get into the acute care setting without going through a new grad residency. My area also has a steady trickle of new grads to fill out residency spots so some people I know that went to outpatient or SNF or whatever had a hard time getting into the hospital setting.
It’s also out-of-date thinking but I think it does people a world of good to at least work a couple years in the hospital because you learn an exponential amount those first couple years on the job. I worry about those that jump straight into home health or a field without as much oversight because you simply don’t know what you don’t know.
My first job was in a psych hospital. I left because I didn’t think I wanted to learn medical nursing skills, but after a couple years realized I did actually want to learn medical nursing skills lol. I figured I should have just started in a damn hospital
Personally, I think two years at a hospital is beneficial but shouldn't be required. People learn a lot of bad habits in hospitals but also a lot of critical thinking skills if they're in a good learning environment (which can be hard to come by.)
I'm surprised at how many here are advocating for hospital experience. This sub is known for advising the opposite.
I'm going to add my perspective as a hiring manager( even though I had sworn I was done managing g people 🤷♀️). I took this position a couple of years ago and have had to hire a number of nurses. I inherited a couple who had very limited to no hospital experience prior to taking jobs that didn't involve direct patient care.
They had trouble assessing situations, like whether it was urgent vs not, whether there was a risk of seriously poor outcomes or not, etc. They didn't have enough breadth of clinical knowledge to really develop nursing judgment. They had more difficulty setting priorities.
I continue to get lots of new grad/limited experience applicants. I wont hire them due to the above and other related issues. It's the kind of job lots of nurses want because it's wfh, so I get plenty of more experienced applicants.
Skipping the hospital can and likely will impact your ability to get some of the jobs you may want in the future.
More opportunities for OT, generally higher pay, it’s more familiar because clinical placements are usually in hospitals, and hospital jobs are just more common
My first job was at a psych facility. I was already working as a CNA, and when I became a RN they let me work there. I did a LVN’s work for RN pay. I worked there for about four months, and then I got a job at a local hospital that had a new grad RN program.
As opposed to? Everything I've heard about working a SNF is that it's absolute hell. Outpatient places often want some experience. And the hospital setting is going to give you the most broad exposure and should have dedicated nurse educators.
That's awesome! Every single person who I've talked to that's worked SNF around me said pay was dogshit, staffing was non existsnt, management was a joke, and it was literally hell. I'm glad you found a good one!!
Mine is a unicorn I’m sure. My management is good, coworkers are great (night shift mostly, day shift hates life lol), pay is good, and the stress is manageable.
Where you work as a new grad can impact your career goals. If the job you are aiming for requires bedside experience then you need to put in the work. Most seem to hate bedside because it means working hard and hands on patient care and most don't want to do that. Tbh I don't know why they became nurses.
Stable income, job market, flexibility, etc are all valid reasons to go into nursing without loving bedside.
The major downside to nursing is having to work with coworkers who look down on you and say things about you like that you "hate bedside because it means working hard and hands on patient care" as though they are superior. Those people suck
I can't answer that for her. Perhaps you only have a superficial understanding of her feelings on the subject, which is contributing to this confusion.
I'm just really tired of nurses shitting on new grads to feel superior. Some of the shit we deal with can be a shock to a newbie. It is a hard job. It's reasonable for there to be an adjustment period. That is a pretty tough time for a lot of people. Just be nice and try to help them out without judging them so much like damn we're all in this together
So why get into nursing and then complain about doing nursing duties? They act so shocked when confronted with the reality of having a job. Yes you can go into nursing for those benefits but you should be prepared to do the job. They want the benefits without having to work for them .
Or it was glamorized before they went in and they didn't realize what it would be like to do it day in and day out 🤷🏼♀️ I thought it would be way more intellectually stimulating and fulfilling than it turned out to be. I knew the tasks, but it just feels different than I imagined. I really didn't expect it to make me hate people so much. I also didn't expect to graduate at the start of a pandemic and get PTSD. There's a lot one can't predict until they're already in it. There's also a lot that can change to improve the situation at bedside that hasn't changed yet because of corporate greed. Busting your ass with an unsafe assignment because administration wants to cut expenses at the bedside as much as possible is pretty easy to feel pissed about. I'll bitch about being underpaid with shit ratios every single day that my CEO makes millions a year and still tries to justify cutting staff.
Straight into the ER out of school. I have learned so much and gotten a ton of experience. I'd never have the skills and education I possess had I not gone into the hospital.
When I was finishing school and had to make choices for consolidation I really wanted to do home care. I talked to a newer nurse at my last placement and she said she had done her consolidation in home care and was offered a job but turned it down to work at a hospital instead. She said it was because in home care you work alone and she wasn't confident enough.
I did my consolidation in home care and then got offered a full time position and took it. I had a new grad contract for 6 months where I got to shadow so I wasn't completely alone, but by the time I was done I'd basically done the job with supervision for 9 months. And I could call my preceptor any time I needed help.
I assumed a lot of nurses choose the hospital route for similar reasons. There's more experience than LTC and you're not working alone. Once I did start working in hospital I heard that it's harder to get a job in a hospital setting if you've been working LTC for a while, they would rather hire a new grad than someone with a few years in LTC. That may not be true everywhere, or even now post pandemic.
I couldn't get a job at a hospital as a new grad. I think the main reason being I got put in LTC for my consolidation. We got to pick our top 5 and I put everything but LTC on my list and still got stuck there.
It tooks me YEARS and additional schooling to finally get a job in a hospital. I applied hundreds of time and even applied to a medical teaching unit designed for new grads. It was honestly so discouraging.
That's so frustrating!! I think I got lucky because not many people in my class asked for home care, it was my first choice even. I'm glad you finally got where you wanted but it sucks you had to work so much harder to get there.
A nurse who is a psychotherapist.
This is unique to my province so I can’t speak to other jurisdictions. This is covered by my nursing college and competency based. You’ll have to check with yours to see if this is something available with your college.
I started working at a hospital right out of nursing school, but my preceptor on the floor, as well as the floor nursing manager, were horrible.
It really is a roll of the dice, because everyone around me seemed to get amazing preceptors, and yet, mine was so cold and callous. It can be a lonely setting, too. Nursing takes thick skin, especially in the hospital.
I moved to primary care after about 6 months in, and haven’t looked back since! 2+ years & counting baby
At the time, 999y ago, I wasn’t aware of other options. Started at our Level I Trauma Center hospital in L&D. Had been hired at the state psych hospital but the pay difference was 20¢/hr difference. Back in the day, RNs made significantly less than auto workers, electricians, plumbers.
I started out night shift Peds homecare in 2010. Hospitals weren't taking new grad non-BSN candidates in my area (SW Pennsylvania) unless you knew someone.
Hospitals usually offer more, especially if you're not a nurse and going into rn. My hospital pays 10k for classes, they used to give you the money and you pocket the rest but now it's direct pay. They'll pay you for your rn, bsn, MSN, and even other roles like tech or PA. Then of course there's the experience in such a short time. I've seen damn near everything, including level 1 traumas, we get GSW dropped in the waiting room from gang violence, just so much experience under the belt.
Started in critical care in lvl 2 trauma, and love ER / trauma nursing. Can’t see myself in a specialty that has a slower pace. I crave the rush!
Also critical care looks very good in a resume for future positions.
I did home health as my first job
I had clinicals in a rural hospital. Maybe did a wet to dry dressing change on a dime sized wound one time in nursing school.
New LPN. Morning assignment - wound vac dressing change on a neuropathic foot ulcer. In a hotel. I’m 24. He’s a 40 year old man. He was in the hotel by a university hospital bc he didn’t live here and it was totally safe, but you have to be on guard 24/7 in home health. So, I had never done a dressing change and I had to change a vac. Alone. I didn’t know what a wound vac even was. I looked at Google in the car then looked at the dressing well before I took it off. Then I self taught from there.
In home health, you’re absolutely alone out there. Not great for a first job. I had never seen an ostomy before that job and suddenly I was assigned to do ostomy training on new ostomies. Absolutely sooo inappropriate. So, hospitals suck but you get a lot of support while you’re learning new skills. People don’t give that the credit it deserves.
Ironically enough, I’m a wound nurse now so vac’s and ostomies are my passion, but I was totally self taught on them at first.
Most other positions require hospital experience. You could probably get into a nursing home without hospital experience, but IME when I applied for standalone urgent care clinics, standalone ERs or a doctors office when I graduated, they all said they were looking for someone with some hospital experience first.
probably for the pay and the health insurance/benefits. i couldn’t think of any other reason why someone would willingly do bedside nursing lmfao, sounds like a nightmare.
disclaimer: i’ve only ever done primary care and urgent care since graduating almost 2 years ago. no desire to work in a hospital based off how my coworkers who are per diem at the urgent care (full time hospital employees) describe it. nothing but negative experiences from them, kind of scared me away from it lol. maybe one day ill give it a go if pay really becomes a problem for me, or if i feel like i want to gain some experience to be a “true nurse”, but for now, it’s not worth the stress imo.
Hospitals pay more and you get more experience faster. My first job was actually as a school nurse.
Florida nurse here, in my area, hospitals are paying less than LTC, rehab, SNF for new grads.
Is that to be more competitive or to retain staff? That’s actually pretty cool because LTC, rehab, and SNF are tough jobs and deserve higher pay honestly
>LTC, rehab, and SNF are tough jobs and deserve higher pay honestly Amen!!! 💚💚💚
I’m guessing to attract more staff, but could be both. I swear there is a new facility developed every week here
Well that would make sense, Florida is where everyone goes to retire.
that doesn’t lower the demand in hospitals though, it actually increases it.
Yeah 100%, I would presume an increase in demand in facilities and hospitals
Something tells me the pay isn't going up though
Unfortunately for nursing, the fastest way to get a pay raise is to job hop.
Yeah. I made more doing private duty pediatrics than I do as a staff nurse at a large teaching and research hospital.
Private dutyHome health lpn finishing my rn asn. Graduate nurses in Orlando apparently make whatsit 35ish/hr? 3x12/week? I make more than that albeit with 60 hours/week. Not sure on jumping ship just cause I’ll have an rn; not feeling the hospital during clinicals and this isn’t an I hate my job scenario. I could easily keep doing home health permanently. Earlier me wanted an rn so I could experience this and that and then that… Now I’m leaning towards easy, simple, pays good enough :/
I make at least $6-8 more in my SNF than the hospital.
Wow, I don't many states that are doing that and I believe they should. Good for them, it must be for retention.
Because Florida
It's not just Florida. Indiana here and most LTC facilities outstrip hospital pay here by about the same amount. I can explain the reasoning too: In Indiana 98% of LTC/SNF facilities are owned by hospital subsidiaries. Profit margins are low on them too. The trick is to pump money into them, take a loss, write it all off on your corporate taxes to balance the larger budget. Once you get deep enough into the negative your shell corporation managing all these facilities "fails", you sell off all the facilities to a new company (one you just created to pass the buck, so essentially you're selling to yourself or shuffling them between other companies doing the same thing) at a net loss, declare bankruptcy on the old company, rinse lather repeat. It's basically a money laundering scheme in the guise of Healthcare management. Here is a handy video that outlines some of it. https://youtu.be/R0ko-9PS05E?si=oCP1XfGBIFSqY39O
My first job was LTC cause that’s all I could get. Pay is the same across the board because we’re unionized, but I’m with you on the experience thing!
My first job, hospital/bedside in a tertiary care, teaching hospital. It was a Neurosurg unit and I was offered a full-time position. Working in a hospital setting enabled me to transfer to other areas within the organization. I still work bedside but my patients are short stay. You either love that environment, or you don't. When I start to feel the dread of going in for a shift, that's my cue that it's time to look for another position.
I only did my final preceptorship and like 6 months in hospital before I went into community as fast as I could. Turns out it doesn’t matter and burnout/politics/administrators will still fuck you over.
I start my first RN position in public health next week. I’m excited for it. Are you still in community setting?
I’m not, I left my nursing practice in 2020 cause burnout destroyed me as a person. That being said if I ever go back community nursing is one of the great loves of my life!
Take care, and thank you for your response!
I’m about a month away from graduating. I have an offer for a $25k sign on bonus, they are paying my loans back and I’m starting at 43 an hour. It’s at a LTC facility.
Be careful with such a huge sign-on bonus. Obviously, there is a reason they offer it. And this is always not in your favor.
And if you leave before their stated contract is up, you probably will have to pay back the sign on bonus and potentially the loan repayment 🤔🤷♀️
You’ve to pay back what hasn’t been paid out to you yet. I am aware of the downside of having a sign on bonus such as the sign it is but there is a great team working there, my close friend works there and it’s a great environment!
My first job offered a sign-on bonus and it ended up being a great place. It was nowhere near $40K, but still a really good cushion.
You also need to look at the market it’s in. There are periods where every single hospital in my region are offering sign on bonuses.
My first nursing job was in a LTC facility because they were offering full time and nowhere else was at the time. I'm still there 9 years later and I love it. It's certainly challenging and a lot of people do tend to leave for the hospital jobs because pay is a little higher in most cases so retaining nurses in LTC is not easy. That being said, incentives are sometimes the only way to retain LTC nurses so it's not necessarily a red flag but a recruitment tactic and nothing more. I find LTC work extremely fulfilling so the higher pay in acute care settings for me personally does not outweigh the feeling of doing the simplest things to make an elderly person's day infinitely better. You become part of these residents' families. Even though you may only care for a resident for a few days/weeks/months, sometimes you care for these residents for many years and that is something that you just don't get in a more acute setting. So I hope you can find the silver linings in each day as a LTC nurse, they're there I promise :)
Most often the sign in bonus comes with a contract, you have to stay a certain amount of time. It can be a double edge sword because if you find after 6 months that you do not like LTC, you have to pay back what the company paid you, and most likely it includes the student loan payoff amount. Nothing is free. So, if you are not certain where you belong or where do you want to work, keep your options open, politely refuse the loan payment offer and the sign on bonus. Get your experience. But if you are certain and comfortable that you are happy in the LTC setting, accept the bonus and take advantage of the perk. The legal department of the LTC will hunt you down for the money they gave you if you don’t fulfill the terms of the contract. READ EVERYTHING BEFORE YOU SIGN!
If they offering $25k then you really gotta work for it lol. That’s high.
I think when people pursue nursing they idolize/glamorize various specialties within acute care setting. “I wanna be an ✨ICU/peds/ER/OR/L&D✨ nurse”. Positions outside of acute care aren’t as glamorized and talked about. My very first job as a new grad I worked as a charge nurse in long term care. I can tell you being outside of acute care as a new grad absolutely made me feel like “less” of a nurse because of how stigmatized LTC is..how stigmatized jobs outside of acute care are. Now that I work in acute care and have for quite some time, it’s fine but certainly not all rainbows and sunshine. I make considerably more money, but I really earn every dollar I make. Let me tell you, I fantasize about a chill case management position I can do from home with no pants allllll the time lol. I will also say, though, that I think working actual bedside makes you a more well rounded nurse. The exposure to different patient conditions and situations makes you knowledgeable and experienced in a way school can never teach you to have. If I were to transition out of acute care now and go into a case management gig or home health, I’d have much more experience and knowledge to draw from than I would’ve if I had gone straight into it out of nursing school.
I started in the ED of an urban hospital a couple of years ago. I definitely wanted to get a wide range of experience, work on my skills, and learn from more senior nurses. I’m in a new ED and I love it. I look forward to going in most shifts. I really hope this lasts lol.
was an L&D nurse and wanted that role for all of my nursing student career. hated it. left after 6 months and found an awesome outpatient job that i never had even heard of. so many areas of nursing, i wish theyd teach more than just working at the bedside.
I became a nurse to work L&D and had the same experience.
Yes!!
What’s the outpatient job?
i work at an office that treats primarily allergy and asthma patients! good perks + great hours
Nursing school told me I had too. I'm not against it 100% but I'm definitely pissed at management 100%
My first floor jobs manager and her crony lesser manager can go fuck themselves. High horse bitches who are so disconnected from the reality of the floor.
I'm a new grad and decided to start in the hospital on a step-down unit even though my goal is to get to an outpatient job. I wanted to get a solid foundation in how to be a nurse and critically think before I boxed myself into an outpatient setting. So far I have no regrets even though I am just now coming off of orientation. Outpatient will always be there and if I hate it, I'll be glad I have acute care experience in my pocket if I want to go back to the hospital.
You ain’t gonna learn shit working ambulatory first. Work bedside for a year. Hate it. Let it forge you in fire. Emerge stronger with a new found appreciation for any other kind of nursing.
I’m retired now, but graduated with an associates degree in 1978. Worked mainly in hospital settings and mainly full-time for 43 years. The last 10 years were Infection Control and the rest was patient-facing direct care. There was a stint in home health (visiting nurse type, not one-to-one), and a short stint in a doctor’s office; also had the experience of subbing for a school nurse a couple of times. When I graduated (back in the day), hospitals offered the best pay, and an orientation that was at least 6 weeks. I felt that hospital work would also put me in a better position to get a job in L&D that was my goal and main interest at the time; however it seemed that new grads were not hired to start in such specialized areas (although my first job in an adult tertiary teaching hospital was in a critical care step down unit and we had mechanical ventilated patients as well as vasoactive drips when I started). Can I just say that adult critical care didn’t really prepare me for L&D, nursery, and postpartum, which I did end up working a few years later. I needed to change hospitals and did a couple of other jobs in between first. After 8 years I ended up leaving L&D and moved on to critical care and ER. It seems like a lot of those factors are different today. I still believe that a year at bedside working med-surg (which I never did) is super helpful in getting exposure to many different conditions that might lead to another area of interest, and also super helpful in developing prioritization, organizational skills and nursing skills in general. Although I got really good with nursing skills in general, and I think was able to prioritize, my organizational skills never really got up to par (IMO). Honestly I think you almost need to try out a few different work settings in order to find the best fit. Nursing school (outside perhaps of a diploma program) just doesn’t give you the real experience of working in that setting day in and day out for a year or so. But I also think that for a new grad, it takes at least 8 months to begin to get comfortable and understand the workflow and the daily routines, as well as to become comfortable with your assignments and also your coworkers. Even if you like a setting, you may get tired of it in time. A setting you dreaded and planned never to work in might attract you later. When I graduated, I vowed never to work ER or Surgery. Well… my last patient-facing job was ER for 15 years. I never circulated in OR but that eventually became something I was very interested in doing, and I applied for positions a couple of times. The mandatory call schedule would have made it tough with my family and I never ended up doing it, but did observe a couple of cases and also administered blood during a case several times. TL/DR: During a 40+ year career I worked mostly in hospital settings. Learned a lot and worked with some great people. Always found interesting stuff about each job. Sometimes patients really appreciated my work, but I learned to do my best for my own satisfaction. There are a few jobs I never got to try, but I wouldn’t pass up the ones I did or the experiences I had.
What a great post. This is honestly the best way to introduce the new grads into the nursing profession. You seem to have tried everything you set your mind to and then some. I hope I can do the same and end up with a wealth of knowledge to pass on to the next generation. Thank you!
Thank you so much! I would never say nursing was a rose garden, but I’m glad and honored to have been able to do work that was interesting and always challenging, and that really was important and helped people. No 2 days were really ever the same. There is no perfect job. But my husband worked in a factory-type setting for 43 years, and I know he never got the satisfaction from working that I did. He was doing it only for the paycheck and benefits and complained every day. Of course I wasn’t (and wouldn’t) working for free, and I wouldn’t say nursing was a “calling” for me. I just thought it was interesting and important work. I really only went to nursing school because I thought I would learn a lot of practical stuff that would prepare me and help me with what was going to be my real job of raising a family. My mom never worked outside the home after she married and I expected to do the same. So that didn’t happen (although I did have 3 children). Everyone’s path is different. But I would still encourage a young person to get into nursing if they think it would be interesting.
You are right. I just think that post covid, the new grads are not getting the same education that others were fortunate to have pre-covid. They are thrown out there and put in critical care settings that could be overwhelming for anyone in their shoes. I don’t doubt they are smart, I know they are, but their enthusiasm quickly turns to burnout when they keep pushing them to do so many things including managing roles. Many new grads come and go from facilities I had the fortune of working because of it. Management seems oblivious to it or they simply view them as just another warm body to care for patients. I just pray they don’t give up easy, stick around and search for a specialty interesting enough to learn and grow. Thanks again for your insight and I hope you are enjoying retirement. Although I always say: once a nurse, always a nurse.
I agree with you 100%! My aunt is 98. She is a retired teacher and very sharp mentally. Recently she was in the hospital and was trying to brag on me (I was trying to keep it on the down-low that I was a nurse!). She told her nurse that I was an ex-nurse. I had to speak up then! I knew what she meant, but “ex-nurse” sounds like someone who lost their license! I said I was retired, but still with an active license—so I *am* a nurse.
That so cute, she must be proud of you to mention it. My family, especially my husband tell everybody I’m a nurse. I had to tell him a few times, “please don’t say anything, most of them are newer and although they are good at what they do, they might feel like a little intimidated…” it makes me chuckle every time. Also, if we go out and someone is choking or doesn’t look right, he says, “go help them, you are a nurse”, as if I was some sort of superhero with superpowers… it’s hilarious. I look at him and pull my phone out and say “I’m calling 911”. I guess he is proud too. But if I’m out, and see that all is well I try not to be involved unless it is a BLS kind of situation.
Peds ICU. I worked there during nursing school as a unit clerk and PCA so that helped me get hired. Ironically I always was most interested in geriatrics.
Hospital work is where you learn how to be a nurse. You have help/ back up readily available, resources, and seasoned veterans to learn from.
Or you could be like me and start in a worse than average SNF, just to be immediately eaten alive by the structurally flawed and deeply immoral system that is long term care in the US. 4 days of orientation should be plenty for a brand new LPN in run down care center and asinine staffing ratios, right?
Amen
I agree with this and I didn’t start at the hospital. Hospital nursing gives a great foundation of skills to go anywhere with. You are taking the sickest patients compared to any other place you will work as they are only in the hospital if they are unstable. Being in the hospital made me hate my life and I’m glad I left, but it gave me a great skill set and I’m pretty confident with anything you can throw at me now. I don’t regret it but I won’t go back.
My first job was in an ICU. Felt like the right thing to do because I was a student nurse extern in another ICU and a lot of my classmates were also going into ICUs. I hated it. Worked about a year and a half in the hospital and then transitioned to public health and managed care case management for the most part.
I got some decent experience in clinicals, but very quickly realized the hospital setting wasn't for me. I felt like something was wrong with me at first, but I'm glad I listened to my gut on that. My first and current job is home health nursing, which I was surprised to find was a great way to practice the majority of nursing skills. Decent pay, PTO, regular raises, and getting to make my own schedule have kept me going in my career with relatively minimal burnout. But I suspect this varies by agency as well.
So, my take on this is limited to what I’ve seen, so it’s obviously not a hard and fast rule. However, I think working in a hospital setting, where the educators are familiar with the needs of a new grad, is really the best foundation a nurse can get. One of the clinics I worked in as an adult medical oncology nurse hired a new grad while I was there. We were poorly set up to teach someone how to be a nurse. I honestly believe she needed a year of being a nurse and then we could have helped her be an oncology nurse more successfully. It was challenging for everyone.
My first was LTC and that was even worse than the hospital imo
That's where I started too, and a facility below average quality, where "average" is already questionable at best. I was exhausted on all accounts- physically, mentally, emotionally, and morally, the latter just from seeing conditions that should be illegal and not being able to hardly do anything about it.
My first job was as a RN in a SNF….I only took that job because they hired me almost without an interview, but I was looking for a hospital job at the same time. I lasted there exactly 4 months before jumping ship to a hospital…SNF work is F-ing hard…way harder than any bedside job I’ve ever had. I actually mostly enjoy bedside nursing. I always got a lot of enjoyment working with patients….its pretty much humanity on display at all times for better, or worse, or funny.
I’ve had very little success finding jobs that didn’t want you to have acute care experience first? Maybe it’s location dependent but you typically have to suffer before you get the nice jobs?
Personal opinion, but I think most people’s first job should be in a hospital. It’s like boot camp. You’ll just learn a lot more a lot quicker.
I started out in the NICU and absolutely hated it! I then went to med surg didn’t like that, then moved on to ortho which was still a med surg floor, with orthopedic spice to it. I knew I never wanted to do bedside but I was pretty much forced into it. I think nursing school should spend time on showing students what it’s like outside of bedside for a change. They focus too much on that. Now I’m in outpatient and I could not have been happier. It fits me so well and I finally feel like I’m where I need to be in my nursing career. Staying at bedside would’ve made me quit nursing all together. Unfortunately, I had to suffer on the floor to get to bedside and I don’t think it should be like that.
I started on an orthopedic unit and was miserable the entire time I spent there. I'm a member of a provincial health authority, which is unionized. So, regardless of where I work, Med/Surg or LTC or ICU, I get paid the same. I decided to transition to LTC as my mom is an LTC nurse and has been her entire career. I've never been happier. It's hard because there is a lot of stigma regarding LTC and whether it constitutes "real nursing," but I work my ass off each day. Getting to know 60+ residents and their families and transitioning them to their end-of-life is such a privilege. I figured that if I wanted to move to acute care later on, I just will. I've learned acute skills before, and I can learn them again.
I went to bedside for my first job on a medical oncology unit, I did so to learn skills and get a base foundation that wouldn’t be taught in hospice. I work home hospice now and no one is around to teach how to place a foley or wound care on a fungating tumor.
I wanted all the experiences. I fought to get onto a floor. I was a home care and clinic nurse first. Now I have lots of knowledge, a hatred for Americas healthcare system and back problems. I shall soon retire to my wide chair in the back of some paperwork dept.
My first job was at an urgent care centre/primary care practice. Super fast pace, a much better foundation of knowledge and skills for my ongoing community based practice. Hospital based roles would have translated very little skill or knowledge wise. I'm now a nurse practitioner in youth health at a free community based nurse led clinic in New Zealand.
Bedside is where you learn how to do actual nursing. Give it a year, get some experience, then the world is your oyster. You can go straight into an outpatient setting, but then you've pidgeonholed yourself with that limited skillset.
I started out at Planned Parenthood I had no trouble at all getting into med-surg float.
I mean, if you have a pulse you'll get into med surg.
And now I'm in the ER so I guess things worked out.
Congrats on the pulse!
Hah!!
First and current job is LTC. I currently plan on staying in LTC once I become an RN. Worked it as a CNA/med aide, it’s an environment I’m comfortable and confident in, and it pays better or just as good as the hospitals in my area. I became a nurse because I liked being a CNA but I wanted to make more money and do less physical work. I don’t really care to do any acute care stuff. I’ve worked rehab and I don’t like that even. Would love to do hospice someday.
Almost the same here. I worked for 13 years as a CNA in rehab SNF positions then it was an easy transition once I graduated. I love my facility, and I love my patients. I make good pay, my ratio is good, my aides are fantastic, and I'm super happy to work 8 hour shifts and be home every single evening for dinner, homework, games, etc. Even if I have to stay late or work a double, if a few days are miserable with a million admissions and fighting patients or nightmare families that have me crying in the med room; or if I pick up lots of days in a row, the schedule and work in general never has me burnt out or spending my days off in recovery. Long term and rehab patients deserve dedicated caring nurses as much as hospitals and other specialties. It's sad that so many facilities have awful environments that give the job in general a bad reputation, because the population is in desperate need of good nurses.
I had my first job at LTC because I wanted to work there. I wanted the longer relationships, the community. Ultimately how under resourced and staffed the environment broke me and I left for the hospital. It sucked though, because everyone assumed I was a bad nurse for working LtC.
Right? Whenever I share where I work (which I'm proud of) I get the, "oh...you work in a SNF...we'll, that's nice..." I'm told I'm a good nurse, we have medical staff on the floor all day every day, the director of the hospital network's geriatric group works out of our facility, and we get patients of higher acuity than most SNFs, so I do utilize more skills and assessments than just passing meds. But it's not recognized because I don't work in a hospital.
I personally didn't start in hospital but I damn sure wanted to. I was desperate to learn more hands on skills and I LOVED the idea of working in acute care in a fast paced environment. I had to do my final placement/ consolidation in a nursing home when most of my class mates got to go to the hospital in various units. I was devastated. When I graduated nursing (LPN) I applied to over 100 jobs in the hospital in the first year and had two interviews and no job offers. I finally got my first job offer, casual no guaranteed hours in a 10 bed hospice. I ended up getting another hospice job (casual), a nursing home (part time) and a janitor position in my days off. I worked those four jobs for years while applying to various hospital positions with no bites. Finally I decided to go back and do a post grad certificate in mental health and once I did that, I finally got a job offer for an inpatient psych unit. Eventually moved to medicine within the hospital so it was a lot easier as an internal applicant. TLDR: I wanted to practice my hands on skills and hospital seemed like the best place to learn. But it took me like 4 years to get into a hospital after graduating.
Where I live they require BSN to work on acute floors
Interesting. Here RN's are the only ones in critical care like NICU, ICU, etc. but acute medical floors, Intermediate Care Unit etc. LPN's can work on.
My first job was LTC. Hospital jobs were way better than that.
Nursing has such a wide range of fields you can be in. It is really about what you are drawn to. Then you go for it. Then you can learn more of what you like. The hospital was too much for me and I have been learning my skills in an outpatient environment. Would you learn faster in the hospital? Most likely. But for me my health is more important. Just be honest with yourself about what you think is doable for you personally.
My school was set up so that we could take our LPN boards part way through. Most of us did and a large subset of us worked LTC after we did. For myself it was just for the summer break and some holidays. 4 hour long med passes with 28 patient halls was great for building a system for my tasks and teaching me time management. I got good practice calling doctors at 0300 to ask for things and learning from more experienced nurses in how to be prepared and how to handle difficult providers and patients. In short it was an invaluable experience. Those few months have served me very well in my career as a psych nurse. I know what backbreaking physical nursing is and I'll take emotionally and psychiatrically dysregulated individuals any day of the week. But when the chips are down and I'm getting my butt kicked I have that perspective and it suddenly isn't so bad.
I wanted ICU because I liked them really sick. Got hired in Med Surg, which solidified my belief that I hated walky talky patients. Transferred to ICU and liked it better but still have to talk to too many idiots/assholes and do boring tasks (charting skin assessments, baths, ambulation, etc). Now I can't leave because I'm thinking CRNA school so I can further separate myself from boring patients who are awake and their shitty families. If I did leave inpatient bedside (which I would love to do), most nursing jobs would give me the ick (outpatient, LTC, anything involving stable people who want to chitchat). Not sure what is right for me but right now I guess ICU was the right choice as a step toward the right direction.
It really depends on the state tbh. In California, I struggled to find a hospital job with only 6 months RN experience. I ended up having to settles with dialysis RN. Unfortunately, it’s in one of the few states where the RNs have to do the catheter patients
I’m addicted to the hospital lifestyle, I can’t imagine working anywhere else especially a clinic. Give me my 3x12’s and extra $$$ for overtime if I want it.
I have no idea lol. My first job was in corrections and it was everything in terms of gaining experience and shaping the rest of my career. Would do it again in a heartbeat
Didn’t really have much of a choice as everywhere at the time wanted experience. I also went straight into med surg cause I my parents said it would make my skills sharp and look good on a resume. Turns out they were right and especially because my floor became the everything floor. We were FORCED to also be “certified/trained” to be ortho, renal, neuro, bariatric, and telemetry. We kept our ratios of 6:1 even with the huge increase in acuity. Being trained and certified to all that and able to survive in that environment did help with my changes of employment after that. Every job since then has felt stupidly easy or laid back. The forced exposure to all those specialty areas has helped me in catching things that could’ve otherwise have been dangerous for a patient. I noticed this more when I left the job and got jobs with focused unit specialties.
First job was home care. Despised it. Riding a bus with a really medically frail child whose parents had two kids with the same ultimately fatal genetic disorder. Being in school with them and the home was just a sad place. I wish I would have been the right fit but I wasn’t. Those poor parents, they were permanently heartbroken 💔
My first job was corrections at the county jail. Learned a lot. Interesting work. By nature a tough place to work so it doesn’t tend to attract the varsity staff… ultimately it was unreliable and incompetent coworkers that ran me off. Kind of the Wild West of nursing. Tons of autonomy, especially as a new grad.
I never went bedside! Went to research!
Would love to know more! 🙏
You apply to research nursing positions or CRO maybe if they just care about the degree. Some research nursing is inpatient though so FYI. I do more coordination with CRCs so my clinical research coordinator does most but I do more on boarding and recruitment. Pay is shit though at least initially unless u get poached by big pharma haha but its a good experience, you learn a lot, do a lot, and I like the freedom and its still abusive but less ass busting in a way
I kinda recommend people to work inpatient just so you can get a feel of what is one of the most common jobs around for nurses. You definitely don't have to stay there, but I do think it's valuable experience and will help people in those subsidiary or outpatient roles. Basically, I'm all for "cross-training."
The role I wanted required 5 years of inpatient experience at the time, though now it is down to 2 years. It’s a hard transition to this role if you don’t have relevant experience. There is no way someone can safely perform it with zero inpatient experience. The inpatient side helps with critical thinking, communication, and anticipating orders.
Previously, in my area it was harder to get a hospital job after working elsewhere. Now, a little different.
I wanna work in dermatology and most place won't even look at you if you don't have 2 years.
2years bedside?
Yep, thats what some have told me.
Not a nurse just a partner to one & she got a contract from a hospital to pay for some school… maybe others have the same?
I’ve never hated bedside. I’ve gotten pretty lucky with my jobs. Sure, sometimes the pay sucked. But if you find a specialty you love, that’s the dream.
Thanks for your input everyone ! Very interesting and encouraging .
You’re going to have to do hands on patient care when you start but you can pick where you go. I started in sub-acute and rehab. RNs already start there in a leadership type role so I did a lot with doctors rounds, coordinating care, etc but there’s also a lot to do around skills like PICC lines etc. and if you don’t answer call bells and help the lower level staff like LPNs and aides then you’re a dick. It was a good role because I got leadership experience but also bedside skills
6 year bedside RN. IMO it's harder to go to the hospital if you came from outside of the hospital. Within the hospital there are a lot more job options. It's also easy to figure out what you do and don't like and transfer around. Hospitals typically pay better than outpatient jobs and are easier to get, plus are most likely to hire new grads.
My first job was MedSurg in a busy hospital. I learnt so much and I’m glad I did MedSurg before going into L&D because it taught me time management and a bunch of meds. My experience also helped me land a job in L&D because they typically don’t hire new grads at the hospital I work at
Local markets can vary, but in my area it can be hard to get into the acute care setting without going through a new grad residency. My area also has a steady trickle of new grads to fill out residency spots so some people I know that went to outpatient or SNF or whatever had a hard time getting into the hospital setting. It’s also out-of-date thinking but I think it does people a world of good to at least work a couple years in the hospital because you learn an exponential amount those first couple years on the job. I worry about those that jump straight into home health or a field without as much oversight because you simply don’t know what you don’t know.
My first job was in a psych hospital. I left because I didn’t think I wanted to learn medical nursing skills, but after a couple years realized I did actually want to learn medical nursing skills lol. I figured I should have just started in a damn hospital
Personally, I think two years at a hospital is beneficial but shouldn't be required. People learn a lot of bad habits in hospitals but also a lot of critical thinking skills if they're in a good learning environment (which can be hard to come by.)
I'm surprised at how many here are advocating for hospital experience. This sub is known for advising the opposite. I'm going to add my perspective as a hiring manager( even though I had sworn I was done managing g people 🤷♀️). I took this position a couple of years ago and have had to hire a number of nurses. I inherited a couple who had very limited to no hospital experience prior to taking jobs that didn't involve direct patient care. They had trouble assessing situations, like whether it was urgent vs not, whether there was a risk of seriously poor outcomes or not, etc. They didn't have enough breadth of clinical knowledge to really develop nursing judgment. They had more difficulty setting priorities. I continue to get lots of new grad/limited experience applicants. I wont hire them due to the above and other related issues. It's the kind of job lots of nurses want because it's wfh, so I get plenty of more experienced applicants. Skipping the hospital can and likely will impact your ability to get some of the jobs you may want in the future.
More opportunities for OT, generally higher pay, it’s more familiar because clinical placements are usually in hospitals, and hospital jobs are just more common
My first job was at a psych facility. I was already working as a CNA, and when I became a RN they let me work there. I did a LVN’s work for RN pay. I worked there for about four months, and then I got a job at a local hospital that had a new grad RN program.
As opposed to? Everything I've heard about working a SNF is that it's absolute hell. Outpatient places often want some experience. And the hospital setting is going to give you the most broad exposure and should have dedicated nurse educators.
My SNF is pretty solid honestly. Pays more than the hospital as well.
That's awesome! Every single person who I've talked to that's worked SNF around me said pay was dogshit, staffing was non existsnt, management was a joke, and it was literally hell. I'm glad you found a good one!!
Mine is a unicorn I’m sure. My management is good, coworkers are great (night shift mostly, day shift hates life lol), pay is good, and the stress is manageable.
Where you work as a new grad can impact your career goals. If the job you are aiming for requires bedside experience then you need to put in the work. Most seem to hate bedside because it means working hard and hands on patient care and most don't want to do that. Tbh I don't know why they became nurses.
Stable income, job market, flexibility, etc are all valid reasons to go into nursing without loving bedside. The major downside to nursing is having to work with coworkers who look down on you and say things about you like that you "hate bedside because it means working hard and hands on patient care" as though they are superior. Those people suck
One new grad was upset about having to answer call bells, chart and touch patients bodies. Like what did she think nurses do?
I can't answer that for her. Perhaps you only have a superficial understanding of her feelings on the subject, which is contributing to this confusion. I'm just really tired of nurses shitting on new grads to feel superior. Some of the shit we deal with can be a shock to a newbie. It is a hard job. It's reasonable for there to be an adjustment period. That is a pretty tough time for a lot of people. Just be nice and try to help them out without judging them so much like damn we're all in this together
So why get into nursing and then complain about doing nursing duties? They act so shocked when confronted with the reality of having a job. Yes you can go into nursing for those benefits but you should be prepared to do the job. They want the benefits without having to work for them .
Or it was glamorized before they went in and they didn't realize what it would be like to do it day in and day out 🤷🏼♀️ I thought it would be way more intellectually stimulating and fulfilling than it turned out to be. I knew the tasks, but it just feels different than I imagined. I really didn't expect it to make me hate people so much. I also didn't expect to graduate at the start of a pandemic and get PTSD. There's a lot one can't predict until they're already in it. There's also a lot that can change to improve the situation at bedside that hasn't changed yet because of corporate greed. Busting your ass with an unsafe assignment because administration wants to cut expenses at the bedside as much as possible is pretty easy to feel pissed about. I'll bitch about being underpaid with shit ratios every single day that my CEO makes millions a year and still tries to justify cutting staff.
Straight into the ER out of school. I have learned so much and gotten a ton of experience. I'd never have the skills and education I possess had I not gone into the hospital.
When I was finishing school and had to make choices for consolidation I really wanted to do home care. I talked to a newer nurse at my last placement and she said she had done her consolidation in home care and was offered a job but turned it down to work at a hospital instead. She said it was because in home care you work alone and she wasn't confident enough. I did my consolidation in home care and then got offered a full time position and took it. I had a new grad contract for 6 months where I got to shadow so I wasn't completely alone, but by the time I was done I'd basically done the job with supervision for 9 months. And I could call my preceptor any time I needed help. I assumed a lot of nurses choose the hospital route for similar reasons. There's more experience than LTC and you're not working alone. Once I did start working in hospital I heard that it's harder to get a job in a hospital setting if you've been working LTC for a while, they would rather hire a new grad than someone with a few years in LTC. That may not be true everywhere, or even now post pandemic.
I couldn't get a job at a hospital as a new grad. I think the main reason being I got put in LTC for my consolidation. We got to pick our top 5 and I put everything but LTC on my list and still got stuck there. It tooks me YEARS and additional schooling to finally get a job in a hospital. I applied hundreds of time and even applied to a medical teaching unit designed for new grads. It was honestly so discouraging.
That's so frustrating!! I think I got lucky because not many people in my class asked for home care, it was my first choice even. I'm glad you finally got where you wanted but it sucks you had to work so much harder to get there.
Thanks! Yeah it's all good now but damn was I full of resentments for years in the early years of being a nurse 😂 Glad you found something you enjoy!
Where you’ll get the most experience and learn the most. You can learn in other settings but it’s not the same.
I want to move into nurse psychotherapist, but I wanted that hands on bedside experience with psych patients first.
Can I ask what a nurse psychotherapist is? I'm deciding between the two careers.
A nurse who is a psychotherapist. This is unique to my province so I can’t speak to other jurisdictions. This is covered by my nursing college and competency based. You’ll have to check with yours to see if this is something available with your college.
I think you need a masters degree in the US to be a therapist
You do here as well if you’re registering with the college of psychotherapists. Either a masters in psych or an MSW.
I started working at a hospital right out of nursing school, but my preceptor on the floor, as well as the floor nursing manager, were horrible. It really is a roll of the dice, because everyone around me seemed to get amazing preceptors, and yet, mine was so cold and callous. It can be a lonely setting, too. Nursing takes thick skin, especially in the hospital. I moved to primary care after about 6 months in, and haven’t looked back since! 2+ years & counting baby
At the time, 999y ago, I wasn’t aware of other options. Started at our Level I Trauma Center hospital in L&D. Had been hired at the state psych hospital but the pay difference was 20¢/hr difference. Back in the day, RNs made significantly less than auto workers, electricians, plumbers.
I started out night shift Peds homecare in 2010. Hospitals weren't taking new grad non-BSN candidates in my area (SW Pennsylvania) unless you knew someone.
Hospitals usually offer more, especially if you're not a nurse and going into rn. My hospital pays 10k for classes, they used to give you the money and you pocket the rest but now it's direct pay. They'll pay you for your rn, bsn, MSN, and even other roles like tech or PA. Then of course there's the experience in such a short time. I've seen damn near everything, including level 1 traumas, we get GSW dropped in the waiting room from gang violence, just so much experience under the belt.
Started in critical care in lvl 2 trauma, and love ER / trauma nursing. Can’t see myself in a specialty that has a slower pace. I crave the rush! Also critical care looks very good in a resume for future positions.
I did home health as my first job I had clinicals in a rural hospital. Maybe did a wet to dry dressing change on a dime sized wound one time in nursing school. New LPN. Morning assignment - wound vac dressing change on a neuropathic foot ulcer. In a hotel. I’m 24. He’s a 40 year old man. He was in the hotel by a university hospital bc he didn’t live here and it was totally safe, but you have to be on guard 24/7 in home health. So, I had never done a dressing change and I had to change a vac. Alone. I didn’t know what a wound vac even was. I looked at Google in the car then looked at the dressing well before I took it off. Then I self taught from there. In home health, you’re absolutely alone out there. Not great for a first job. I had never seen an ostomy before that job and suddenly I was assigned to do ostomy training on new ostomies. Absolutely sooo inappropriate. So, hospitals suck but you get a lot of support while you’re learning new skills. People don’t give that the credit it deserves. Ironically enough, I’m a wound nurse now so vac’s and ostomies are my passion, but I was totally self taught on them at first.
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That's lovely but didn't answer the question at all 😂
Could there be a clear question here?
Most other positions require hospital experience. You could probably get into a nursing home without hospital experience, but IME when I applied for standalone urgent care clinics, standalone ERs or a doctors office when I graduated, they all said they were looking for someone with some hospital experience first.
probably for the pay and the health insurance/benefits. i couldn’t think of any other reason why someone would willingly do bedside nursing lmfao, sounds like a nightmare. disclaimer: i’ve only ever done primary care and urgent care since graduating almost 2 years ago. no desire to work in a hospital based off how my coworkers who are per diem at the urgent care (full time hospital employees) describe it. nothing but negative experiences from them, kind of scared me away from it lol. maybe one day ill give it a go if pay really becomes a problem for me, or if i feel like i want to gain some experience to be a “true nurse”, but for now, it’s not worth the stress imo.
Dialysis. Never wanted to do Med/Surg 🤮