Author Topic: Should I prioritize launching my new nursing career or living local/car-light?  (Read 2577 times)

BWholehearted

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I will be graduating in three months with a two year nursing degree (I have a previous BA). My husband got a job in Enumclaw, WA (Near Seattle-Tacoma area) and we will be moving across the state in June when I finish.  I am starting my job/internship search and am weighing my options: location of work vs. the position itself, quality of workplace, etc.  Enumclaw is within an hours drive of Tacoma, Issaquah, Seattle and therefore a number of great hospitals. But there is also a 33 bed hospital in Enumclaw that is about 2 miles from my husband's office and we could easily rent a house within a few miles of both jobs.  In case it makes a difference, his position is temporary so we will likely live there for 2-4 years, position renewed annually at the end of each year (so we will know one year in advance that the position will last another year)

I would LOVE to live a local life where we didn't need to use a vehicle during the week.  I also want to get my new nursing career started right.  Should I suck it up and spend a year commuting and getting experience at a big fancy hospital like UW, Seattle Children's, Harborview, etc. or shoot for the smaller hospital in Enumclaw?  Thoughts?

Nursing specific details for those who want to know: I am currently most interested in PCU (step-down from Intensive Care Unit) but am also interested in possibly the Emergency Department in the future.  Several friends in the area have recommended trying to get a year of experience in ICU because then you can go anywhere.  I don't think the ICU is where I would want to be long-term, it seems awfully stressful, but being that my other interests are fairly high acuity, it's certainly in the same area of expertise. I am also taking Advanced Cardiac Life Support over spring break in a few weeks so hopefully that will add to my marketability right out of school.

Also, if there is anyone in the area that has some local knowledge or suggestions, I'd love to hear them too: internships, who hires new grads, and who is awesome to work for?

Thank you so much!
« Last Edit: March 10, 2015, 11:32:37 PM by BC »

badamsa

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Little background on me: Currently an ICU nurse working in TX. I completed a new grad internship in an ICU setting after I graduated. Been in the ICU almost 4 years, working nights for the past 2 years due due to low pay at the hospital I'm at. I'm burnt out and ready for a change. Luckily I have one on the horizon :)

It all depends on what you want. Do you like the idea of 12 hr shifts, every other weekend and holidays? Or would you prefer 9-5? How would you feel about working nights? Would you prefer 5-6 less acute pts or 2-4 more acute pts?

The first thing to keep in mind, it is always easier to move from a more acute to a less acute setting. Same goes for hospitals: easier to move from a bigger hospital to a smaller one (assuming they have openings). Also, the first "level of acuity" experience you get will have a bearing on jobs you can get in the future. Like you said, having ICU experience means you can pretty much go where you want. If you start out on a general med/surg floor, it will be more difficult to move into the ICU or other specialty setting (not impossible, just more difficult). What types of units do you have experience in so far? Any that you have liked? Why the PCU? (its not a bad choice, just trying to gather info)

I will say working nights while my wife works days has gotten old pretty quick. It works for some people, just not for us. I haven't gone to days due to lower pay because she is getting her master's. She is graduating soon thankfully.

ACLS is good to have, but most hospitals hire who they like and then get them ACLS certified.

I would recommend an internship in a unit you are interested in. It keeps you from having to just take any job and helps to separate you from the large pool of nurses that recruiters choose from. Having said that, working 12 hr shifts in an ICU plus an hour commute would be miserable IMO. Doable for some, just not me.

I have no knowledge of that area unfortunately, but most of the hospitals will have the info on internships listed on their websites.

Hope this helps!

MsPeacock

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I am not a  nurse - I work in mental health and train psychologists during their internship year (PhD). Since you are just starting out I would recommend going where you will get the best training (which sounds like a larger hospital, ICU - based on PP). You state you will only be there for maybe a maximum of 4 years. IMO, the better your early training the more flexibility and choices you will have later. If you don't get the experiences in early it will be very difficult to get them later. My friends who are nurses have widely varying experiences in terms of how much call they have to take, how much choice they have in the shifts they work, etc. If you have strong opinions about what you want later (e.g. not working nights) I would say the better your training is now the more you will be able to pick and choose later.

money_bunny

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Background: I am a Nurse Practitioner. I also had a BS in something else, and then got an ASN then an MSN. I am applying now for DNP programs.

Since this is MMM: My employer is going to pay for 90% of it. Which is great. Tuition reimbursement is something you will want to look for as you go along your career path. If "Two year degree" is a ASN, then you are going to have difficulty getting hired compared to BSN RN's. Especially for positions like ICU. Magnet requires a certain MSN/BSN/ASN ratio or better. One of the places wanted to hire, but because I only had an ASN I could do travel but not be on payroll as a permanent employee.

I agree with the internship option. Every year the schools disgorge their flock of new RN's and they go and all send their resumes to all the hospitals. The three "Highly ranked" hospitals by me that I have worked at generally hired ONLY out of their Internship pool for new RN's and then poached other facilities 2-3 year seasoned graduates with their better benefits and higher pay rate. The ASN students I graduated with, most of them had offers upon graduation. Since a large number of new RN's quit or change jobs in the first year, they shy away of investing 0.5 to 1x of salary on training and not get a decent ROI. Many facilities have had an issue where the new graduate with a BSN needs 1-2 years of ICU to be eligible for Nurse Anaesthetist programs and they then leave for NP school. 12-14 week orientation with another RN, all that lost. Something to not mention if that is your plan. Something to mention if you are a smart, motivated RN, who wants to stay an RN.

The other thing I want to mention is they used to not start new graduates in ICU. That is a complicated low room for error environment. 5-6 pumps, complicated sterile procedures, sedation, lots of "If you miss something patient dies" situations.

You may end up working in an environment on shifts you don't want and commuting in an non MMM way for the first year or two until you get enough experience (and networking) to then have your resume even looked at by the local nurse recruiter at your local hospital.  It's called paying your dues, and it's part of being in a hierarchical system, and it's something we all have gone through. I'm not saying that to be patronizing or to "Eat our young." It's that like in Goodfellas "Sometimes you just have to take a beating."

Good luck.



MayDay

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My mom started in NICU (got in probably because she had been teaching childbirth ed at that hospital for years) then later moved to ICU.  Since having that ICU experience she has been able to do anything she wanted.  She is now the manager of diabetes education, giving her an amazing daytime schedule with no call, nights, holidays, weekends.  But to get there she was working 12 hour shifts nights and weekends at the ICU. 

I'm not sure you need to be at the big city ICU, though.  My mom's experience was all at medium sized town/small city hospitals and not being in a major city hospital never mattered- just the department she was in.  So I'd say apply for ICU at the Enumclaw hospital. 

I have a friend who just graduated with a BSN and she was not even considered for ICU positions as a new grad.  She took a nursing home job where she was doing vent patients- she need a couple years of experience with that type of thing before an ICU would hire her.  She is in a market with quite a few nursing programs, though, so the job market may be a bit tighter than where you are. 

lizzzi

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Hi, I'm an RN-BSN with 42 years experience, about half hospital and half home care…civilian and military. I'd recommend starting with a big, teaching hospital…ICU experience would be great, but I agree with whoever said they may not put a new associate's degree grad. in the ICU. Your career--whatever you choose to do in the long term--will benefit big-time from a year or two starting off in general med-surg. work--the med-pass, dressings, IVs, Foleys, dropping NG tubes, whatever…just general bedside care and learning to work well with the patients and the other staff. I am a great believer in living close to work…my absolute longest commute over the years was 30 minutes one-way…but if you have to live a little further to get the good experience, I would do it for awhile. Just make sure you only do eight-hour shifts…which of course will turn out to be 10 hour shifts, because you won't get out on time. (Yeah, nursing…dontcha love it.) Then after a year or so, if you want to go into something more specialized, you can start looking around. And don't forget to plan how you are going to get that BSN. You'll need it to open doors. I was an associate's degree RN for ten years before I picked up my BSN. I never had any trouble finding work, but it was the BSN that got me out of the hospital and into a fabulous position as a public health nurse…a nine-to-five case management job with a real opportunity to make a difference in patients' lives. I thought I died and went to heaven, although once in a while I missed the technical aspects of hospital work. The trouble is…and it's everywhere…they never give you enough staff to really do a great job on the floor. And that gets frustrating. (Good old nursing--the job we love to hate.) OK, I"m rambling, so will stop.

acrosstherainbow

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I would say that it depends on what your long-term goals are. Do you want to go to NP school? Go into management? I would tailor what you'd like to do to where you'd like to work. You will learn and experience more in bigger hospitals, and Harborview in particular is probably the most acute place. But if you don't really care all that much about where you end up later- go for the local hospital. Most places are doing 12 hour shifts now, which IMHO are great because then you get 4 days off and can take up to 8 days off in many places without using any vacation time.

 But keep in mind that the WA market isn't the best right now, from what I've read, especially for new grads with no ties to the area, so it might be a situation of you taking what you can get (I'm from Washington, but didn't work there as a new grad, by choice since I got a great offer out of school somewhere else). Best of luck with the job search!

MayDay, just a quick pet peeve- NICU is the ICU too ("Neonatal Intensive Care Unit"). Of course some NICUs are more like "progressive" care units instead of an ICU, but there many that have patients as acute as sick adults, intubated, on ECMO, pressors, etc etc.

Sunnysof

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Don't know if it's the same in the US, but in Canada small hospitals are great for getting hands on experience in everything. You may not have all the fancy equipment of a bigger hospital, but you are a vital part of the team. Your clinical skills will develop much faster. You'll have to do different kinds of nursing, work with all kinds of patients. It can be more stressful initially because you have less back up, but I think you'll learn more. Plus you often have more freedom to make decisions, and influence how you work because there is less bureaucracy. I know if I were hiring, I would take someone with small town general experience over a fancy hospital super speciality because I know the former would be adaptable, resourceful and independent.

Fuzz

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Invest in your career now. There are two simplified routes:

(a) You can optimize for income now, and optimize for low expenses and lifestyle later. Or (b) you can optimize for low expenses and lifestyle now, and never really have the chance to optimize for income.

In the mustachian quest to financial freedom, we sometimes focus too much on minimizing expenses, where extra effort on maximizing income will go further toward financial freedom.

Bracken_Joy

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Following.

I don't have much to add, I am just in a very similar situation (even same length of commute). Going to watch the feedback with interest!

accolay

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Is the closer hospital hiring?

If it were me, commuting sucks for many reasons, but I think it'd be best to "pay your dues" at a larger hospital, preferably a trauma level one where you're going to see and experience taking care of sicker people. In the meantime, work on that BSN.

Additionally, people complain about unions, but I know the nurses at my hospital would be screwed if we didn't have one.

As far as the units you think you want to work: you just never know what unit you're going to end up loving...it could be the place you thought you hated most. Work place environment also depends on co-workers and your manager.

darkadams00

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DW has two close cousins (BSNs) who married doctors-to-be near the end of med school. After graduation, each doctor relocated to pursue his own career, and the wife followed. In both cases, the primary decision was to support the husband's career first. The wife's career was considered secondary, so job search parameters were set after the husband doctor's job was secured.

Unless you live in a fairly populous area, few couples can equally pursue both careers. Small towns rarely offer equal job opportunity for both careers. In your case, if it's simply a  brutal commute issue for a measurable period of time, then it might be okay. Don't worry about "Mustachianismo." As a married man who has observed a variety of family/friends, I would be more concerned with 2 years stretching to 4 years stretching to 5 years and so on and potential marital fallout/resentment. The key decision here is not "which town", "which hospital." It's "what happens if I do x and find out it is unbearable beyond the first year." Is the DH supportive? Does he have high expectations of your career/your income level? If you tough it out for 2 years, would he consider moving closer to your work and finding a job for himself? Who gets first priority in the long-term? Worry less about the commute. Spend much more time and effort discussing future career/income/life expectations with the DH.

BWholehearted

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Thanks for all the input everyone!  I appreciate hearing all the different perspectives. I want to reply more specifically but I've got to go punch my last final in the face.  I have one more quarter to go, so I'll be done in June.  I've started applying for internships for new grads around the Puget Sound to keep my options open so we'll see what happens next.

Cheers!