MSN, RN, NPD-BC
Being a new nurse graduate is an interesting experience of varying emotions and tough decisions. You may experience the relief of completing one of the most challenging academic programs. At the same time, you’re careful not to get too relaxed, as the NCLEX is up next. Amidst all that, you’re fine-tuning that resume and practicing interview questions.
All that work finally pays off, and you think all of your major decisions have been made. But it doesn’t end there.
As a new nurse graduate, you should know that not all nurse residency programs are the same. For some organizations, your home unit will be determined before the start of the program. The new graduate nurse chooses a track (medical-surgical, surgical, progressive care, critical care, emergency services, etc.) and then interviews for multiple units within those areas, as applicable. After being selected for a home unit, the nurse residents begin classes and orientation.
For other programs, nurse residents are hired in a track and don’t interview for their home unit until completing a series of classes, shadow experiences, and orientation on multiple units within their track. Whatever structure you encounter, if you are offered positions on multiple units, your next major decision is which one to accept.
Many nurse residency programs have contracts that require you to work on a certain unit and the organization for a specific period. Breaking that contract usually results in the nurse resident paying back a set amount of money to the organization.
If you’re anxious about making the wrong decision, or worried about feeling stuck in an environment that’s not conducive to success, consider these factors to determine what’s best for you and your career.
Trust your instinct. It’s something you’ll need when you start your first nursing job anyway, so you might want to get ahead of the game. Sometimes, the monitor may not show clear signs of patient decline, but you have a bad feeling and run in to check on the patient. The same goes for choosing which unit you want to work for. If it feels wrong, it most likely isn’t a good fit.
I could probably stop here, but let’s explore some other factors that might help with your decision.
There’s no guarantee you’ll get your shift of choice as a new graduate. Many times, the shift you are offered will depend on the unit’s needs. Reflect on whether the shift you are offered is a dealbreaker.
This applies to those who receive offers from multiple hospitals or a healthcare system with multiple campuses. A lot of times this comes down to whatever shift you accept. Some say a job closer to home eases anxiety about waking up earlier to beat traffic. For those who work nightshift, a job closer to home shortens the amount of time on the road while sleepy.
There are a few factors to consider when choosing to work on a smaller unit or a larger unit. Depending on your perspective, these factors can be pros or cons.
The environment on smaller units tends to be more of a family atmosphere, where everyone is accustomed to jumping in and helping each other out. There is an “all-hands-on-deck” mentality.
Smaller units tend to get closed periodically due to low census. This could mean you may be put on call and need to use paid time off if your shift eventually is cancelled.
You might also be frequently floated to other units. Being floated can be a favorable experience, depending on your learning needs. But it might not feel like a favorable experience if you think you would benefit from learning the specialty of your unit alone. If you embrace the challenges of a diverse experience, floating may be a great fit.
Larger units sometimes can indicate larger amounts of staff and coverage. But it could also mean higher nurse-to-patient ratios. Larger units may have more resources, such as preceptors. While at the same time, if there’s turnover, those resources may be spread thin due to frequent onboarding.
Nurse-to-patient ratios are often out of the control of the unit leadership. Reflect on what different nurse-to-patient ratios mean to you. Would you be able to build your time management and prioritization skills to manage large ratios? What does support look like on that unit? Would a smaller ratio help you focus on your patients more effectively?
Be sure to inquire about the orientation structure during the interview. Ask about the length of orientation, its structure, and preceptors’ availability. Remember that preceptor availability is sometimes out of the control of the unit leadership. However, there are questions that are important to ask
In addition to preceptors’ availability, you can ask about their consistency. Will you have a primary preceptor that follows you the entire orientation? Will there be a secondary preceptor as backup? Is there a mentor system in place
With different preceptors, you learn different nursing styles, and that can help you establish your style. However, having too many different preceptors can cause gaps in communication and barriers to the continuity of your learning. Ask yourself if the orientation duration and style fit your individual learning style and needs.
If the interviewers don’t offer to have you shadow a nurse on their unit or give you a tour of the unit, feel free to ask for a shadow experience. During that time, you can get a feel for the culture of the unit. Did you feel at home? Did you feel welcome? Was everyone willing to answer your questions?
There is no such thing as a perfect job, especially in nursing. While the profession is super rewarding, there will be challenges. Every shift is unpredictable and sometimes does not go as planned.
With that said, it is important to put significant thought into your decision on which job offer to accept. Go where you feel you will be most supported in navigating those unpredictable and challenging shifts. Go where you feel those challenging shifts will be used as learning opportunities not failures you cannot recover from. I wish you all the best with your next decisions!
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