Just as patients evaluate different settings for their medical treatment, nurses should, too, to find the one that best fits their career goals and life situations.
And there are many choices. In addition to hospitals -- acute care, teaching and rehab, to name a few -- nurses can work in prisons, schools, public health departments, clinics, nursing homes, home healthcare, physicians' offices, colleges and universities, workplaces and research facilities.
With all these options, nurses must carefully examine their skill sets, professional goals and personality types to determine the best venue for their careers.
Location, Pay and Schedules
Unless you want to see the world as a traveling nurse, you will probably choose a facility close to home. Hospitals, public health departments, clinics, nursing homes and schools are found in communities of all sizes, but metropolitan hospitals and rural hospitals offer very different opportunities and pay rates.
"If you want to work with higher-acuity patients, then look for a larger hospital," says Kathy Murphy, clinical director for Nursefinders, a healthcare staffing service in Arlington, Texas. Such experience will allow you to move more quickly into critical care, emergency and other specialties. "If you want a greater connection with the community and less acuity, then community and rural hospitals are the better choice, because you have a much more intimate relationship with your patients," she says.
Not surprisingly, metropolitan hospitals typically pay more than rural hospitals, and this may be a significant factor in your decision. But if a slower-paced environment with a more predictable schedule is more important than higher wages, then smaller hospitals are a good match, as are schools, prisons, community clinics and public health departments.
As for other settings, home healthcare nurses have the satisfaction of being able to draw on their assessment and education skills to treat patients, but they must work solo. That can be stressful when it's midnight and you are trying to decide if your patient is having a heart attack, says Murphy.
Psychiatric facilities offer good pay and challenges unique to other healthcare settings, but unless you possess considerable patience and empathy, you may be dissatisfied with not seeing much improvement in your patients. If you would find helping disabled patients regain functionality rewarding, consider rehabilitation hospitals. If you want to work with the latest technology, look into teaching hospitals.
Third-Party Validation
Regardless of the size, setting or location of a healthcare organization, accreditation, awards and Magnet designation can give you nonbiased clues as to the working conditions at a particular facility.
The Joint Commission on Accreditation of Healthcare Organizations evaluates and accredits more than 16,000 healthcare organizations in the US based on strict guidelines. State and public hospitals also have accreditation programs that ensure nurses a measure of commitment toward patient care.
Awards can say a lot about a venue's staff and management. A good place to look is in "best places to work" reports in Fortune, Working Mother and regional business journals.
Recognition in a specialized area of treatment can also be telling. You can find those rankings in US News & World Report's guide to the nation's top hospitals.
Finally, Magnet designation from the Magnet Recognition Program is awarded to organizations that have a proven level of excellence in nursing care. The American Nurses Credentialing Center developed the program to recognize healthcare organizations that provide the very best in nursing care.
Whatever setting you're considering, be sure to review its policies and to ask around. For example, some hospitals are moving toward restricting mandatory overtime. Other facilities are increasing whistleblower protection so nurses can report unsafe conditions without fear of a backlash.
"The bottom line for all nurses is that we come into the profession to provide quality care to patients," says Valerie Magee, RN, director of nursing for Beitler Staffing Services in Chicago. "We want to give the best patient care in the best possible care setting that we can. Accreditation, awards and Magnet status [are] important -- and so [is] word of mouth."
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