Without any first-hand experience, it’s hard to imagine how everything will play out from the outside. Do hospitals pay CNAs more than nursing homes? Will a nursing home provide me with better promotion opportunities? Which one is the best stepping stone to my dream job?
This article will cover the main pros and cons of working at a hospital versus a nursing home. We will focus on the working conditions, the potential for benefits or professional growth, and the type of patients you can expect in each case.
Working at a General Hospital: More Opportunities, More Stress
Hospitals are inpatient centers meant for acute care. They provide services across various specialties and have their own laboratory, diagnostic, and imaging departments.
When it comes to patients, the focus is typically on getting better and getting out – either back home or back to a nursing home. On average, the typical length of stay at a hospital is just 4.5 days.
Hospitals tend to be larger and easily count their staff in the hundreds. This provides them with a more “corporate” feel, where each position has clearly defined roles and limitations. This provides more excitement, but it can be very intimidating.
Just like in any other field, a large company with revenues in the millions is more likely to offer extra job benefits, more comprehensive insurance plans, or a private pension plan such as a 401(K). On the other hand, you will also need to deal with more bureaucracy, and it can feel as if you are a cog in a massive machine.
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Do Hospitals Pay More than Nursing Homes? – 4 Pros of the Hospital Environment
General medical and surgical hospitals are the largest employer of nurses in the United States. It would be impossible to list the characteristics of each unit, but they do offer significant advantages:
A broad skillset
At a large general hospital, nurses can employ every facet within their scope of practice. Many units, such as Intensive Care, will require additional training or orientation, especially if you are a new graduate. However, once you have a few years of bedside experience under your belt, you can become a “floater” and migrate across different floors as needed – or stick to one unit and go up the ranks.
Easy internal transfers
If you are still trying to find your dream specialty, a large general hospital will give you the chance to request transfers more quickly to a different specialty. You may need to go through orientation again – but that’s less work than finding a new job from scratch.
For many nursing educators, nurses are truly forged by the hospital bedside experience. If you plan to pursue a Master’s Degree, become a midwife, Nurse Practitioner, or Nurse anesthesiologist, working at a hospital for a few years will strengthen your application considerably. Most highly-paid travel nursing positions also require one to two years of hospital experience.
Higher pay (on average)
Naturally, figures will vary depending on your state, but being a hospital nurse often pays better than working in a nursing home. According to the Bureau of Labor Statistics, the mean yearly salary for an RN at a general hospital is $81,680, whereas at a skilled nursing facility it is just $72,090. Hospitals are also more likely to offer sign-on bonuses and tuition assistance programs.
Unfortunately, not everything is rosy in the hospital world, and depending on your goals and personality, it may not be the best setting for you.
As hospitals deal with sicker patients, they often have more pressure and a more stressful environment. It is easy to feel that even minor slip-ups can have devastating consequences.
The bureaucracy at a large hospital can also be daunting: due to their stricter policies and protocols, many nurses often feel like management is permanently breathing down their necks. You will most likely need to work on a rotating schedule, including day and night shifts – at least until you get enough seniority at a specific unit.
Being a CNA in Hospital or Nursing Home – Advantages of the Hospital Environment
Most of the advantages of hospital work for nurses will also apply for CNAs: neither type of nurse is likely to be bored from repetitive tasks. Hospital salaries are also higher for CNAs than nursing homes: in 2021, the annual mean wage for a CNA at a hospital was $32,540, versus $29,650 at a skilled nursing facility.
Two more advantages to working at a hospital will be particularly important for CNAs:
More training opportunities
Many CNAs see their position as a “stepping stone” that will help them fund a Bachelor of Science in Nursing (BSN). At hospitals, CNAs will typically spend more time assisting nurses in more complex procedures, which will provide valuable learning opportunities.
Working as a CNA at a large hospital will strengthen your application to a nursing school.
More supervision and support
At a general hospital, CNAs often work directly under an RN. They will be in charge of most critical decisions and provide you with more feedback. You will also be more likely to have access to other forms of support, such as unions, hospital-sponsored student loans or tuition assistance programs, or sponsorship for extra certificates.
On the other hand, hospitals don’t hire as many CNAs as nursing homes do. As a result, you may find it harder to get a job at a hospital directly, or you may need to go through a staffing agency.
In some units, such as Emergency Departments, working at a hospital exposes you to more violence. This may include patients directly attacking you or other staff members or simply witnessing painful injuries or the aftermath of abuse cases.
What About Nursing Homes?
With a smaller size and a more permanent patient population, nursing homes offer a very different experience than hospitals.
There are two levels of nursing homes: skilled nursing facilities and assisted living facilities.
- Skilled nursing facilities handle slightly sicker patients who need prolonged rehabilitation or closer monitoring. Patients will be more likely to have active IV accesses or ongoing wounds.
- At assisted living facilities, most residents (not patients) have permanent disabilities or chronic conditions but no active medical care. Instead, the team will provide the closest approximation to a “home” environment.
Most nursing homes have more accessible visiting hours, with relatives coming and going unannounced or staying throughout the day. Both nurses and CNAs will likely see their impact on a patient’s well-being. Deaths may be less frequent, but they’re felt more acutely.
From an administrative side, most nursing homes operate like small or medium-sized businesses. Nursing home staff can truly feel like an extended family at a well-managed facility. However, if relations with your coworkers go sour, you may have no other unit to escape to.
5 Advantages of Being a Nurse at a Nursing Home
Depending on your priorities and ambitions, working at a nursing home can offer the following advantages:
A more predictable routine
A nursing home will have a stable patient population. It will be easier to fall into a routine and find time to relax or rest with the residents.
In many states, assisted living facilities are only required to have one nurse on call during the night shift or holidays, so you can dodge the fatigue of a rotating schedule. While accidents do happen, it is a far cry from an E.R. or a post-surgical unit.
The chance for more independence
At skilled nursing facilities, Registered Nurses pretty much run the show. At hospitals, you routinely need to liaise (and occasionally, butt heads with) doctors, radiologists, and managers.
At a nursing home, you will be in charge of designing and implementing your care plans and will have to rely more on your own clinical decisions.
A deeper, less-traditional skillset
Many complex nursing procedures are not done at a nursing home, and even simpler ones like IV insertions happen less frequently. On the other hand, nursing homes allow you to gain a much deeper knowledge, or even specialize, in other in-demand procedures like wound care or pressure ulcer management.
A better insight into chronic conditions and their management
If you are hoping to specialize as a family practice nurse practitioner or enter public health, consider working at a nursing home. Here, you will get a much closer look at the realities of managing chronic conditions.
You will get to see the effects of medication compliance and learn what kinds of diets and routines are sustainable beyond a 5-day hospitalization period.
At a nursing home, you can be promoted into a management position after just three or four years. At a large general hospital, you would need at least 5 (and typically, around 10) years of experience before becoming a floor manager.
Some of these advantages have very clear counterpoints. For example, even if you are promoted more quickly, your opportunities for growth at a nursing home may cap out quickly. Salaries at nursing homes are also generally lower at all experience levels.
If you decide to return to the hospital after a few years at a nursing home, you will likely need to get recertified in CPR or Advanced Life Support.
Being a CNA in a Nursing Home: Is It Better?
Nursing homes traditionally rely heavily on the work of CNAs. You can expect the following advantages:
Less hectic work
Most shifts tend to be predictable: you are more likely to know how many people you will be working with and plan your tasks and breaks ahead of time.
More predictable and independent work
At nursing homes, CNA’s primarily deal with assisting residents with their Activities of Daily Living. Your CNA license allows you to do these tasks independently. Few patients will have severe bed sores or injuries that would require a nurse’s supervision.
Closer, more intimate relationships
CNAs frequently develop deep bonds with the residents under their care. At assisted living facilities, you will also be tasked with encouraging residents to attend recreation activities, crafts classes, and social mixers. In this sense, you will be playing a significant role in preserving their mental health.
It will be much easier to find a job
As a fresh graduate, entry requirements at a nursing home are much more attainable than at a hospital. Most staffing agencies that serve large hospitals and home health agencies will usually prefer CNAs with at least three years of experience.
If you look beyond the money, you will find no final answer. Many of the advantages of being a hospital nurse versus a nursing home nurse, such as excitement or variety, can quickly turn into a downside. It depends on your personality and the type of life you want to lead.
If you dream of being part of the code team at a busy ER, a nursing home may not be for you. If you have an introverted, empathetic personality and seek deeper connections, a nursing home will allow you to do the most good.