In the hospital is more acute illness and aggressive treatment, procedures, surgeries, etc. with less patients to care for. In the NH you may be the only RN on your shift usually as a charge nurse and will supervise others and the patient care that is given. NH patients can be very ill but are usually chronic and not expected to recover. I've worked in acute and long term settings and I liked both. It is very different. I really got attached to the long term care residents I cared for. Good luck with whatever you choose to do.