Requirements for new nurses - page 3

After having been in nursing for twenty years I feel that there should be some requirements for new nurses. It is nice to work in specialized areas such as ICU but you need to have an overall... Read More

  1. by   JMP
    The one thing you will learn on a TRUE med-surg floor is orgainization. There can be in invaluable lesson learned in this enviroment.

    I spent only 8 months on a surgical floor in a large hospital, and due in part to the fact it was a teaching hospital and a PRIMARY care based nursing unit...I gained insight and knowledge that can only come from doing it. I LEARNED NOTHING LIKE IT WHEN I WAS IN MY so-called CONSOLIDATION- but that was due to the hospital ( small and backward) not the teaching staff.


    I also found that the longer I was there, the more sure I was that I DID NOT WANT to stay there.


    Many nurses use med-surg as a place to step out with basic training, get a taste for what is out there and THEN decide where to go.

    I think RN's who go directly INTO a specialty are doing themselves OUT of a GOOD LEARNING EXPERIENCE.

    Nothing can replace EXPERIENCE........ but it has taken me two years to really SEE that.

    My opinion, based on experience.
  2. by   JMP
    Now I am rethinking my last post and re-reading some of the previous posts and want to add- after spending over a year ICU, I can tell you with EXPERIENCE that you DO NOT get the same organization skills that you get up on med-surg floor.

    I work with new grads that come staight to the unit and they are fine, keen, etc. BUT require ALOT of help and support, which is FINE, but had they been up on the floor first, I feel they would have been more confident and had more experience with the multi-systems problems that ICU pts often have......

    I am two years out of school, have taken a year long critical care program AND many courses, like TNCC, ACLS and degree courses and........... would I will tell you NOTHING CAN REPLACE experience on a busy, active TEACHING HOSPITAL floor ........ that is just the hard reality.

    However, many new grads can walk into ICU, CCU etc with NO experience because of the nursing shortage..... and I would have too...except the person who interviewed me wanted me ...encouraged me...... to take a few months and try the med-surg enviroment. I am glad I did.

    Not doing it would have taught me nothing....doing it TAUGHT ME SO MUCH.
  3. by   Enabled
    JMP, just a quick query is the BSN still the entrance level required in Canada? I have a cousin in Halifax that wanted me to go to school there. I don't know how it would affect licensing in the States. The "Colonies" have done pretty well for themselves I might say. I found that it was a bit warmer in Florida but not this week. I found the Canadian people to be warm and inviting. Some of the horizons in the Eastern Passage area are magnificent as they are true painting of the Man upstairs. I remember the sun coming up around 5am. I still have relatives in the Halifax area. We are a bit slow when it comes to changing entrance into the profession. Since 1965 ANA has had a position paper that entrance should be the BSN. I have also been to Montreal and Quebec. They were friendly but not as much as the maritimes. Many would be speaking in English and when they saw someone who was a visitor they switched to French. I hope to return to Canada someday as I really feel like it is a home away from home.
    Also when it comes to some time on med/surg at the beginning procedures as simple as dropping an NG tube can be learned without have to do it for the first time in a crisis situation.
    Enabled
  4. by   sbic56
    I used to think that med/surg experience was very important prior to working on a specialty unit. I have come to realize that is old thinking. In medicine, as in most fields, the focus is on the specialized rather than the general aspects of the field. Remember when most docs were GP's with only a few specialists? Now they are mainly specialized and family practice docs are quick to refer to the specialists when the problem is out of their scope. I see a similar evolution in nursing. Nursing school focuses most on med/surg nursing. While extra clinical experience on med/surg may be ideal, I don't think it is as necessary as it once was because we are so much more specialized than we once were. I think the time would be best spent with a more intensive orientation on whatever specialty unit the new nurse chooses instead of the med/surg experience.
  5. by   JMP
    Enabled

    Many proviences have or are mandating that ALL new RN's have a BScN to graduate.

    Ontario ( where I am ) has mandated it and as of 2005, you need to be a graduate of a degree program to write the RN's.

    Many proviences ( like the ones you mention ) in the Maritimes, ( east coast) have mandated it as well.

    When it comes to simple procedures - you mention insertion of a NG tubes- I think it depends on where you practice, as a student, I witnessed many RN's do it, but now I work in a large teaching hospital and feeding tubes and NG tubes are inserted by eagar residents.

    I stand by my feeling that a new nurse should spend some time consolidating their skills in a place like med-surg..... and then go to their specialties. I know nursing is becoming specialized, but basic training is still basic training and in order to specialize you need the clinical judgement and skill that comes with "doing" not just reading about...... just my own thinking here.
  6. by   New CCU RN
    Enabled,

    You posted to my response a long while ago... but I just wanted to say that the majority of ICU orientation.... at least in my experience are much longer than a floor's as a result of the higher acuity patients... mine was 4 months. Many of the other hospitals I considered were comparatively long. All of my classmates that went into ICU also had at least three months orientation.... I agree that six weeks is no where near enough time...

    Anyway, I just wanted to restate that it really depends on the nurse. We just had a nurse with ten years experience come to the unit and not make it through four weeks of orientation when she was told she wasn't cutting it. We also have new grads that are doing awesome at the same time. It all depends on the person and their ability to learn quickly.
  7. by   Enabled
    Originally posted by JMP
    Enabled

    Many proviences have or are mandating that ALL new RN's have a BScN to graduate.

    Ontario ( where I am ) has mandated it and as of 2005, you need to be a graduate of a degree program to write the RN's.

    Many proviences ( like the ones you mention ) in the Maritimes, ( east coast) have mandated it as well.

    When it comes to simple procedures - you mention insertion of a NG tubes- I think it depends on where you practice, as a student, I witnessed many RN's do it, but now I work in a large teaching hospital and feeding tubes and NG tubes are inserted by eagar residents.

    I stand by my feeling that a new nurse should spend some time consolidating their skills in a place like med-surg..... and then go to their specialties. I know nursing is becoming specialized, but basic training is still basic training and in order to specialize you need the clinical judgement and skill that comes with "doing" not just reading about...... just my own thinking here.
    DITTO
    Since you have eager residents doing it they should be supervising interns and med students in doing it. They should be beyond putting NGT down or replacing a G tube. Occasionally, nurses where I worked were able to put GTs in if they had just come out and there had been an established tract from the length of time it was in. Many times the GI docs used a foley catheter with a 39 cc balloon. Let me know if you have any problems getting a foley into a male patient one of our urologists gave a suggestion so that it was more comfortable for the patient and not as time consuming if there was BPH. The trick is to put lubricant down before the foley. I also found it more controllable to leave the saline syringe in place with the saline that way they never get mixed. Docs don't care to come in at 3 am for someone who made a mistake and used the lubricant. Also, it is easier to drop an NG if you have the patient swallow ice chips as it will help to bypass the gag reflex. Nurses need to learn these procedures just as much as the docs as they maybe in a situation when a doc isn't available. We use NGT that have a separate line to suction and do enteral feedings if necessary. It is easier when you are able to continue giving a patients their meds.
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  8. by   MrsK1223
    I am a fairly new nurse...2 yrs out...looking at specialties...started in Psych and now in dermatology. I'm looking for my niche'. I enjoyed my medsurg rotations in school but honestly in the state of nursing especially on med/surg floors with few nurses and too many patients...I can't stand the thoughts of being in a stressed state all the time. Instead of sentencing new grads to Med/surg just because thats where's the biggest shortage is...maybe more nurses should really rally together against their hospitals for making jobs on Med/surg units so stressful and dangerous with High acuity/ low staff, long hours and mandatory overtime. At my local hospital, I've heard more horror stories from new grads I graduated with and senior nurses on this particular med/surg unit...no one stays more than a month or so and they are running for the hills. I worked too hard for my license to lose it because I'm new and have been thrown out to sink or swim. I think med/surg would be great experience but I just don't think I have the strength to go thru the the stress of having so many lives in my hands and taking care of responsiblities of the doctors, the aids, dietary, maintenance..etc.....and they don't pay enough to carry that load. Like I said...I'd do med/surg but not in the state it's in right now. I'd gladly take a 7-5pm job for less pay.
  9. by   Enabled
    Melissa, I was not saying to have new nurses go to med/surg for staffing purposes but to get skills and procedures down before specialization for which I was crucified by specialty unit nurses. If every keeps the same attitude about the staffing in med/surg the will be less nurses and more stress and nurses are speaking out loudly in public about there discourse and the public is taking it the wrong way. The public needs to be educated that there isn't just a nursing shortage but that in the next 15-20 years the life expectancy once again could drop as there will not be anywhere near enough nurses to take care of even half the patients they have now. After having a relative in the hospital recently on a tele floor I believe that some not all nurses make problems for themselves. Each time going by the nurses station the nurses were standing casually. My relative asked for Tylenol for a h/a and got the reply when the nurse returned I usually forget things like that now. You don't say things like that in the presence of a patient whose wife was there and is an RN. That unit has a 3-11 ratio of 6 to 1 with monitor techs and additional aides. The med/surg units are barely staffed and they are still being pulled from because one of the other nurse managers can't keep staff. That leaves the med/surg nurses with the possibility of 9 patients with up to half on tele without a monitor tech.
    Now with the shortage a well know law firm is having commercials about nurses making errors that would be malpractice now that they are not going to get the big bucks out of the docs. If you know anyone who does not have liability insurance now is the time to get it before the rates skyrocket. I have emailed the firm and asked what they have done to deplete the shortage in the area such as a nursing scholarship. I would also suggest that they don't go to any facility that can see the commercial.
  10. by   MrsK1223
    Hi Enabled. I think the experience one gets from med/surg is priceless. But there's not going to be an increase in nurses to that area as long as the current nurses don't try to do something about the conditions. My mother worked med/surg at the same hospital I was speaking of for 5 long years while i was growing up and we never saw her and there are lasting effects from it. Before I'm a nurse I'm a mother and wife. My son has ADD and I have no support other than my husband and the local medsurg unit works their nurses easily 16 hrs if not more. That's no life for me or my son. Like I said, I would love to get that experience but I saw it first hand what a shift is like there. Moving is not an option right now for me. So now I work for a meager $13.50/hr and can't even get full time. I've seriously thought of applying for the ICU opening. I prefer specialties, it's just finding one that is full time and pays decently. And what you said about the lawsuits and commercials..it's terrifying for nurses these days. I have liability insurance and I jsut work for a dermatology office. But you never know who is going to find something to sue you over. I'm telling you, maybe my fear is unwarranted but I am scared to death to work in our hospital....it's in bad shape. When I would love to do it....but there needs to be adequate orientation and skill checks and mentoring/or preceptors to help nurses new to the area/ or new grads. Then I would surely go for it.
  11. by   Enabled
    Maia, its unfortunate that some nurses don't want to go to med/surg or OR from what I have been told. I am now disabled as a result of my previous employment but still feel as though I can be a productive nurse. Many times patients get five minutes of diabetic teaching on how to inject insulin or do a fingerstick. It is miraculous that both get accomplished. Disabled nurses could do patient education, advocacy, be a preceptor for a new grad, support for the staff in obtaining orders so the nurse can stay with the patient, phone triage, call discharge patients the day after discharge and then 3 days later. By 2020 there is estimated to be nearly a half million positions that will be open and I can assure you that the greatest portion will probably be med/surg and OR. If nurses and new grads are not attracted to this area then those who are working will be heading out the door for retirement or burnout. I don't think it is fair for the tele floor to have 6 and tele monitors and med/surg have 9 tele but no monitors and one tech with 36 patients. If we don't start helping each other I feel we will loose our status as professionals as professionals hang in there when the going get tough. The local hospital also offered incentives to RNs and not LPNs and the RNs were told they were milking the overtime and you can imagine the tension between the LPNs and RNs that was caused by administration. LPNs who worked over should have been given an incentive increase also. As I said the public is hearing the word shortage but it really doesn't phase them. There is also another group of nurses beside disabled ones who could be productive and that is a nurse who has small children who go to school and they come in after the child is in school and leave in time to pick the child up or meet the bus. My girlfriend is a nurse manager and she said that they would consider that nurse and the disabled one as part of the entire shift staffing even if they did not work anywhere near those hours. Then they would pull from the floors. I always seems that most of the pulling comes from the med/surg units. We have had tele nurses refuse to come to the unit and we give them the easiest patients and only 6 as they are use to and no admissions and they still complain when they float. We didn't get a chance to refuse. I went to ICU one evening and ended up with 4 pts and was told you handle a lot more than that upstairs. That doesn't matter as I was out of my field. We frequently have an RN floated only to possibly get a tech and there isn't any equivalency in that equation. You should move as here in Florida a starting RN gets about 29K and moving and other reimbursements. In the northeast and far west the new grads start at almost double but their cost of living is much higher. Major hospitals in the Boston area have closed beds but the community hospitals here refuse and I know it is the final bottom line. I don't believe it is good care to have a patient on a stretcher in the ER for days waiting for a bed. Other hospitals refuse. The law is to stabilize and transport to another facility. No because they charge more bucks than the other. With my recent admission fingersticks were $24 each time and I was QID. They could have purchased a new monitor and 50 strips for that and I was just one patient I sure there were more on the unit.
  12. by   MrsK1223
    Enabled, did you say you was from Florida? My husband and I have actually considered that state, around Coleman...he's in the prison system...working not serving a sentence. hahahaha. The way things are going here in eastern KY...we will have to eventually move...there really isn't any work here. If I could have it my way..hahaha...I would like to work in community health and education. I love patient education. MY goal eventually is to get my masters and obtain nurse practioner licence. I have so many ideas and interests that are in and outside of bedside nursing. I think having an education clinic would be awesome. At the same time, I would love to work in an ambulatory clinic...I work in a specialty office right now. Let me know what hospitals or medical facilities you know of in your area. YOu never know...I may be on my way one day.
  13. by   MrsK1223
    OHHHH Enabled....I think utilizing disabled nurses to help mentor/or precept new grads or nurses new to certain areas would be great. There is buzz in the nursing realm that the seasoned nurses (not all but some) that eat their young and have seen it for myself...makes the field intimidating to the new.
    We as nurses need to embrace each other cause we are so short... I would love to see that here!

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