Requirements for new nurses

  1. 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 background in med/surg. I think that at least 6 months to a year should be required and then if someone wants to specialize than so be it.
    I have been in enough classes now that I am at almost completion of my BSN to know that there are a few facts that disturb me. First, in each class the "specialized unit" nurses always seem to slam techs and UAPs to the limit. Many being in these specialized units have a much lower patient load than those on the med/surg units. I worked for many years on 3 to 11 only to have a minimum of 7 patients. The only time the census went down was at the holidays meaning Thanksgiving, Christmas, and New Years. Med/Surg gives a new nurse a generalized knowledge on the patient who may have multiple health issues as well as learning and being able to perform procedures proficiently. There are over 2000 hours in a work year and that is a lot of experience. Unit nurses ususally have 1 to 3 patients Granted there are more specialized technical equipment but most of the unit patients are on vents so that there is little physical activity as it is passive when done by staff. Many units will not employ techs or UAPs for patient care but for doing supplies and trash, etc. Second, on the general med/surg unit the tech can make or break a nurse or the unit. I guess I was lucky with the techs I worked with. I would see to it that they recieved report unless there was an emergency within an hour or so of my getting report. They were trained to do fingersticks and other procedures. Periodicaly not only the facility required competencies but the unit would do competencies. If there was a deficit than the nurse or the tech would then be monitored until performed correctly. Also, the unit I worked had seasoned techs who could tell you more about some patients than the nurse who just had that patient for the previous 8 to 12 hours. Third, many of my classmates did not even want techs giving baths or assisting with baths. Well, with a lighter load that is somewhat attainable. On the m/s unit we split responsibilities. If there was a particularly difficult patient than we did it together. If one shows trust and professionalism and not condemn techs can be not only lifesavers but licensesavers. I worked with one who had been an LPN who gave up her LPN so that she could have closer contact with the patients. There is always going to be one that like anything else doesn't work out well. That happens everywhere in every position. We must utilize these staff members or the shortage predicted to worsen over the next 5 to 10 years will even be worse than anyone anticipated because the nurses will be doing all and there will be less of us.
    So my colleagues and soon to be colleagues. get that year of experience so that you know what to look for in a multiple entity situation. Know what it is like to have more than one patient crashing at a time and ER on the phone insisting to give report. Those things will help you develop your skills in prioritizing, how to delegate responsibilities to other staff members, and yes to prepare you for those "Specialty units"
    Several have posted that they are going from one program to another higher academic program. Once you have your RN get your experience because when you fill out those applications for school and future employers they do not want to see that someone hasn't had enough patient contact hours or that they have been working one or two shifts a week while in school. Two classmates complained the most. One worked one shift a week and worked at another nonhealth care job and the other in employee health.
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  2. 43 Comments

  3. by   frankie
    I say let us all welcome new nursing grads with open arms - wherever they are hired to work. I worked in CCU in nursing school and as a new grad. It has not made me a less seasoned nurse. My nursing carrere has been long (greater than 20 yr) and satisfying. The new nurses need to be slowly integrated into this harsh world of prospective payments, UR, QA, PI. TQM, managed care. We had the benefit of "working" 3 days a week in the hospital as "clinical", and caring for 10-15 patients each day. The we worked evenings as a nursing assistant. Let's not eat our young. They have worked hard in shcool and deserve our mentoring. take care, frankie
  4. by   NICUNURSE
    As a new grad nurse who is starting out in an ICU (NICU) I have to say that I don't agree with you ENABLED, for three reasons. First, with the nursing shortage, the average new grad program in 6 weeks in length ( I should also add that most hosptials that accept new grads on a specialty unit give them extended training.). After that, a new grad nurse is expected to function independently. Working on a med surg unit, that means being responsible for 8-10 patients, whereas on a specialty unit, that means 1-2 patients. Since you said that new grads need to work on their organization, etc., it seems to me a bit safer to have a new grad manage 1-2 patients, rather than 8-10. And truthfully, in nursing school, I felt like a much safer and more effective nurse, in my critical care rotations, when I was able to give my full attention to my two patients.
    Second, I don't think that having a blanket rule that every new grad start in med-surg suits the needs of every new nurse. While in school, I worked approx a year on a perinatal floor (we had med surg/post-op patients also) and another 6 months on a cardio-thoracic telemetry floor as a nurse extern. When I graduated from school, because I had been functioning pretty much independently for the last 6 months, I really didn't feel like I needed to work med-surg to learn how to delegate and become organized.
    Third, I have to disagree that working med-surg first makes all nurses better. I've met nurses who started out there, and were stuck there, and all that did was make them bitter nurses who hated their jobs.
    Hope none of this was taken personally, but I think I've just heard one to many people make the "new grads should start in med-surg" statement.
  5. by   Enabled
    Frankie and NICU Nurse, I don't mean that the time on med/surg is just for organization and delegation. It gives the new grad the exposure to multiple situations such as contolled chaos and chaos. When there is a low census the nurses from the 'specialty areas" refuse to take even 4 patients and thus are not any help as the regular staff usually ends up doing most of the care and don't tell me they don't. The other is well, I mght get called back. Well, when that happens the rest of us will deal with it. Some of those things are necessary. Having one or two patients is ideal however the reality is that there are far more med/surg patients than there are 'specialty unit' patients. The majority of a hospitals income is the med/surg units. If all the new grads go to specialty units who is suppose to staff the floors that are already far to understaffed.
    When I first started 20 years ago, and where I last worked the orientation was not limited to 6 weeks. It was geared to the grad and his/her preceptor. A contract was established that had room for changes. I have also found much hostility with specialty unit nurses when it comes to med/surg. Even tele floors have a great majority of med/surg and the monitoring is precautionary usually because of past history or that the doc doesn't want a patient on a particular floor. Our tele floor doesn't want to take more than 4 patients on evenings. That is unrealistic when the med/surg units are up to 10 each. The med/surg floors are ususally the heavier floors physically. It doesn't hurt to want to have someone who can assist.
    Many new grads come out of school and have little experience on doing some basic procedures. These need to be accomplished first before monitoring a Swan Ganz or a specialized drip that they have only heard of. I know if I was admitted to a specialty unit I would want someone experienced in that area but also someone who would also be familiar with other disease processes that are not ususally seen in such a situation.
    Studies have shown that those who go into specialty areas do have a calling but many do it because of a lessen work load and a higher salary. I am not denying they deserve the higher salary. But what about the resentment that seems to happen when the med/surg units need techs and the unit nurses vote them out because they don't use them because of the one on one or one on two.
    I have floated to SICU and ICU and it seems funny that when a med/surg nurse goes there thay they certainly get the patients that have less intrusive care but I have had more of a patient load there as I have been told "you're use to it" Maybe we should base salary on the physical work.
    In one class a nurse said her tech understood that it was a sacrifice for her to assist in changing an incontinent patient. What would she do if she didn't have a tech. She would have to do it alone.
    A typical night on an 8 to 10 patient team usually had a couple of diabetics, most in chronic CHF, or other respiratory illness, peritoneal dialysis to be done twice on one patient. and transfusing two. Of those 4 were in various types of isolation. Unit nurses also refuse to take isolation rooms. Gee, I thought that there was isolation in the units.
    I also monitor beds at the same time. I can do EKGs and report the findings to the physician for treatment. The same is happening with doctors. Soon there will be according to the latest studies few general surgeons. Most surgeons are "specializing" in such areas of Plastic or Cosmetic so that they can have a 9 to 5 day and spend time with their families in the evening and weekends. The reasons that are also stated are that they don't have to go through the training that requires them to spend years literally taking call all hours of the day and night and weekends.
    So, maybe not a year but six months of exposure. This can be lengthened or shortened as needed. If a facility take the time to hire a nurse they need to make a long term investment and be certain that the nurse is prepared to do his/her job description. I would rather get some of the kinks worked out so to speak and have a more well rounded nurse.
    If nurses are specializing immediately out of their nursing programs than there will be a closing of beds since there isn't adequate staff or the facility will keep it open with the already strained staff until something happens that may be detrimental to a patient or the end of a nurse's career. Hospitals are going to abandon the nurse at the drop of a hat so that they will not be responsible for any monetary settlement.
    I am sorry that you have heard the med/surg requirement so much but I cherish those experiences and hope that they have made me a more competent nurse so that my patient's outcome is not drastically altered because of a lack of knowledge.
    As they say we are all entitled to our opiniion
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  6. by   neneRN
    I absolutely disagree with the med/surg first theory for all new nurses. However, for new nurses who genuinely like med/surg, for those who don't have a strong desire to pick a specialty , or for those who desire more experience in assessments, skills, etc., then yes, med/surg is a good idea.

    My thinking is that in order to become a confident nurse who is really satisfied with her job, it is important that you are doing something you LIKE to do. I respect med/surg nurses, but that is a job I will never do. Throughout my rotations in school, I found my niche in the ER and have been there since I was a new grad. I love my job and can't imagine doing anything else.

    Secondly, med/surg is actually a specialty itself. No matter which area of nursing you go into, there are completely different skills and priorities to learn. Think about it, whether a new grad starts out in med/surg, ER, LD, whatever, they are still only beginning to learn-we all know what you learn in school is only the bare minimum when it comes to nursing in the real world. Who is to say that med/surg is a better place to start out? Whether you are monitoring two high acuity pts in the unit or 8-10 pts on the floor- there is a high amount of stress in either place. Success comes with the new nurse finding which area of nursing is most compatible with her strengths and weaknesses.

    Finally, no new nurse has to feel like they need to pay their dues by working on med/surg because as you said "if all new grad go to specialty units who is supposed to staff the floors that are already so understaffed?" Personally, I don't feel that it's my problem that med/surg floors are understaffed-yes understaffing ultimately affects the pt. But that is the responsibility of administration to solve that problem. I worked very hard to get my RN, with the ultimate goal of having a profession that I loved. And I have done that- no new nurse should ever feel that she HAS to work in an area because administration doesn't solve their staffing problems, if anything it should make her want to work that area even less because it shows how they really value their nurses.

    I apologise if anything in this post offends anyone- it is NOT my intent to do so, but I feel very strongly on this issue.
  7. by   frankie
    Hi guys - I hear your frustration, but I just can't cookie cut all nursing students. I never believed in that pay your dues stuff - work nights until you almost die. I say if a person is mature, self-suffient, caring, a paitent advocate, and a generally OK nurse, let them work in thier area of interest. You can't keep the pace forever. Even though I hate to admit it, I would have a very hard time keeping up with the young ones out of school. I know I will get shot down in Equador for this statement, but..... Some people never get it - like some of the new grads that went to CCU with me never, ever got it - they were good nurses, but they did not have good organizational skills, and they did not pick up on the sublties of the cardiac patient. So.,...having said that, I agree with both of you guys - it really depends on the person. Take care - frankie
  8. by   Love-A-Nurse
    "it really depends on the person. "

    agreed!

    i have my sight set on er and do not want to do med/surg first, if at all possible. although i worked med/surg has an lpn, i still know from this experience, i want to work another area as an rn.
  9. by   frankie
    Future LPN, go for the ER - if you have time while in school, work in the er - i worked a bit over 1 year in the er, but that was 1984. Things were different - not so much trauma. Work hard, apply yourself and dream - follow the dream - take care
    frankie
  10. by   Love-A-Nurse
    originally posted by frankie
    future lpn, go for the er - if you have time while in school, work in the er - i worked a bit over 1 year in the er, but that was 1984. things were different - not so much trauma. work hard, apply yourself and dream - follow the dream - take care
    frankie
    thanks, frankie!
  11. by   OzNurse69
    Just on this topic - is there such a thing as a Graduate Year program in the US? We have them here in all large and most small hospitals. The new grads are contracted for a year with no promise of ongoing employment (although with the current shortage they all get kept on as permanent staff if they want). The grads are rotated to 3-4 areas over the year, including specialties if they want (it's usually their choice). When they hit a new area they are given an extensive orientation (up to 4 weeks supernumery), a ward-based preceptor for their whole rotation, paid study days every month or so where they can develop their skills, debriefing meetings on a regular basis. The hospital I am currently working for also has an optional extension program, where a grad can do an extra 6 months in his/her preferred specialty area with the option of taking up further study programs, e.g. Grad Certificates. And they get paid the appropriate RN rate while they are there. Seems to work well - the excellent nurses advance quickly, while the slower ones are given the support they need to bring their skills up to speed before they are thrown in the deep end.
  12. by   New CCU RN
    As a fairly new grad who went straight into ICU, I have to disagree with your statements ENABLED about going into Med/Surg. They are two different playing fields with two entirely different games. I totally respect Med-Surg nurses, but personally knew from day one that Med-Surg was not for me. Why do something you don;t like. I went to a four year BSN program, worked a year as a CNA in Med Surg, a year as a Nurse Extern in OB. I can't see myself doing anything other than ICU. My plans are to go back for my CRNA, so going into Med Surg would by no means put me in the correct direction. And as far as input from staff that I work with, they all say I am doing awesome..so, I guess it depends on the person. No one should have to "do time" somewhere they don't like.
  13. by   Gardengal
    As a critical care nurse, I have no problem with new grads in my area. If a new nurse cares and is interested they can learn, no matter the environment. i think sometimes though that new grads can do themselves a disservice by entering ICU right away. I work with some nurses who started in ICU and they feel limited because theydon't know about the healthier areas of a hospital or positions outside of the hospital

    I believe that starting as a generalist can sometimes help you in the future because it can broaden your viewpoint long range. This of course is person specific and is not necessarily true for all.
  14. by   Ortho_RN
    I don't feel that new nurses should be forced to work in MedSurg if they don't want to.... Stick someone in an area they don't want to be in and have no interest in working that is a good way to have a very Unhappy RN who finds a new career shortly....

    The choices that a nurse has is one of the main reasons I am in RN school now... I plan to work in Pediatrics, hopefully at the Children's Hospital in our state... Why do I want to waste 6mos in a area that I never plan on working on.... If I go to Pediatrics work for years get tired of it, than I have the "choice" to go to a different area...

    I feel that you will get the experiance that you need no matter what area you are in...

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