new RN's in specialty areas

[sunny261]

I have been noticing many posts of new nurses being overhelmed. Many seem to be entering specialty areas soon after finishing their RN programs. Does anyone else see that perhaps a trend here that going right into the toughest areas before getting comfortable in assesment skills or even just time management is not the wisest choice? I was an LPN for 10 yrs before I got my RN and I was offered a job right out of school in my hospital's SCU. I turned it down ...I felt that I needed to feel more comfortable in getting my skills down before I entered one of the most high stressed areas in the hospital. I worked on the Med-Surg floor and although it wasn't glamorous it made me a better SCU nurse... I learned charge duties and how to call miserable docs in the middle of the night and all sorts of valuable education that I might have felt overwhelmed in a high stress area while learning these other invaluable lessons......

[nickola]

If you read my post, you will see that I never said ALL new grads, so you don't need to be defensive. What I object to is management expecting staff to train these people - I also had to go thru an intensive 3-6 mo program, which included classroom time, to work my specialty area- and that was after many years in other areas. I have worked 2 specialty areas & both times it was required to go thru their programs, obtain proper certifications, etc. despite the fact that I was already an experienced RN. I had a preceptor who did not take an assignment, which is preferable to a staff nurse taking a full load of patients & teaching a new person who has never done it b/f. Ideally you probably should have to work a pediatrics floor to first, and a year as a student is not the same as an RN- sorry, but there is much more liability as a licensed professional. I have worked hospitals in several states in my career, from large teaching facilities to small rural hospitals, and as I said, this seems to be a new trend that is happening due to management's desperation to fill vacancies. It may not be the same everywhere, but it has been true in the last 2 places I've worked- both large metropolitan areas in 2 different states. You're still a student, and if you're not too proud to ask questions that is to your benefit- it is much more preferable to over-confidence. NEVER be afraid to ask questions- nobody has all the answers, I don't care how much experience they have. Good luck to you.

[Otessa, BSN, RN]

I agree that a strong med-surg background for a minimum 1-2 years makes a much better specialty nurse and enhanced assessment skills that can save a life!

otessa

[sunny261]

I'm sorry if you feel that this was a negative post toward new nurses...that is not what this is about. Every nurse was at one time new.

I have just been reading and seeing many nurses who are new become overwhelmed with the work and stress. I was just making an observation and trying to find out if others saw this trend also. I just was trying to relate as to why many areas have high turnovers. Specialty nursing is not for everyone and sometimes I feel that the jobs for these areas are sometimes seen as more attractive. imho

[MikeyJ, RN]

I'm sorry if you feel that this was a negative post toward new nurses...that is not what this is about. Every nurse was at one time new.

I have just been reading and seeing many nurses who are new become overwhelmed with the work and stress. I was just making an observation and trying to find out if others saw this trend also. I just was trying to relate as to why many areas have high turnovers. Specialty nursing is not for everyone and sometimes I feel that the jobs for these areas are sometimes seen as more attractive. imho

I agree. But I don't think all of the bittnerness should be directed to the new-grad. It is the hospitals that market these positions to new grads. It is the hospitals that offer these positions to nursing students while doing clinicals. The PICU manager where I will be working as been trying to recruit me since August. Everytime I see her she comes upto me and asks when I will be graduating so I can start working in the PICU.

[sunny261]

I'm not bitter just concerned for the new fresh RN's who get into a high stress enviroment and then take a couple of months of crap from other nurses, docs or facilities and then quit the whole profession. Are we doing any one of these nurses any good?

[MikeyJ, RN]

I'm not bitter just concerned for the new fresh RN's who get into a high stress enviroment and then take a couple of months of crap from other nurses, docs or facilities and then quit the whole profession. Are we doing any one of these nurses any good?

I guess bitter wasn't the right word to use. I agree. But I think all of this should be directed toward administration and not the new-grads. If these positions are strongly promoted to the new grads, they are going to take them.

[sunny261]

I agree with you about facilities trying to fill slots but do you think that a new grad will be fully aware of the downside of these jobs? They sound good but then when you are in that situation of having a code plus other unstable pts and phones ringing and families. Not to mention that just starting out in a new job is stressful in itself. I think that if the new nurse was aware of the not so nice sides of these areas they would be better prepared. Schools do not train nurses for specialty areas you pretty much get the basics and then you are on your own. There are many people who walk away from nursing due to the fact that the real world isn't all rosy and clearcut as in school.

[SDS_RN, RN]

"I think it's hard for a nurse used to waiting for orders, or directions to be thrust into an are where YOU must initiate these same orders, meds and other things quickly. It's hard to learn as a newbie, but for some reason harder for some of the med-surg nurses. I just think its a "role" thing and maybe just "what you are used to"." end quote

I did a year of working on a surgical & peds floor before going to the ED and it did benefit me w/ my assessments for a variety of age groups that come through.

The statement in quotes above to me is so true. That has been one of my challenges since switching to the ED is that I don't have to wait for the order I can just do it. It's hard to break that mentallity after it's been drilled into your head in school and on the floor. I have been getting better w/ it but you are definatly right.

I'll also agree that it is stressful after only having 1yr experience and then going into a specialty area. I've found it very challenging and I feel like I'm a new grad all over again, but I'm loving the ED and learning every day.

However, one of the girls I graduated w/ started out in the ED immediatly and I can see the differences between her and I. I personally think she does a better job because it's all she's known. She was trained immediatly to think like a critical care nurse and did not have to come in w/ the floor mentallity, routines, & habits experienced w/ floor nursing. So I would say it's a toss up between experience and no experience in specialty areas. I can see the pros and cons from both sides.

[MAISY, RN-ER, BSN, RN]

After the week I have had with a family member in ER, tele, then med-surg---I can easily say that the only good experience was in tele.

ER had experienced nurses....weren't vigilant....no urgency, even though critical situation.....didn't even know I was an ER nurse, and still acted that way. Only started reacting afterwards. A newbie would have been at the bedside concerned and attentive. Admitting dx: Aspiration of vomitus, possible cva, rapid afib and renal failure. Definately thought he was a goner.

Telemetry nurses were excellent, one just a new grad, the other new to the facility. Both had great assessment skills, and were on top of every problem, and had a plan. Re-evaluation, assessment, and care was on target. Looked great-sitting up, talking, thickened liquid diet-good to go.

Med/Surg a mix of experienced nurses and new grads-HORRIBLE EXPERIENCE! Father in law now has sbo, lots of problems, poor assessments, no bms charted, aspirated several occasions, sick, pain, misery for him, in restraints-pulled ng tubes all kinds of problems that could've been avoided with continued assessment. ESPECIALLY SINCE AWARE OF ABDOMINAL HX.

I don't know what the training is for med surg nurses---I do know that in my facility it's about half the training we get. My feeling is that a patient can become an emergency in a matter of seconds. You need to know what's going on at all times. When I walked into his room on day one of med surg time-in one minute I knew we were in serious trouble.

I think any nurse can be overwhelmed. I was when I started, and am daily. Patients are much sicker and really require alot of work. While some may say the ER isn't a learning ground, I'd say for the right person it is-no matter where they come from.

If it's your interest, go for it! If it's not a good fit, try on something else.

Maisy

[nickola]

I'm not bitter just concerned for the new fresh RN's who get into a high stress enviroment and then take a couple of months of crap from other nurses, docs or facilities and then quit the whole profession. Are we doing any one of these nurses any good?

I agree, it is tough as a new nurse. I resigned from my first nursing job in a large teaching hospital b/c of fear & feeling overwhelmed. They had hired me on the spot right out of college, and it was nothing like I imagined it would be. I had worked as a CNA & Nurse Tech for 6 yrs b/f I graduated, and I was not prepared for the short staffing, the heavy patient loads, and all the responsibilities of an RN. To make matters worse, I was put in charge after only a few months. I take it personally when we lose a new nurse b/c she feels overwhelmed or they make judgement errors on my shift- I have always tried to helped the new grads/inexperienced people- it is not easy when I have a full patient load myself. However, management is not allowing these nurses to get the proper orientation/classes due to cutbacks and high turnover. This is a problem management needs to look at, it is not the nurse's fault. If I had known what I was getting into as a new grad, I'd have looked for a better orientation/internship.

[Virgo_RN, BSN, RN]

I'm a new nurse on a specialty unit, and an LPN at that. I'll be a new grad RN soon. I do get overwhelmed, but where I work, everyone gets overwhelmed. We use what is called "teamwork" to help each other out when we need it. I also take responsibility for what I do not know by asking questions.

[penguin2]

I am going into a specialty area (ED) in July after I graduate in May. This post makes it sound like it is a bad idea. I was not able to get an interview for a med/surg position in one hospital and this manager requested to interview me as I precepted in the ED and interned with this hospital system last summer. Should I have turned down a job in an area that i am interested in, and just hope a job in med/surg comes along? It is very competitive for jobs around here, even med/surg jobs. Would I prefer to work a year in med/surg? Probably, even though I don't have a desire to stay there. But do I feel that I can be trained properly to work safely in an ED. Yes. I specifically asked the manager about new grads and she has had many start there with much success. She has had a couple that do not work out but not many. I asked many staff while i was precepting there what their opinion of new grads was and no one seemed to have issues with it. I obviously have tons to learn but even if I started in med/surg and moved to ED I would still have tons to learn. Would one yr med/surg make me a better RN? Not sure. I have had some tell me that every area is so different it is like starting over. I think it is unfair to say it is unsafe for new grads to work in these areas. Yes, we have much to learn but that doesn't mean we will do our job unsafely. That is my biggest priority, is pt safety. I have no sense of entitlement. I do not find this statement true at all of new grads. I would think that all RN's should try to work together to provide care. New grads are a necessity. without them, there would be no one to fill the open jobs. It isn't our fault we are new. It doesn't mean we can't do things or that we will do them wrong. I'm sure there are many experienced nurses who do unsafe things daily.

I seriously doubt "there are many experienced nurses who do unsafe things DAILY"!! If that's the way it is, it's the blind leading the blind when it comes to orienting/training new grads & I really hope I never get sick!!!!