Advice for Grad, Jobs: Fact or Fiction

Nurse_ · Jun 26, 2014

I say go with your own beat.

Experience is experience no matter where you are, what unit you're in. It's how you present the experience that will get you the job. You'll be oriented at work anyway... hiring boils down to who can be well suited to be in the team and more than likely, it's not who's the best nurse but the nurse who will work well with the current team.

Listen to advice and take it with a grain of salt. Advance degrees are good but finding a job and being happy with it is another story. Do what you think is best for you. The hell with what everybody else thinks.

Cuddleswithpuddles · Jun 26, 2014

I never understood why med-surg is hailed as the premier starting point for new grads but, then again, I fell in love with critical care right away and started in a telemetry/progressive care unit. I would argue that telemetry is just as good of a starting point, if not better. You will have no shortage of opportunities to practice basic nursing skills such as medication administration, IV therapy, wound care, managing the needs of multiple patients AND you get to hone your EKG skills as well. In my experience, telemetry "carries over" just as well to other areas of nursing. You have a foundation of the same basic nursing skills, and can read strips AND know how to intervene on arrhythmias in case they ever happen in pediatrics, intensive care, labor and delivery, in a doctor's office etc. etc.

i♥words · Jun 26, 2014

The hell with what everybody else thinks.

I think I need a poster that says this. :)

ThePrincessBride, MSN, RN, NP · Jun 26, 2014

@cuddles,

The reason so many nurses/instructors recommend starting into med/surg is med/surg is viewed as the foundation of nursing and nursing skills. Most clinics and specialized areas prefer nurses to have at least one year of M/S experience because it allows the new nurse to become competent in basic nursing and critical thinking that are not as readily gained on different types of units.

That being said, I have no desire to work in med/surg. I plan to specialize early in the NICU (which is a whole 'nother world on its own). Although I do sometimes worry about super-specializing early, I LOVE babies and know that I would be happy staying in NICU for the rest of my career and plan to advance as a Neonatal nurse practitioner. Plus, ICU nurses still have all the skillsets one could learn in M/S and more.

To your other question about APN, I think there is something to be said about gaining experience prior to pursuing an advanced degree. After one year, a nurse is just competent. But I, too, have been encouraged to straight to grad school/Master's program by nursing instructors and lecturers.

It's tough.

Esme12, ASN, BSN, RN · Jun 26, 2014

There is a national trend towards the hiring of BSN grads only. The job market in many areas across the US are scarce.

Advanced degree? Yes if you are young you need to think about it seriously. I believe the days of being in anything except bedside care is going to require MSN or higher as we go forward. So if in 10 years you want out of bedside nursing you need to go to school before life gets in the way. Do I agree with it? No...but it is the reality.

There was a time in nursing that you could NOT get hired in any "specialty" without med-surg experience. EVERYONE had to "do their time there" first. This requirement has been bent as the years go by...however...I believe a good year on the floor honing those newly minted nursing skills will make a transition to a specialty area much easier.

Editorial Team / Admin · Jun 26, 2014

In my opinion, med/surg is a specialty in its own way. After all, it has its own professional organization (AMSN) and certification exam. Can it provide an opportunity to learn basic nursing care? Sure, but so can other specialties. There was one hospital I considered applying to when I graduated. They required a year of med/surg before any nurse could move to another specialty. I never completed the application. For me, med/surg would have been a career killing move.

i♥words · Jun 26, 2014

Advanced degree? Yes if you are young you need to think about it seriously. I believe the days of being in anything except bedside care is going to require MSN or higher as we go forward. So if in 10 years you want out of bedside nursing you need to go to school before life gets in the way. Do I agree wit it? No...but it is the reality.

Good to know. Thank you for your input!

Cuddleswithpuddles · Jun 26, 2014

@cuddles,
The reason so many nurses/instructors recommend starting into med/surg is med/surg is viewed as the foundation of nursing and nursing skills. Most clinics and specialized areas prefer nurses to have at least one year of M/S experience because it allows the new nurse to become competent in basic nursing and critical thinking that are not as readily gained on different types of units.
That being said, I have no desire to work in med/surg. I plan to specialize early in the NICU (which is a whole 'nother world on its own). Although I do sometimes worry about super-specializing early, I LOVE babies and know that I would be happy staying in NICU for the rest of my career and plan to advance as a Neonatal nurse practitioner. Plus, ICU nurses still have all the skillsets one could learn in M/S and more.

I should I say I never personally agreed with the rationale behind med/surg being the one unit every new grad needs to be in first.

As for ICU nurses having all the skill sets one could learn in med-surg, I agree for the most part with a few exceptions. ICU nurses do not routinely juggle the needs of as many patients a med/surg nurse handles on a daily basis. Med/surg nurses also cannot rely on the constant noninvasive and invasive monitoring that is standard with most ICU patients. When ICU nurses in my hospital float, we are almost always aghast and confused beyond the usual uneasiness that comes with an unfamiliar unit.

I recently floated to telemetry. Patient load was not nearly as bad as our med-surg units but I was still stressed. When I saw a patient walking in the hallway, I immediately thought "%$@! Someone escaped!! GRAB HER!!" Then I remembered when I was and the ICU control freak in me calmed down. A little.

Although the ICU nurse have the same skills as a med/surg nurse would, putting it all together for 5-6+ patients is a whole different ballgame that makes med/surg nursing unique.

allnurses Guide · Jun 27, 2014

Every clinical my preceptor asks me what area of nursing I want to be in, and when I say I'm not sure yet because I like too many things I get puh-lenty of advice.
Don't specialize too quickly
This one comes up a lot.
"Don't get into pediatrics unless you are for sure, or you won't be able to get out."
"Don't work at a doctor's office, or you won't be able to get a hospital job."
Start in med surg even if you don't like it
This sometimes goes along with the first bit advice, but sometimes it is on its own. Many have the opinion that med surg is the best starting spot for new grads, and that if you don't start in med surg you won't learn nearly as much.
Go back to school ASAP
Are advanced degrees the "in" thing right now, or are they really going to be the new required in the next several years? The majority of my classmates have plans to become CRNAs and NPs. Most of the nursing instructors encourage advanced degrees as well.
Thoughts?

My thoughts are that the ground has shifted considerably in nursing in the last 5-7 years, and that many of us never thought it would actually happen so there are probably a lot of people out there who will give incorrect or outdated advice.

I absolutely agree that you need at least a BSN to be marketable as a new grad.

Nursing jobs are no longer like a buffet table where you can pick and choose what to start with and for how long, etc., so while there is merit to the "year in med-surg" rule it isn't always practical or possible. I did not do that and I don't think it hurt me.

I got into pediatrics right away and have since worked in lots of jobs other than pediatrics so I'm not sure why she said that. Pediatrics right away isn't usually going to be an option for new grads in the present job market in a lot of areas.

I believe that individual facilities may require an advanced degree but I doubt they will be written into law. Though there is not currently a nursing shortage there are still lots of current ADNs in the workforce, and people who hire nurses will want to maintain maximum flexibility should the pool of available nurses for hire dwindle as it has in the past.

Your posting here to ask was exactly the right move --- get a wide variety of opinions!

Best wishes!

Pepper The Cat, BSN, RN · Jun 27, 2014

Keep an open mind.

i always thought I'd go for peds/NICU.

My path did not go that way, my specialty is now Gerontology and I love it.

ThePrincessBride, MSN, RN, NP · Jun 27, 2014

I should I say I never personally agreed with the rationale behind med/surg being the one unit every new grad needs to be in first.
As for ICU nurses having all the skill sets one could learn in med-surg, I agree for the most part with a few exceptions. ICU nurses do not routinely juggle the needs of as many patients a med/surg nurse handles on a daily basis. Med/surg nurses also cannot rely on the constant noninvasive and invasive monitoring that is standard with most ICU patients. When ICU nurses in my hospital float, we are almost always aghast and confused beyond the usual uneasiness that comes with an unfamiliar unit.
I recently floated to telemetry. Patient load was not nearly as bad as our med-surg units but I was still stressed. When I saw a patient walking in the hallway, I immediately thought "%$@! Someone escaped!! GRAB HER!!" Then I remembered when I was and the ICU control freak in me calmed down. A little.
Although the ICU nurse have the same skills as a med/surg nurse would, putting it all together for 5-6+ patients is a whole different ballgame that makes med/surg nursing unique.

That is true. Med/surg nurses do have some crazy organization skills that would make the average ICU nurse dizzy. I've always heard, however, if one can survive med/surg, one can survive just about anything...since med/surg nurses see just about everything, it seems.