by nola04

I will be graduating in May 09 and I am having trouble deciding where to work. My heart is set on working in ICU and cross train in the ER after 3 years of ICU and then move to travel RN with 5 years of RN under my belt. My dilemma is that I have been getting mixed reactions to my career path. I have been told that I need to start in MedSurg to get a strong foundation as a RN which will help with my prioritizing skills however I have gotten A's thus far in my clinical rotations. I will admit that my lecture grades are not that good since RN school grades are so inflated my B's on a 4.0 scale are C's in RN school so I do have a concern on that part however, I believe that my lecture grades does not predict how well of a RN I will be because I am able to put it together during clinicals its just the test format I don't preform well. I have also been told by others that I should just go for it because I won't know until I try and that if I feel as though it's too much then I could step down to medsurg and then return to ICU. It's funny to me because the RN's that tell me to start in medsurg started in ICU so I am not sure why they are suggesting that I start in medsurg. Also the hospital that I want to start I have been told that they actually "Eat their Young" which is frieghting to me because they said that they have had friends that started in ICU in the hospital that I want to work who have reported to them that the preceptors actually make bets to see which interns they will fail. I understand that working in the ICU gives you more autonomy but I just don't want to be put in the situation whereby the preceptors have this attitude towards GN. I have not worked in the clinical setting prior to RN school however, my school only does MedSurg rotations and I have been given great evaluations during clinicals. My clincial grades are high A's and I believe that I do work for it and that my instructor is not just giving me my grades. Also I have worked as an Extern since the summer in MedSurg and have been given great responses as to have fast I have caught on how to manage my time as well as learning the procedures. I have also externed in ICU but will spend more time here since it's my last semester and is where I want to start as a GN however, this particular hospital I have been told is not a good place to work because of its rep of not being a good facility for GN as I will not learn much because its not a "real" ICU and that the RN's here are burnt out and ready to retired and are their to only get a pay check and this scares me because this is where I was thinking about working since it is a smaller hospital and I am familiar with their process and thought I could get some experience here and then move to the level 1 hospital where my heart is set on. I know most will say just go with what you feel and just apply and see what happens but in my mind I just don't want to make the wrong decision that could have a potential negative outcome if I do not start my RN career with a hospital that has a good rep. Then I have been told to start in tele in the hospital of my choice and then go to ICU because it is easier to start in tele and then go to ICU then to just start in MedSurg but I have also been told that medsurg is sometimes considered tele only that the pts are placed on monitors so is a slight step up from tele. I apologize for such a long post but I would really appreciate some responses if anyone is having the same feelings are have been told similar suggestions. I know I have a semester left but I am planning on applying for internships in February. I am just so confused in a time that should be my happiest time of actually in my last semester however I am so concerned about messing up my RN career before it even starts.

Thanks in advance for all replies,
Nola:scrm:

Re: 4th semester student with concerns on where to start RN career

nola04:
Wow, it certainly seems like you have given your future career a lot of thought!
When I was a young graduate nurse (from a 24 month diploma program) we did not have the option of considering where or what floors we would like to "start our careers" on. We all had to start on a medical surgical floor/ward, take and pass the Boards, then if we so desired we could request a transfer. At that time (waaaay back in the day) there was only 1 ICU/CCU. Now times have changed and progressed and there are telemetry units, CCU, combined ICUs, CV-ICUs, Burn units, BMT units (bone marrow transplant units), oncology critical care units....
If your hospital has an outstanding internship program for new graduate nurses, or nurses new to critical care, then I would say GO FOR IT. If your hospital hasn't such a thing in place, then perhaps working on a telemetry unit or a med/surg unit or whatever unit may, may help you with prioritizing and managing your time and care. But that in and of it self is not fool-proof as I have been a nurse for almost one hundred years and when I worked evenings on a busy telemetry unit at the VA I almost always left the floor ~ 2 or 3 am (and my shift officially ended at 12 midnight). Was I that disorganized? NO. Was I unable to "manage my time" appropriately? YES if you consider we often had a full house (24 patients) and we each had 8-9 patients! Plus admissions, transfers....and almost no help from the WHEN supervisors (of course, oftentimes their collective hands were tied.....)
Yeah, sometimes you hear the phrase how "Nurses Eat Their Young" but fill in the Nurses with almost any other profession and you get the same thing: the "Good Ol' Boys/Girls Club" where "things haven't changed in x number of years", or "if it was good enough for me to go through" type of bull-dinky. I say, "Only IF You Let Them".....It is all about power and control, for some people, those people who get off on making someone else feel bad or go through what they went thru, back in the day....What happened to respect? Or treating each other like the Professional we are? Doesn't matter if you graduated 20 years ago or last week. You are a (soon-to-be) Graduate Nurse. You are an RN c P (RN with Permit we used to use back in the day)
Anyway, I digress: I would recommend you check out From Novice to Expert: Excellence and Power in Clinical Nursing Practice by Patricia Benner. Prentice Hall publishers. I don't have the ISBN available, sorry but I saw it on Amazon.com for $38.69. Or check out your school medical library, or ask them to obtain it for you...
As Eleanor Roosevelt said, "No one can make you feel inferior without your consent"
Good Luck in your choices! Good Luck with your upcoming graduation. You should be very proud of yourself!
Let us know how you are doing from time-to-time.
athena

Re: 4th semester student with concerns on where to start RN career

Nola04, go for your passion. Since you know that you want to go into the ICU, look into those residency programs that support this. Since you will be graduating in May, now is the time to be applying to these programs. I wish you well !!!!

Re: 4th semester student with concerns on where to start RN career

My advice would be to check out other hospital ICU's and list the pros and cons for each, then make your decision where you want to start. Maybe check with Grads that graduated a few semesters ahead of you see what their perceptions of the hospitals are like. If u want to work ICU then I say do it. It is not as if you will be stuck in only one position forever. It may be good to work in Icu, ER and medsurg if you want to be a travel nurse.

Re: 4th semester student with concerns on where to start RN career

Working as a new grad is not the same as school or a student extern. Just becasue you get A's in clinical dosen't mean much becasue when you start working, there is a expectation that you know your stuff and know what to do all the time. As for experinced nurses, they forget what it is like to start as a new grad. If ICU nurses are telling you to start in med surge, than maybe you should listen.