A question for those nursing in a hospital setting.

[Ericm]

I'm new to the healthcare field, and I'm interested in how nursing responsibilities/scope of practice vary from department to department. Moreover, I'm very interested in what nurses feel is most rewarding and challenging about working in their given departments/areas of specialization. Also, why did you choose your department in the first place? What were the factors that made you decide to not only work in that aspect and specialization, but continue to do so after you began?

The reason I'm asking this is because as of August I'm going to be volunteering at Methodist hospital in Sacramento, and need to choose a department. I know that I would like to be in a hospital setting versus any of the other available avenues as I do progress in my nursing career, but any information I can gain before I commit and move further would be of major benefit to how I end up taking my steps.

Thank you.

[lkwashington]

The unit I worked on for 3 yrs as a RN. I had clinicals on this unit. I decided to get a PCT job on the same unit. I love the unit so much decided to stay there because I knew the ropes and the doctors. At this time, I am working in the Central Resource Pool. This pool enables me to work all different unit. I love changes I am able to work Tele, ICU, Med-surg, and ER. I can even float to Endo if needed. I love it because I dont get bored and the environment and patient load is different. I hope this answer your question. The floor I had clinicals on was a Tele Unit.

[roser13, ASN, RN]

I think to a certain extent most new nurses go where the jobs are. Sometimes you can't afford to be choosey. Right now is a perfect example of that - a new graduate will most likely take whatever comes their way.

It's after you have a couple of years' experience under your belt that you start to make decisions about your future or your "specialty." You either enjoy your first position or you don't. You have a clue about what kind of environment you might really thrive in, and what type of position will best fit your family's circumstances.

I will caution you to try to be open to all experiences that you have as a volunteer. I have yet to meet a nurse who ended up specializing in what they thought they would want as a nursing student. Experience changes everything, it seems.

[lkwashington]

I knew I wanted to do Cardiac/Critical Care or Oncology related to family illnesses. I can learn from my patient to teach myself and family members. I agree with the above post. A new grad should take whatever job openings that are available. When you get a year or two under your belt then you are able to make some wise choices where you really want to work or specialty that interest you. Where I work they have hired at least two new grads. Someone having some good luck.

[anonymurse]

If you can get it, I recommend tele for a mess of reasons:

1. It teaches time management very well. Wherever you go, this will be appreciated. Say you end up in the ER or ICU. You'll be way better prepared for suddenly having to take an unusually heavy patient load. But if you go to M/S, it won't be a huge leap in pt load.

2. On the continuum between order and chaos, it balances somewhere in the middle, so if it proves too chaotic for you, you'll know to choose a more orderly job, and if too orderly, you'll know to choose a more chaotic path. Plus during your learning experience, it's not too far to either extreme to totally throw you if you discover you tend to one extreme or the other.

3. Your pts are largely conscious and verbally interactive, giving you a chance to learn how to teach and how to involve pts in their recovery. However they are also monitored, giving you as a newcomer an important safety net in knowing when your pt's getting in trouble (most tele setups include the option to display CPOX and periodic BP on the monitor along with cardiac activity).

4. You will learn cardiac drugs and strip reading. This will serve you well anywhere (you might be wondering about how strip reading will be useful, but every crash cart has a monitor/defibrillator that puts out data in strip form).

5. Tele is the crossroads of the hospital. You'll get ER admissions, direct admits, pts from PACU and the cath lab, pts stepping down from the unit, and pts stepping up from the floors. You'll also transfer pts to higher or lower levels of acuity, you'll learn to give and take report from those levels, and you'll learn how those decisions are made.

6. You'll learn tele things like sheath pulls and many kinds of drips not done on M/S floors, but still learn things universal to all units like wound vac and other drsg changes, diabetic mgmt, postop activity, and of course how to address the full range of comorbidities.

7. You might just fall in love with tele and stay there forever, in which case you'll use all of your experience.

[fiveofpeep]

I always knew that critical care was where I want to be. Im very detail oriented and like to do every thing for my patient (I always knew I would go crazy in tele or medsurg because I'd want to do total patient care but wouldnt have the time). This has more to do with me being a perfectionist than anything else.

I like how by the end of the night with hourly neuro checks you really know your two patients inside and out. You start to pick up on subtle cues like a hand tremor that indicates pain/anxiety, for example.

I like managing drips and analyzing ABGs and labs and thinking about where things are going with my patient. I like the hours of repetitive assessment that are interspersed with picking up on crumping and doing something about it.

It's very satisfying to see a neuro patient comatose for months that you thought would never walk again, come back walking and talking and functioning on their own.

Im not saying that nurses in another specialties dont think. Im just saying that I think with my personality, I would get so bogged down with the little details between 4+ patients and all the tasks that go along with it, that as a new grad, I dont think I would be able to get everything done and use my brain too. Floor nursing sounds tough!

[brownbook]

It can't be said enough. Volunteer in as many different departments as you can. What is rewarding and challenging to one person is yucky and boring to another! Most nurses have worked in a variety of different departments. I'm where I am now because I don't have to work weekends, holidays, and nights!! But I also enjoy it, it is not just the hours.