All preferences aside, what is the best "track" for a new nurse to learn?

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If neither personal preferences nor lack of availability of jobs were an issue, what would be the best "track" in a hospital for a new grad to best learn and hone skills? From reading this board it sounds like ER should def NOT be your first job and it sounds like med/surg might also be a bit much. So where should a new grad start and for how long should they be in that area? What next? Med/Surg and for how long? Then E/R? Then what? ICU? I'm interested to hear how things really ought to be done in the ideal hospital setting so that the new grad nurse learns the most AND we give the best care possible to our patients.

Happy Thanksgiving, everyone!

My vote goes to Med/Surg. As a 20 year Med/Surg nurse I get to see it all, but best of all I get to see almost all of my patients leave to go home or rehab. I have a question for this board............I get the distinct impression that many of us do not value Med/Surg nursing. It is ABSOLUTELY a speciality. My nurses manage 7 patients, various/multliple drips that include tridil, cardizem, heparin, amiodarone, bumex(just to name a few), epidurals/PCA/CBIs, teach/education patients/families, etc. I challenge most critical care nurses to walk one shift in my nurses shoes...............I'm convinced they couldn't.

Thanks for letting me once again stand on my soapbox!

Cardizem, amiodarone, tridil, bumex? Your's isn't any med/surg I've ever heard of. Where I work, those drips wouldn't be allowed anywhere except a cardiac floor or ICU. Plus, if you are trying to manage 7 patients with those drugs, that's highly unsafe! It's not a matter of CAN someone manage that many, NO ONE SHOULD be having to manage that many under those circumstances. I'd be getting the heck out of Dodge, sister!

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Specializes in MR/DD.

Med Surg all the way! I worked as a PCA on a med surg floor for 2 years. I was able to witness many new grads come on to the floor. In the beginning they were all the same; scared, confident lacking, grossed out, intimidated, and overworked.

After a few months they became some of the best nurses I have ever known.

I will always view med surg as a type of boot camp for nurses. :)

As an LPN I am unable to get a position on a med surg floor but as soon as I finish my RN I will apply on every med surg unit in the state if I have to!

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My vot I challenge most critical care nurses to walk one shift in my nurses shoes...............I'm convinced they couldn't.

Thanks for letting me once again stand on my soapbox!

And let me get on my soap box :D Come work a 12 hour shift in the unit with two vents, swans, an ICP bolt, and an IABP while titrating levophed, epi, and an insulin gtt and charting q15minute vitals all day! While we might have 2 (sometimes 1) patients it doesn't mean our workload is any less or less difficult to juggle (Not saying you believe this but some folks do!)

/soapbox

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Specializes in OB/GYN, Peds, School Nurse, DD.

I think it's never a bad idea to get a good med-surg background. The variety of conditions you will see will be invaluable to your post-school education. From there you can be prepared for just about anything else. Some people go straight to ICU/CCU, which is also a good choice if they have a great orientation. Once you've had some ICU experience you'll be ready for ER or PACU or Surgery.

I bypassed med-surg and went straight to L&D because I thought that was really going to be my calling. After 2 years I wanted to move on. I went to med-surg for a couple years and I was really shocked by how much I didn't know. But I hung in there and when I returned to Mother-Baby, I had a much better understanding of my patients' medical issues, not just their post-delivery issues. That paved the way for going to NICU and PICU, where I learned to operate pretty independently. And all of it has come to bear in my current job as a school nurse.

Good luck whatever you decide. :nurse:

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i think everyone should start out in med/surg! get familiar with nursing skills, meds, everything really.. I think it helps to build up some confidence, even though the first few months will be undoubtedly stressful. A good med/surg job will help you to "learn the ropes" and make you so much better prepared for wherever you might choose to go after.

it really bugs me when new grads say I would never work med/surg:mad: I can understand not wanting to work LTC because you will not have as much opportunity to practice the new skills you just paid good $$ to learn. but med/surg? You will experience all types of patients there, you will learn and do so much! it seems more and more new grads these days dont want to spend any time in med/surg. I know some do just fine as a new nurse working a specialty, but the fact is, many do not and I can't help but think how their nursing career could be so much more positive if they started out with a more humble and realistic outlook.

my personal preference:D med/surg, ER (where I am now) and I always thought ICU somewhere down the road, but I just don't know if I'll ever be ready to leave the ER, certainly not anytime soon

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Specializes in LTC.

I started out in LTC (been there 2 months). I'm a LPN and the local hospital doesn't hire LPNs in med-surg. I could drive 30 minutes away and try my hat at med-surg I suppose. However my heart is really into LTC. This is where I enjoy and also I live 10 minutes from work so that is another plus!

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Specializes in Family Practice, Urgent Care, Cardiac Ca.

A nurse is NOT a NURSE is a nurse....etc. not all nurses are alike, but all are equally important...consider your goals! I love the ICU, but it doesn't work towards my goals of being an FNP, so I work in a huge family practice center. I love it! Med Surg would have slowly killed my inspiration for being in nursing, but that's just me. :)

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Specializes in LTC, med/surg, hospice.

I would say a telemetry unit would be a good start. It's similar to med-surg but you (obviously) get a good helping of cardiac patients, some drips and looking at monitor strips.

The patients are complex but usually in fair condition...not as poorly as a stepdown or critical care unit.

I work on a straight medical floor with a little oncology thrown in the mix. I am doing well on this unit but I'm ready to branch out and I can't say how well my experience will transfer. Nobody likes floating on our unit because we really work hard (not that they don't but this is coming from their own mouths)

I would not recommend going into psych or the OR unless you have no desire for another area. Nothing against that area but the skills used are soo different to me. Those nurses NEVER come to our floors.

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Specializes in ICU, ER.

I challenge most critical care nurses to walk one shift in my nurses shoes...............I'm convinced they couldn't

Having spent ten years in ICU I agree with you-I left M/S because I couldn't handle the stress!

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A nurse is NOT a NURSE is a nurse....etc. not all nurses are alike, but all are equally important...consider your goals! I love the ICU, but it doesn't work towards my goals of being an FNP, so I work in a huge family practice center. I love it! Med Surg would have slowly killed my inspiration for being in nursing, but that's just me. :)

This may be true if you had to be there and knew you could never leave. But if you knew you were required to spend the first 6 months to 1 year in med/surg and then you could go anywhere you wanted to, I think you could have dealt with it if it meant you could eventually meet your goals.

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The original question was, all personal preferences aside, what would be the best environment for a new grad to learn and get the best start in nursing. IMO, from a hypothetical/ideal perspective, the best option would be a general med-surg unit in a small hospital -- where you would see all different kinds of med-surg clients on that one unit (not a bigger hospital that has a separate GI unit, separate ortho unit, separate GYN unit, etc.).

I have taught med-surg clinical on a unit like that, in a smallish general hospital, and we saw everything (except the people who went to the facility's small ICU) on that one unit. It was a great learning experience for the students (unlike previous experiences I had had at the same school teaching med-surg clinical in a larger facility, where the students were supposedly in "general med-surg" clinical, but placed on a specialty ortho unit, or a specialty cardiac unit, etc., for the entire semester).

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