Best way to avoid bedside care?

Nurses General Nursing

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I'm in an RN program and I could use a little advice. Before starting the RN program, I worked in a hospital as a nurse aide in med-surg and hated it. I also work in a primary care clinic (mostly in pediatrics, some in family practice) as a medical scribe and I really enjoy it. It's early at this point and I just finished my rotation at a SNF, but I still dislike everything about bedside care.

I really like the patient flow and the vibe of the community clinic I work at. Patients come in, they get help, then they leave instead of needing to be tended to and monitored all day and all night. Obviously there are patients who need to be in hospital, and those hospital nurses are great, but I don't feel like that's a good fit for me personally. My clinic job is not easy and most days everyone hustles pretty much all day. We see about three patients per hour depending on complexity, but generally we see them one at a time. My previous job at the hospital was just crazy busy, especially for aides like me with 10 to 12 patients each. I'm never doing that again if I can help it.

Should I try for a new grad job in public health or primary care without doing time in a hospital first? I could probably do a couple years in hospital if absolutely necessary to gain experience, but I'd rather not. In the hospital setting I felt stretched too thin with too many patients to care for at once, and the nurses were not impressed with my performance (mainly my speed) even after a year. In the community clinic, it took only a few months before everyone respected me and wanted me to be their scribe. I'm very concerned that if my first job is in a hospital, I'll do poorly and get a reputation for mediocrity that might have a lasting negative effect on my nursing career.

I'm a bit torn by what I hear about the ICU. It's bedside care but only one or two patients at a time, and I've heard you get great experience doing detailed assessments which increases your medical knowledge. However the ICU patients are fragile and very ill, so they have multiple problems to manage and as a new grad maybe i would not have the necessary knowledge to care for them.

At the clinic where I work they just hired a new grad RN to train as a pediatric triage nurse, so I know at least a few of those jobs are out there. However, they tried this several months ago with another new grad RN and she quit for a hospital job saying she felt like she needed the experience. The veteran pediatric triage nurse does have misgivings about new grads in triage without hospital experience. The RNs in the clinic do mostly triage and case management but also help with catheterization, etc. I actually love talking to patients. My dream job would probably involve wellness checkups, triage and patient education.

Helpful advice is much appreciated. Telling me I'm lazy for wanting a day shift clinic job or that I simply won't be a real nurse if I don't do bedside care is probably less helpful, but if that's the way you feel go ahead and share. I'm so sorry for this long post I can't stop writing! Thank you for any help!

Specializes in Med/Surg, Tele, Dialysis, Hospice.

I think they ask for this experience because they can, due to the demand for non-bedside positions these days. I have many years of solid clinical experience in several areas of nursing and I have never received a call back from a UR or insurance CM position that I applied for. I recently applied for a CM position with Blue Cross/Blue Shield through a recruiting agency due to getting nowhere by applying directly with BC/BS and was told by the recruiter that over 1,000 nurses had applied for 20 positions. This, in an area where even the best, most reputable hospitals are having to use travelers and staffing agencies to fill their bedside positions that offer great benefits.

It's too bad what has happened to healthcare. The Bottom Line rules and this seems to have made bedside nursing very difficult, and obviously almost unbearable, for many.

Specializes in ICU, LTACH, Internal Medicine.

Insurance/QA/CM all require previous experience, very often within particular specialty, and pretty often either already MSN or being on the way to it. Especially QA.

One has to be familiar with real world before starting playing with policies, you'now.

And, please, not private duty. Too many of these guys are REALLY complicated nowadays, and too many families have that perfect disaster mix of 110% confidence with 100% denial of objective reality to get a new nurse to be trown into it and swim out of there alive and safe.

I think they ask for this experience because they can, due to the demand for non-bedside positions these days.

Well, also because it's v. difficult to be a competent, effective case manager without having a thorough understanding of how the larger healthcare system works, clients' needs, and the solutions to those needs, usually acquired through years of experience.

Specializes in Pediatrics, Emergency, Trauma.
If you're absolutely positive that you have zero interest in bedside nursing (hospitals, SNFs, LTACHs, LTC) then I don't think hospital experience is a must. It will hone your assessment skills and clinical skills but if your goal is to work in a clinic for the rest of your career then it's not particularly pertinent. Not every nurse desires to run the every day rat-race of floor nursing. And I don't blame them.

As for career options, consider these:

1. Urgent Care

2. Clinic

3. Private Practice (Primary Care)

4. UR (Utilization Review)/CM (Case Management)

5. Public Health (Education Focused)

I hope these suggestions help! Good luck in finding that right fit!

In number 1, at least in my area, requires 2-5 years of ED experience, especially when there is going to be the solo nurse present, just FYI.

I found myself funneled into my first nursing jobs based upon what was available to me. I think you need to remain aware that, unless you get a good lead from your colleagues, that finding a suitable job will be extremely difficult. It may even not be possible under your circumstances. As long as you keep your expectations realistic, you can pursue nursing while realizing it won't be an easy path, especially at first.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

You may be right. I more meant for insurance companies since much of it is policy based. But it would definitely require looking into more.

Last year I obtained a CM position with an insurance company after having worked the floor for 10 years. All my newly hired CM colleagues had appreciable years of bedside experience.

Much of the work is policy-based, but a CM or utilization review nurse in this type of setting needs the clinical experience to inform the decisions he/she makes.

It's good you know what you do, and do not, want. However, getting the first year of bedside 'under your belt' is a good idea for a foundation to work from, utilizing nursing skills in your new role. Believe me, it's very different than when someone is a CNA, etc. And yes, they work very hard and trust me, I could not do my shift caring for my patients with all of their needs without the wonderful ones we had on our unit. But, the CNA and RN jobs are very different, and it is this 'difference' where only bedside experience can give you that knowledge.

If you can land a job out of the gate that is non bedside, kuddos to you :) I have recently left bedside for the many reasons other's post that I am sure you are aware of if you have spent any amount of time on AN. Things from a toxic environment, unsupportive managers, rude pts, etc. Thank goodness my coworkers were awesome; only reason I lasted as long as I did.

So with that being said, no matter who says what, follow your heart and your gut instinct :)

Specializes in med-surg, IMC, school nursing, NICU.
I would say NO to SN unless you are Jen-Elizabeth. :)

You are working alone, and there's downtime until there isn't. Most SNs have years of experience.

I definitely wouldn't have felt comfortable taking my SN position without experience. You need that autonomy to work alllll byyyyy yoursellllfffff. Plus, you need the confidence to speak up to parents, administrators, etc that only comes with year of experience.

Specializes in Adult Internal Medicine.

If you love working in primary clinic adn being a scribe, why not just get your MA and continue with that? What's the draw to nursing?

Specializes in Utilization Review.
If you love working in primary clinic adn being a scribe, why not just get your MA and continue with that? What's the draw to nursing?

This is a good point, MAs are starting to be able to do a lot and at least in my area there is a lot of opportunity for them.

If you're set on nursing, I totally understand the aversion to bedside nursing. Someone mentioned this already but utilization review or case management jobs will be tough with no experience. MD offices are cutting back on RN hiring but still out there. Someone else mentioned correctional facility nursing which I think would be a great place to get experience but not have to worry about it being like a bedside hospital job because if any of them start to have serious medical issues and need advanced treatment then they'd be sent to a hospital themselves.

ICU might not be so bad to start. Yes, your patients are acutely ill but you will always have another nurse near by and most hospitals are very good about doing 3 month orientation periods where you will get a great refresher and learn the essentials for your work.

Best of luck to you in whatever life throws your way!

Home health, hospice, school nurse, camp nurse and health department to name a few other options. you also have contacts at the clinic you are at so maybe network to get hired there - even as a new grad. Most home health and hospice agencies want some experience but it's still possible. Dialysis is another option as some offer the training.

As far as UR or CM, at least where I live the RN has to have experience AND be certified.

Specializes in Med/Surg, Ortho, ASC.
Home health, hospice, school nurse, camp nurse and health department to name a few other options. you also have contacts at the clinic you are at so maybe network to get hired there - even as a new grad. Most home health and hospice agencies want some experience but it's still possible. Dialysis is another option as some offer the training.

As far as UR or CM, at least where I live the RN has to have experience AND be certified.

Stay as far away from home health as you can, as a new grad. Today's patients are SICK, with vents, wound vacs, trachs, etc., etc. Those skills are learned in an acute care setting, not in nursing school. Do you really want to be on your own, making every decision without anyone to collaborate with?

School Nurse & Hospice have always required experience. Again, as a school nurse, do you really want to be the only medical person in the room when an emergency strikes?

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