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!
Absolutely not to the first two. It takes an exceptional new grad to feel comfortable working independently in home health/hospice. Where do the medically fragile people in hospital go when they're discharged? They go home. Caring for the dying patient at home can require complex symptom management as well. In both cases, the nurse has to be able to function by him/herself, and do so confidently. A new grad likely doesn't have the skill set nor the fund of knowledge to do so. That's why the majority of home health and hospice agencies require prior experience.
I'm not saying new grads never get hired into either of these fields, but it's much harder to find positions in these areas for nurses who lack experience.
I was asked by an MD to be a summer camp nurse for a week at his church camp. I was a pretty new grad, working ER but took a week's vacation. I survived but the doc was also present at the camp, so I knew there was immediate back-up. I was scared and hypervigilant and textbook-y. In other words, a new grad.
In later camp work, I saw an MI, a post-AB hemorrhage, an attempted wrist-cutting, an ankle fracture, serious rope burns that required opiate pain control and Silvadene dressing changes, along with many less severe ailments. In other words, it's not all sunburn and poison ivy.
OP, you're limited to Acute Dialysis, Psych, Corrections, and Pre-Ops; they're all highly paid, so that's the good news.
As a new grad, you're unlikely to qual for pre-ops (from *my* clinical rotation experience, it's a very cushy gig).
Pre-ops is where COBs go to die. GREAT job. So is Same Day Surg. I've been fortunate to get the tap on the shoulder when nurses were out for an extended period, and have worked both.
Specializes in Care Coordination, Care Management.
I am a newer nurse, and I do care management at a primary practice - a lot of patient education, hospital follow up. It's a great job where I can interact with people while avoiding the bedside. However, I notice most other care management jobs in my area are at hospitals, require a BSN and bedside experience.
Home hospice is perhaps the last place for an inexperienced nurse. It is such a complex time of life with perhaps more family involvement than any other field (peds, perhaps).
Working with dying patients in their last hours is frightening until you get the hang of it.
I work in a specialty clinic doing triage. I came with a few years of hospital experience but I don't know how much it helped. Honestly, outpatient world is so much different than inpatient. One of my colleagues started in the position as a new grad, and she is absolutely fabulous. The only situations when I may be more comfortable than her is during a medical emergency. BUT that doesn't happen often at all and includes calling 911 as your primary intervention. so eh... She could do it too but I'm just less nervous.
I think what will determine your success at any first job is the amount of training your employer can provide you. If you'll be working alone, you should have a fairly long orientation period. I would also probably avoid the ICU as a new grad if you aren't particularly passionate about critical care. It's a lot of work to train there even for experienced acute care nurses, and employers may not be willing to extend an already lengthy orientation if you need extra practice.
I work in a specialty clinic doing triage. I came with a few years of hospital experience but I don't know how much it helped. Honestly, outpatient world is so much different than inpatient. One of my colleagues started in the position as a new grad, and she is absolutely fabulous. The only situations when I may be more comfortable than her is during a medical emergency. BUT that doesn't happen often at all and includes calling 911 as your primary intervention. so eh... She could do it too but I'm just less nervous.
I think what will determine your success at any first job is the amount of training your employer can provide you. If you'll be working alone, you should have a fairly long orientation period. I would also probably avoid the ICU as a new grad if you aren't particularly passionate about critical care. It's a lot of work to train there even for experienced acute care nurses, and employers may not be willing to extend an already lengthy orientation if you need extra practice.
Good luck, OP!
I agree with the long orientation period. At the clinic I got none, but I was hired for my experience and adaptability.
As for ICU, OP doesn't want to work at the bedside. At all. She/he wants to skip that part of nursing. So, I don't think ICU need worry.
Hospice can be difficult enough for nurses who have bedside experience to learn, let alone a new grad.
I've seen fairly seasoned nurses run screaming into the night after a month or so of trying Hospice.
Why? Because it isn't the easy job they thought it would be.
I went into Hospice with over 20 years of bedside nursing under my belt. That experience comes in handy when doing what Hospice nurses do; managing symptoms. You still have to know WHY a disease process causes certain symptoms, even if you aren't trying to cure it.
I also do evaluations to determine if a patient is appropriate for Hospice care. That usually means doing a chart review. Sometimes finding an appropriate terminal diagnosis takes detective work, including discussions with the primary physician and the Hospice medical director.
If I didn't know what I was talking about, I wouldn't last long with my medical director; he's invaluable for helping fit the puzzle pieces together, but I'm expected to anticipate what information he's going to need me to have handy, and not spend half the conversation saying "Um, I don't know, let me look that up".
Also, while I don't spend my day doing a lot of direct patient care, if I walk into a code brown or a nasty wound dressing, I don't just turn around and delegate to the facility staff. I roll up my sleeves and help. If it's a home patient, I don't even have the luxury of facility staff, I do it myself.
I'm not averse to bedside care, but it's not what I ultimately want to do. I'm in nursing school because I want to do education and advocacy, and hope to work in public health or correctionals. I know this is a very reasonable possibility as a new grad because I've contacted hiring managers from both sectors and have been tracking job postings for these positions for three years. Have a spreadsheet and everything
That said, I might still seek a hospital position for a year or two to make me a more well-rounded nurse. Ya never know what the future might bring, and I feel like it's wise to be prepared...
Kooky Korky, BSN, RN
5,216 Posts
I was asked by an MD to be a summer camp nurse for a week at his church camp. I was a pretty new grad, working ER but took a week's vacation. I survived but the doc was also present at the camp, so I knew there was immediate back-up. I was scared and hypervigilant and textbook-y. In other words, a new grad.
In later camp work, I saw an MI, a post-AB hemorrhage, an attempted wrist-cutting, an ankle fracture, serious rope burns that required opiate pain control and Silvadene dressing changes, along with many less severe ailments. In other words, it's not all sunburn and poison ivy.
The point is that a newbie is a newbie.