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!
I worked in a SNF for 10 months after graduation prior to landing my job in a clinic. A clinic job was my "dream job" because it fits well with my background prior to nursing. However, I think my time in the SNF helped me transition into my current position, as I'm the only nurse in my clinic and was responsible for creating policies, procedures and standing orders to ensure I practice within my scope. Our clinic is mostly MAs, which is how most clinics operate I think. I did try to get a clinic job right out of school but was turned down.
What state do you live in? I got into a new grad ambulatory program at Kaiser Permanente in California and the training is extensive! We are training in family, peds, nurse clinic, urgent care and specialties for 6 months with a preceptor, weekly classroom training and after our 6 months we continue with monthly classroom training. We are even being floated to GI lab and ED during our training.
I worked as an LVN in ambulatory for 5 years prior to transitioning into an RN role and it's definitely not a job for the lazy haha so ignore anyone who calls you lazy.
Personally, I wish I would have gone to the hospital because I'm craving that acute care experience but if ambulatory is what you want definitely pursue it!! The RN role is extensive in ambulatory and often times I've seen inpatient nurses transition to ambulatory thinking it'll be a vacation and a place to retire but they end up going right back.
We possess a different type of skill... We triage not only in person but over the phone without the ability to see, listen or feel. We care for patients of every age at every stage in their disease process, we educate, and we are seeing more and more acute patients in clinic! Don't let anyone tell you that you won't be a "well rounded nurse" if you don't work bedside! I used to beat myself down over this and now realize it's not true. The future of nursing is changing and the ambulatory care setting is growing day by day. We are even providing phone and video chat appointments/treatment for our patients which is revolutionizing the way we look at healthcare.
It's also dependent on how much you apply yourself. I stay up to date with my education (ACLS, PALS, NIHSS, EKG certs, etc) and love being able to pick the providers' brains right then and there while the patient is being treated. Our doctors are all so nice and love providing education because they depend on us and often times even ask for our input for treatment and management.
Our nurse clinic is completely independently ran by us (with a provider in clinic available in case we need to consult) so the level of responsibility, time management, triage skills and clinical skills is high. We provide diabetic teaching to all our newly diagnosed and chronic diabetics (insulin, diet, glucometer, lifestyle). We're even taking on home health patients who no longer qualify as being "home bound" and come to us for infusions. As far as wound care, we see everything! Even wound vacs, post op care (including drains), diabetic ulcers requiring unna boot compression, and it's up to US to decide the treatment and assess progression of the wound process. We see the usual immunization update so we have extensive knowledge of immunization schedules for both the pediatric and adult population. Additionally, we have a travel clinic so we are also expected to be knowledgable on travel vaccines and medication needed for travel.
I'm even doing port and PICC line care as well as removing PICCs in clinic, taking care and managing complex wounds and managing my staff (LVN's, MA's), back office intake, interdisciplinary collaboration with specialty departments and scheduling, etc. Want to call us lazy? We do our own EKG's, breathing treatments, back office tests, assist in minor surgical procedures, perform our own ortho supply fitting and even do our own splints. We have so much autonomy that often times it's even us placing the orders for the providers.
It's great experience so don't let anybody discourage you from it if you're passionate about it!!! If it wasn't for the fact that I'm truly passionate about trauma and hope to eventually land there some day, I'd gladly stay in my position because of the fact I have the ability to float around from so many departments so the exposure and experience is excellent!!
P.S. Choose wisely and don't let people on here discourage you because of "the crappy pay." I'm making a 6 figure income as a NEW GRAD without working any OT so the pay can indeed be extremely rewarding! Fully paid for medical benefits for myself and my family and did I mention I get a pension, too?
I loved working bedside... For 7 years... Until I didn't. When staffing became unsafe and management just got worse and worse due to budget cuts, nurses quitting and not hiring new nurses to fill those FTEs. We were stretched thin. Having to take more patients then safe, PICU pushing out patients on drips who are still PICU status, home vents, Trachs, chemo, DKAs on insulin drips changing fluids every five minutes, fresh post ops, traumas (level one trauma center), etc etc etc ... Not to mention all the new policies, procedures and paperwork we had to keep up with. No lunch, no water, no bathroom breaks. The catty high school crew always talking crap about people... Staying after a 13 hour shift to finally chart, then getting yelled at for not clocking out on time, Enough was enough. I loved loved loved my patients, but I was done being a floor RN. Now I'm in NP school and work outpatient.
Yep. This is why I stay away from inpatient. I get paid less, but I work M-F 8-5, no holidays, overtime is my decision if I need it to keep up with patient needs. My boss is phenomenal and my job satisfaction is very high. Of course I still have to deal with the "catty high school crew", the MAs I work with are very catty, but I just do my job without getting involved in the drama.
You could try the OR...one patient at a time, they are under general anesthesia and no family to communicate with just the OR team you work with. Something to think about...😊
Most non bedside roles require 2-5 years of bedside nursing experience at a minimum. OP, you would be wise to obtain some bedside experience and then move on.
Specializes in Informatics, Med-Surg, Trnsplnt, HemeOnc.
Keep an eye out for clinics which may be hiring Specialty MDs/DOs or Primary Care Providers. Those Providers will all need a Triage Nurse or Rooming Nurse (typically LPNs)- if you can sell your skills from inpatient nursing which rounds out your clinic experiences, you may be able to show them it's worth hiring you. Make friends with Pharmacists hired as Medicine Therapy Management personnel (teach patients about new meds prescribed or overall medication management and teaching); they could teach you a lot. Take extra classes on diabetes, see about getting certified as a Diabetic Educator so you could teach patients about managing various stages of pre-diabetic and actual diabetic diagnoses.
Take heart; nursing schools have to get 'with it' and start including ambulatory concepts and having ambulatory clinical time. Way back when I was a new grad 30+ years ago, 'they' were saying then that clinics of the future would be as big as hospitals were then and hospitals would be a small as clinics were then. I am seeing clinics adding floors building UP and no more hospital additions/expansions because the focus has been outpatient treatment and NOW there are governmental financial rewards for keeping patients OUT of the hospital. Pretty soon, there will be much FEWER opportunities for inpatient care. Go get, 'em, Lemon Bars!
Specializes in Ambulatory/Family Practice (*yawn*).
I only worked 3 months in a SNF/ICF after graduation then landed a clinic job in family practice and have been an RN in a clinic ever since. Actually I would like some bedside experience but with my family situation (a special-needs intellectually disabled daughter, not too medically complex but still needing more than your average kiddo; plus a husband who works out of town during the week), the 8-5 no holidays or weekends works best for us. Right now I'm working on my BSN to hopefully get on at a tertiary hospital in the Peds Specialty Clinic, as it is a magnet hospital.
This will allow you to make a generally higher wage than the average floor nurse, will be challenging in its own respect, and will eliminate the long term/bedside care of the client.
Although I would HIGHLY recommend at least two years of floor nursing beforehand, with at least 1 or both of those years being in an ICU. This will give you much better assessment and critical thinking skills, than just working in a clinic, or even jumping directly into procedural nursing, which can be harder without requisite critical care experience.
Some options to look into Research nursing. Depending upon the dept there is little to a lot of patient contact and it also depends upon the study. Some are more chart reviews and no patient interaction. Some have a good deal of patient interaction and phone calls. There is a lot of paperwork that you have to deal with in this line of work.
Another option is working in the OR as a scrub and/or circulating nurse. You work with one patient at a time. Depending upon the place and surgery it can be hectic. But as the nurse since the majority of patients are asleep the majority of the time you work with them you don't get to know your patients that well. You work as the patient's advocate to make sure that they are positioned correctly so no injury happens, that the correct procedure happens, ext. There are lots of hospital systems that have new to the OR programs that take new grads and nurses who worked on the floor. I would try to see if you could spend a day in the OR observing, an hour or two does not really let you see the whole process.
As far as bedside nursing, I am with you I never wanted to work on a unit in which 6-7+ patients to care for. I did my year working on a step down unit (heart and lung transplant) and typical ratios where 4 pts or less for the day and 5 or less at night. We had a few LPNs at night so you would have one pt with them (so that made the 5th patient easier to care for). The good thing about step down is that the patients are less fragile than icu for the most part (some times they deteriorate and you have to send them back to the icu). Being on a transplant unit we got people waiting for a transplant, post icu/fresh transplants, and patients back in the hospital for any reason (colds/flu for the most part, though some people in rejection). Depending upon what type of patients we had they tried hard to balance pts who needed more care with pts who needed less. Overall I loved the patient population.
I will be honest with you the farther you get from graduation and not doing a year bedside it makes it harder to transition into different kinds of roles later in your career. But it can be done, you just typically have to deal with more nos than yeses.
Make sure to use the resources that you have. Talk to the managers and the nurses about what they think about working in a traditional nursing position out of school. They might be able to create a position for you or be willing to teach you things you need to know.
Wow! I'm so surprised at all the negativity & lack of support. This is why nurses get a bad wrap for "eating their young" When I was half way through nursing school I realized I could not do bedside nursing due to a skin condition. I've found a rewarding & successful career in public health (psych) that I love. Some friends from nursing school have commented that I don't do "real" nursing, too. Today we need nurses in such a wide range of practice bc of our aging population & poorly run health care systems. I applaud this student's bravery for bringing the question!
Yes, acute care/bedside nursing is valuable experience but definitely not necessary.
Some other options (several already mentioned)
* Public health RN (through County, state, non-profit or home-care agency
* school nurse
* hospice RN (in facility or home)
* case manager
* correctional RN (prison, jail or workhouse)
* urgent care
* VA home care programs
* CD treatment center or eating disorder treatment
Just a few ideas. One other suggestion I have is to find a nurse mentor! Good luck to you!
OrthoRN1979
12 Posts
I worked in a SNF for 10 months after graduation prior to landing my job in a clinic. A clinic job was my "dream job" because it fits well with my background prior to nursing. However, I think my time in the SNF helped me transition into my current position, as I'm the only nurse in my clinic and was responsible for creating policies, procedures and standing orders to ensure I practice within my scope. Our clinic is mostly MAs, which is how most clinics operate I think. I did try to get a clinic job right out of school but was turned down.