Career Path For A New Rn?

llg, PhD, RN · Dec 3, 2005

You don't get anywhere until you make a decision.

Sometimes, all you can do is "pick one" and give it a try, knowing that it might not be the perfect choice. You can always change your mind.

Perhaps the best approach might be to interview in all of those areas still on your list of possibilities and go with the unit that feels best for you as you interview, tour the unit, etc. and compare their managers, their orientation programs, etc. Since you seem to be most interested in adult med/surg areas (and related areas), the particular unit's subspecialty is less important as many of the general skills you learn on those units will apply wherever you end up.

Good luck,

llg

Daytonite, BSN, RN · Dec 3, 2005

Was there any clinical experiences during school that you particularly liked? I was going to suggest med/surg. It's a good place to start. However, a lot of people forget about the surg side of that--a general surgery unit. It's fairly routine which is a good place for a new grad to start out. The less chaos during your orientation the better for you. If you don't want to start in the hospital you can always go to nursing homes. However, if you are looking to be an Adult NP a medical unit would be a very good place for you to start out.

SuzanaS · Dec 3, 2005

Thank you so much for your advise. I truly appreciate it.:)

You don't get anywhere until you make a decision.
Sometimes, all you can do is "pick one" and give it a try, knowing that it might not be the perfect choice. You can always change your mind.
Perhaps the best approach might be to interview in all of those areas still on your list of possibilities and go with the unit that feels best for you as you interview, tour the unit, etc. and compare their managers, their orientation programs, etc. Since you seem to be most interested in adult med/surg areas (and related areas), the particular unit's subspecialty is less important as many of the general skills you learn on those units will apply wherever you end up.
Good luck,
llg

SuzanaS · Dec 3, 2005

Thank you for your suggestion. We actually have 3 hospitals in the area that offer excellent orientation programs for new graduate RN's that last 8+ weeks. I really would like to have a slow start and be comfortable in my area and unit. Real world is so much different from clinicas, no matter how excellent of a student I was.

What scares me most is that due to the shortage of nurses, many new graduates do not receive the orientation or preceptorship they are promised when recruited. They are sort of thrown in and told to "swim or sink". I known many RN's who became charge nurses in six months or less from their graduation. Needless to say they were scared, stressed and burned-out. This is not something I am looking for. I need a quite start...

So, surgical side of the med-surg sounds really great for me! I truly appreciate your help.:)

Was there any clinical experiences during school that you particularly liked? I was going to suggest med/surg. It's a good place to start. However, a lot of people forget about the surg side of that--a general surgery unit. It's fairly routine which is a good place for a new grad to start out. The less chaos during your orientation the better for you. If you don't want to start in the hospital you can always go to nursing homes. However, if you are looking to be an Adult NP a medical unit would be a very good place for you to start out.

MIA-RN1, RN · Dec 3, 2005

One of the hospitals near me offers a kind of new-grad float where you can choose four rotations from a large list and you spend a few months on each one, being precepted the whole time. After each rotation you have the option of choosing it or moving on to the next one. Perhaps the hospitals near you have a similar program? I am sure the nurse recruiters have had others like you that are just undecided. They might be helpful. Good luck!

SuzanaS · Dec 3, 2005

This sounds great! I will look into it. Thank you.

One of the hospitals near me offers a kind of new-grad float where you can choose four rotations from a large list and you spend a few months on each one, being precepted the whole time. After each rotation you have the option of choosing it or moving on to the next one. Perhaps the hospitals near you have a similar program? I am sure the nurse recruiters have had others like you that are just undecided. They might be helpful. Good luck!

Daytonite, BSN, RN · Dec 4, 2005

What scares me most is that due to the shortage of nurses, many new graduates do not receive the orientation or preceptorship they are promised when recruited. They are sort of thrown in and told to "swim or sink". I known many RN's who became charge nurses in six months or less from their graduation.

If you know of these specific hospitals that do this with orientees then just stay away from them. The fact is that the way new grads go from school to their work situations is flawed. It got worse when DRGs caused units to tighten up on staffing and patient length of stays and then the commercial insurers followed suit. I hear it talked about and discussed all the time by nursing leaders, but no one seems to be able to come up with some acceptable alternative. Ideally, I think there should be a year of clinical practice following formal nursing education very much like the residencies that doctors do. However, I don't know that it would work because no one wants to work without getting compensated monitarily for it. And most nurses are not going to want to pay another year of tuition to work as an unpaid employee. The old hospital nursing programs of the 40s and 50s required their nursing students to actually work as scheduled staff and that is how they got a lot of their training. That, I don't think, would fly today. If someone is going to make a full wage, the employer expects performance. It's a kind of Catch 22 situation. I think the best places for new grads are on med/surg units, the more specific type of patient, the better (EX: neuro, ortho, GYN, GI), if you can find it. The patients are pretty much coming in with the same kinds of illnesses and a nurse has a chance to focus on illnesses occurring one particular body system while also struggling to learn time management and prioritizing. Recall that much of our learning involves repetition. So, by working on a more specific medical or surgical unit you are going to have a lot of repetition with a specific set of medical problems as opposed to a stepdown or critical care unit where you are going to be exposed to everything from soup to nuts with a good sprinkling of emergency situations coming up. Code blues don't occur on med/surg units with anywhere near the frequency that they do in the critical care areas. I feel that stepdown units (I worked on one for 5 years) and units such as ICU, CCU, OB, OR and ER where patients are often in a critical situation are not appropriate for new grads unless they are performing exceptionally well and/or have really, really good preceptors backing them up.

Being a charge nurse after 6 months is a reality in today's working world. Don't let the term scare you. It's meaning varies from place to place. Sometimes, but not always, it's more of a glorified title bestowed upon the person who helps determine the patient assignments for the shift. During my years of working as a staff nurse, the other RNs I worked with shared charge nursing equally. It becomes a bit more stressful when you are the only RN on the unit. Then, people are going to be coming to you with problems. You just remember to do some assessment with your own eyes of the situations being brought to you before you pick up the phone to call a doctor or the supervisor to take action. Remember that your training in assessment has been much more extensive than that of the other licensed and unlicensed staff despite any amount of experience they may have had.

How well I understand your reservations about that first job. I suffered through a sink or swim situation as a new grad myself. I didn't have a preceptor and wasn't in a new grad oreintation program. I don't wish that kind of a start on anyone. The problem is that you never know exactly how things are going to go on a job until you actually get into it. It's almost impossible to feel that you can trust what you are being told while you are being recruited when you've heard some terrible scenarios of those who have gone before you. There is also the wild card factor of people on the nursing staff who really don't want to have any part in helping to orient new grads. That's something recruiters can't always be aware of. You are, unfortunately, going to run across these people throughout your career. What you try to do is try to minimize the probability of these kinds of things happening to you by choices that, hopefully, assure that. But, always have a Plan B just in case.

neeko02 · Dec 4, 2005

I am becoming increasingly 'freaked out' :eek: by all of the choices and not knowing which unit would be best to start out in. I am interviewing with the nurse manager in Subacute, but other students told me that was a bad floor because it is like a nursing home. I love to get to know my patients and there is such a variety there. Yet, I have been told to start on an ortho/neuro or med/surg floor. So far, a good majority of my class is applying to those floors and I feel at a loss. I am terrified that I'll end up on a floor were I won't be happy.

ps. I worked my 10 week internship this past summer in ICU. Not sure that it's for me.

SuzanaS · Dec 7, 2005

Thank you for your thorough response. I am so glad to hear that I am not alone in wanting to be properly oriented in my new role as an RN. Thank you for your encouragement.

If you know of these specific hospitals that do this with orientees then just stay away from them. The fact is that the way new grads go from school to their work situations is flawed. It got worse when DRGs caused units to tighten up on staffing and patient length of stays and then the commercial insurers followed suit. I hear it talked about and discussed all the time by nursing leaders, but no one seems to be able to come up with some acceptable alternative. Ideally, I think there should be a year of clinical practice following formal nursing education very much like the residencies that doctors do. However, I don't know that it would work because no one wants to work without getting compensated monitarily for it. And most nurses are not going to want to pay another year of tuition to work as an unpaid employee. The old hospital nursing programs of the 40s and 50s required their nursing students to actually work as scheduled staff and that is how they got a lot of their training. That, I don't think, would fly today. If someone is going to make a full wage, the employer expects performance. It's a kind of Catch 22 situation. I think the best places for new grads are on med/surg units, the more specific type of patient, the better (EX: neuro, ortho, GYN, GI), if you can find it. The patients are pretty much coming in with the same kinds of illnesses and a nurse has a chance to focus on illnesses occurring one particular body system while also struggling to learn time management and prioritizing. Recall that much of our learning involves repetition. So, by working on a more specific medical or surgical unit you are going to have a lot of repetition with a specific set of medical problems as opposed to a stepdown or critical care unit where you are going to be exposed to everything from soup to nuts with a good sprinkling of emergency situations coming up. Code blues don't occur on med/surg units with anywhere near the frequency that they do in the critical care areas. I feel that stepdown units (I worked on one for 5 years) and units such as ICU, CCU, OB, OR and ER where patients are often in a critical situation are not appropriate for new grads unless they are performing exceptionally well and/or have really, really good preceptors backing them up.
Being a charge nurse after 6 months is a reality in today's working world. Don't let the term scare you. It's meaning varies from place to place. Sometimes, but not always, it's more of a glorified title bestowed upon the person who helps determine the patient assignments for the shift. During my years of working as a staff nurse, the other RNs I worked with shared charge nursing equally. It becomes a bit more stressful when you are the only RN on the unit. Then, people are going to be coming to you with problems. You just remember to do some assessment with your own eyes of the situations being brought to you before you pick up the phone to call a doctor or the supervisor to take action. Remember that your training in assessment has been much more extensive than that of the other licensed and unlicensed staff despite any amount of experience they may have had.
How well I understand your reservations about that first job. I suffered through a sink or swim situation as a new grad myself. I didn't have a preceptor and wasn't in a new grad oreintation program. I don't wish that kind of a start on anyone. The problem is that you never know exactly how things are going to go on a job until you actually get into it. It's almost impossible to feel that you can trust what you are being told while you are being recruited when you've heard some terrible scenarios of those who have gone before you. There is also the wild card factor of people on the nursing staff who really don't want to have any part in helping to orient new grads. That's something recruiters can't always be aware of. You are, unfortunately, going to run across these people throughout your career. What you try to do is try to minimize the probability of these kinds of things happening to you by choices that, hopefully, assure that. But, always have a Plan B just in case.

GooeyRN, ADN, BSN, CNA, LPN, RN · Dec 7, 2005

If you aren't sure what you like, I would interview at a few places and then take the best offer.