Things have changed..

icuRNmaggie, BSN, RN · Oct 20, 2015

https://allnurses.com/general-nursing-discussion/new-grads-in-1000096.html

This discussion from July goes into all of this in great detail.

Some people made it personal and it really became heated.

You could bump it by posting there.

RNNPICU, BSN, RN · Oct 21, 2015

WIbound..

I think now, there are so many orientation programs that give guidance to new grads that it is possible to start in these specialized areas.

Time management in med/surg is so different from time management in an ICU.. many people who transition have great difficulties especially recognizing urgency where as a new grad is molded into that mindset.

I was a new grad in the PICU and could not have imagined starting anywhere else. The assessment skills and time management that I learned in the 6 months orientation prepared me to have a good start. A few med/surg transition nurses started with our group as well and struggled more than us that were new grads.

There are benefits to having a broad introduction, but then what happens to the floor that trains those med/surg nurses to leave for the ICU because they didn't want to be there. Many nurses do pick med/surg because they want it. I really liked the ICU environment, knew that the kids were super sick, learned that you have to be very observant for subtle changes, have quick math skills, and really hone in assessments.

Dranger · Oct 21, 2015

Lol you are worried about baby nurses in the ICU/ED?

What about baby nurses going straight to NP school?! All of our younger nurse on my unit are in NP school currently and it increases throughout the hospital everyday.

Pick your battles.

WIBound · Oct 21, 2015

Lol you are worried about baby nurses in the ICU/ED?
What about baby nurses going straight to NP school?! All of our younger nurse on my unit are in NP school currently and it increases throughout the hospital everyday.
Pick your battles.

Amen! Baby nurses who do not have any foundations go straight thru -- I know a few of these and YIKES!

Okami_CCRN, BSN, RN · Oct 21, 2015

I am a brand new nurse in a mixed medical/surgical ICU and I could not imagine starting anywhere else either.

We have a very involved orientation with two preceptors that lasts anywhere from 4-6 months, with a critical care course and countless other classes to increase our knowledge on things like cardiac monitoring, de-fib, cardioversion, etc.

I think that not everyone is cut out to be in a specialty fresh out of school but those that are should not be forced into the "1 year of med/surg" mentality that is pervasive in nursing. The nurses that I work with in the ICU are so open and willing to share with us new grads and when we go to nights we have the support of nurses who have been there for 15-20 years and are great resources.

PaSSiNGaS, MSN · Oct 22, 2015

I am seeing more and more brand spanking new nurses hired into specialty areas such as ICU, SICU, ED, etc...
I remember when I was a baby-faced nurse you were placed into medical-surgical areas to develop time management skills and to have a solid base of knowledge before moving to a specialty areas.
When students ask me for advice where they should begin I always suggest 1 year in med/surg but if their heart has always been in some area like L&D, Psych or PEds those are exceptions (with the understanding that it is very hard to move out of those areas with no other background).

This post is just idiotic. What does medsurg experience give you? Oh yea, you can manage your time acting like a waitress delivering meds and bedpans, and wiping butt in a timely manner. I'm not knocking anyone who does medsurg but sorry you do not need this training AT ALL to be a good ICU RN. Being in medsurg also doesn't teach you hardly any of the critical things you need to know in the ICU, that's why these ICUs have a 3-6 month orientation for RNs to go through.

ChipNurse · Oct 22, 2015

I started in the SICU as a "baby" nurse and have managed just fine. I did work as a tech in the hospital system, so I was familiar with the charting system and did a practicum in the SICU within the same hospital system, so that may have helped as well. I also studied every day after work and looked (and still look) up things that I am not familiar with. I do not think that everyone is cut out for the specialities straight out of nursing school, but if you're motivated and willing to study, then I think that a new grad can be successful. As far as being an NP with with only 1 years experience? I do not understand it at all. I thought that NPs were valuable since they had so much nursing experience, so that replaced all the med school. It seems to me if you skip the whole bedside nursing experience thing, then what do you have to offer as an NP?

WIBound · Oct 22, 2015

Not all nurses can or should go directly into an ICU and like it or not many green nurses do benefit from the surrounding that is let acute. Get them use to their new role. How many nurses start their first job not knowing any of the medications listed on the MAR.

Yes, I have been in an ICU with newbie nurses that have gone into full-blown panic mode over the drop of the hat! One actually came SCREAMING from her room because her patient would not wake up.

I have also seen nurses do rather well from the start in an ICU usually ones who have worked as a PCT and have a better understanding of how the system works.

Truth is - you do not know what you are going to get with a brand spanking new nurse unless you crack them open and see what spills out but then they are useless.

WKShadowNP, DNP, APRN · Oct 22, 2015

I don't think new grads going into NP school is necessarily a bad thing. I used to. But it is a different skill set. Sure I feel that my years as a nurse (and my medical field work prior to nursing) aids me in my studies and in clinic. That's not to say the less experienced NPs are going to suffer, or those for whom they provide care. Individuals vary so some may be good, some not, regardless of their experience.

Dranger · Oct 23, 2015

I don't think new grads going into NP school is necessarily a bad thing. I used to. But it is a different skill set. Sure I feel that my years as a nurse (and my medical field work prior to nursing) aids me in my studies and in clinic. That's not to say the less experienced NPs are going to suffer, or those for whom they provide care. Individuals vary so some may be good, some not, regardless of their experience.

I mean in all honestly you can say that about anything. A small subset is never going to fit the mold and will usually be brought up as an anecdote on here.

Point is for practicality reasons, new grads going straight to NP school hurts the market for NPs (jobs aren't limitless) and increases the bedside nurse deficit. Getting 102 years at least draws out enough time for new grads to replace the newish grads.

The clinical/skill site is another discussion, if there were less online schools I think I would favor the direct entry route more.

SororAKS, ADN, RN · Oct 28, 2015

Not everyone is cut out for a specialty straight out of school, but I think their success depends on a few factors. First and foremost, the facility. Critical care classes, flexible orientation, and experienced staff that really support the new grad make all the difference. If the new nurse has been exposed to the environment prior to graduation, so much the better, and a true desire to learn is great. So much, in my opinion, depends on the support available. I've seen it both ways. The units and hospitals that take care of their staff tend to have less turnover and happier nurses, regardless of where they are in their career.

When I precepted new grads in ER, I was able to tailor my precepting to their skill level. Most were ER techs prior to graduation, but not all. They were willing to follow directions, work hard, and do the study work necessary to learn the specialty. As a preceptor, I couldn't ask for better.

I was told the same thing about Med Surg. I didn't follow the advice and turned out well in spite of it. That doesn't mean I didn't pay my dues.