Dear new grad...

rumwynnieRN · Dec 7, 2012

I am a potential nursing student, and I'm a little confused. What is so awesome about working ICU/ER? I imagine that if I become an, ICU or ER would be the last places I'd want to work until I had a little more experience as a nurse. I think I'd much rather start out in LTC or a non-ICU floor in a hospital. Or even doing something like working in a clinic or home health. Then after I felt fully competent in one of those areas, I'd consider ICU.

When you do your clinicals, this is entirely dependent on how you feel, you tend to do more, you get more skills in, and you find out your nurses may only have 2 patients he/she is responsible for. My family has tried steering me away from doing floor nursing because that's when they can pile on the patients (you should have, say, 4, but then someone calls in, so now you have 8), and school wise, I found my first floor experience to be, well, boring. No one needed anything -- no NG tubes, no IVs, foleys, etc., because they were already done in the ER or ICU. Even in the ICU, a lot of that isn't done because, it's done in the ER.

To each his own, and in the end, I can only speak for myself and some of my classmates because the above was our experience. Out of school, a lot of people think they'll be that "blood and guts" nurse, they'll know what to do in a code after training, all that (okay the latter is a bit of an exaggeration). Other nurses have echoed the sentiment my family has. They think it's better for me to go to ICU before going to a regular floor because I'll have my skills rather me going to floor where I'll lose them. I prefer to work the floor before going to the ICU because I know where I personally am. Some of my other classmates I can see going to straight to the ICU, and it would be a waste for them to just go to the floor (at least in my opinion).

In the end, it's what works for you.

wgc2345678 · Dec 7, 2012

I am starting my nursing program in January, and I have thought a lot about my career goals. I read on another thread that new nurses never dream of working LTC. I guess I am a different breed because that really interests me. My Mom has lived in a skilled nursing facility for 10 years, so I think this has had some influence on me. I will soon have the privelage of taking care of her, as she currently lives in another state. I look forward to this, and it makes me feel like LTC is maybe where I am destined to be. I want to give to a family what so many nurses have given me (comfort, support, care, love). I am humble, however, and I will be happy to get experience where I can get it.

MN-Nurse, ASN, RN · Dec 7, 2012

When I was a new grad I absolutely dreaded the possibility of working in a nursing home. It was a nightmare scenario.

Not because of career goals and not because nursing school taught me that "hospital nursing was REAL nursing."

It was because I worked as an aide for 2 years in a nursing home.

anon456, BSN, RN · Dec 7, 2012

I work on a unit with lots of chronic total care peds patients. I have to manage gtubes, trachs and vents, TPN on some patients, huge amts of nightly meds (my record patient is 14 meds at bedtime but it's typical to give at least 5-6), seizures, turning on schedule, oral care Q4H, diaper changes on big patients, agitation and tremors that make the cares harder, and then they are in the hospital for antibiotics or something so I have to also make sure that problem is getting better. I also have to frequently bag the more fragile patients who can't handle diaper changes or other things without a bit of breathing help.

Taking care of long term care patients is no picnic! I was a home health respite night nurse for several months and took care of one such patient in their home. I have floated to other units and taken care of normally developing patients with short-term health issues, and it was so much easier (and less mentally challenging) than taking care of my long term kids.

Don't think I'm complaining either. I really have grown to love and care for these most innocent, vulnerable patients.

squidbilly · Dec 7, 2012

I am thankful I stumbled upon this thread. I graduated in May 2012, and I applied for literally hundreds of hospital jobs (med-surg, OB, ICU, ER, PACU). I finally ended up with a job in school nursing which I have grown to LOVE. My mother, who is a retired RN, often makes me feel as though this job is below me and that the income is insufficient to support me. I know she is not the only RN who feels this way, and I certainly agree with whoever mentioned how nursing schools hammer into their students that "real" nurses work in hospitals. Thank you for reminding me that I AM A NURSE.

Not_A_Hat_Person, RN · Dec 7, 2012

I worked in LTC for about a year. I have plenty of respect for LTC nurses. When we had to put my mother in a nursing home, I was picky about which facility she went to, and I was very impressed with the nurses there. That said, I will sell my body on the street before I work in LTC again. Med-surg level patients need med-surg level staffing and supplies.

I work home health. Sometimes I feel like a glorified maid or (on peds cases) babysitter. However, I've learned a lot about trachs, vents, diabetes, and other things. Because of me, people who would have been institutionalized a generation ago can live in the community. Plus, I get paid to go to the park, the fair, camping, the mall, and the beach. When we were dropped off for my client's program early, I got paid to to hang out at Starbucks for 30 minutes.

Unfortunately, many non-hospital jobs want nurses with hopsital experience, and too many hospitals refuse to consider LTC or home health experience.

AlaBro2010 · Dec 7, 2012

I am thankful I stumbled upon this thread. I graduated in May 2012, and I applied for literally hundreds of hospital jobs (med-surg, OB, ICU, ER, PACU). I finally ended up with a job in school nursing which I have grown to LOVE. My mother, who is a retired RN, often makes me feel as though this job is below me and that the income is insufficient to support me. I know she is not the only RN who feels this way, and I certainly agree with whoever mentioned how nursing schools hammer into their students that "real" nurses work in hospitals. Thank you for reminding me that I AM A NURSE.

Ditto to that! I just got hired into a clinic and everyone looks at me like I've got a third eye when I say it's somewhere I can see myself for years, "but,but you really need experience in the hospital". I plan on getting an MPH so it's perfect. Go us :)

LTCangel, ADN, BSN, LPN · Dec 8, 2012

I started out in LTC as an LPN and then after 1 1/2 years got a job at a hospital. I worked in this hospital for 14 yrs. While there I obtained my RN and then my BSN. I worked on a busy Orthopedic/Med-Surg unit. I ended up leaving that job for reasons I don't want to go into and I got a job at the same LTC facility I started out in. I have to tell you that I have not lost any of the skills I gained in the hospital. LTC residents are much different now than they were 16 yrs ago. There are also many RNs working there now. It used to be only LPNs and an RN who was the DON. The acuity level of these residents is extremely high, they are being discharged from the hospital quicker and sicker. A LTC nurse has to be on their toes and know their stuff or they won't make it. The stigma that LTC nurses are not real nurses needs to end! I am a great nurse, my assessment skills are excellent, and I love my residents as if they are my own family. Yes, it is stressful. Yes, we are understaffed. Yes, we have to care for too many at once. But I did the same things in the hospital. This is just my experienced humble opinion.

Music in My Heart · Dec 8, 2012

I've got no problem with a person feeling disappointed that the only job that they're able to get is in a SNF. Just as many nurses would hate my job in the L-I ED, I would hate working in LTC... that's not to cap on those who fill that vital role but it's not for everybody.

By the same token, I consider a new grad a fool to turn down any clinical job offer and an even bigger fool not to give everything they've got to that first job, in whatever capacity.

I took the first job offer I got even though it had many more negatives than positives. It's taken three years of concerted effort and major sacrifice but things have finally panned out for me. I was quite disappointed that my first job but I didn't let it show and I gave it my all... from which opportunities slowly arose.

Every job presents opportunities to learn and chances to demonstrate one's skill and work ethic... not to mention a paycheck.

nguyency77, CNA · Dec 8, 2012

By the same token, I consider a new grad a fool to turn down any clinical job offer and an even bigger fool not to give everything they've got to that first job, in whatever capacity.
I took the first job offer I got even though it had many more negatives than positives. It's taken three years of concerted effort and major sacrifice but things have finally panned out for me. I was quite disappointed that my first job but I didn't let it show and I gave it my all... from which opportunities slowly arose.
Every job presents opportunities to learn and chances to demonstrate one's skill and work ethic... not to mention a paycheck.

Exactly! Kudos to you!

I hope when and if I graduate, I'll be strong enough to do the same. I'll take any experience I can get.

Some friends of mine are always saying, "I want to work in L&D or with kids right out of school!" etc. etc. And I'm thinking...So does almost every other new RN + possibly some RNs with years of experience who are looking for a change. Unless you know-someone-who-knows someone. In other words...Fat chance. :sarcastic:

smurfynursey · Dec 11, 2012

Wow!

I didn't expect such a response on this...

I have done pediatric snf, adult snf, Pedi home health, peds hospice and adult hospice...its really interesting to see the looks I get when I tell people I've never worked in a hospital. My aunt is a nurse on a ACE/adult CF unit and there are things I can do really well (vents, trachs, ect) that she never gets on her floor.

SionainnRN · Dec 15, 2012

People think I'm weird when I say I want to work MedSurg before going to ICU. A lot of nurses have told me "no no, go to ICU first! You want to work there anyway! You'll burn out on the floor." I already know where I'm weak, and before I start going into critical care, I want some of my basic skills like assessment and gathering my meds in order. I guess I'll find out after next week, after graduation, so I hope I'm not that picky new grad people complain about.

Honestly ICU is so different from any other floor that it can be hard to go from MedSurg to ICU because you have to unlearn a lot of things while trying to learn all of the new things. This is why a lot of ICU's like to hire new grads, they have a blank slate to work with.