Do I have to do bedside nursing as a new grad?

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Do I have to do bedside nursing as a new grad?

Hello Nurse Beth,

I struggle with basic bedside skills, but I'm graduating soon. I'm in SoCal and want a job in this area. Do I need to do bedside?

I didn't know much about nursing, but decided to do it because it's practical. However, my clinical skills are weak. I'm not just being hard on myself. I have poor memory (even though I try to write most things down), and I'm very bad at physical work. The work doesn't come naturally, and I need more practice than my peers.

I used to practice in the Sim lab every week, but it closed due to the pandemic. Also, I dislike the bedside work I've experienced. I don't mind dirty work, but I get stressed because I'm slow and once I'm an RN I'll have too much responsibility. Anyway, I'm more interested in public health or mental health nursing or outpatient. I also am interested in teaching but wouldn't that require bedside experience? I'm considering applying to big hospitals to get good new grad training at the bedside, but I hate that I may need to sign a contract for 2 years. Aren't they always hiring new grads to do bedside because it's undesirable work?

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9 Answers

Specializes in Tele, ICU, Staff Development.

Congrats On Your Graduation!

The short answer is "No, you do not have to do bedside". The beauty of our profession is the almost endless career choices.

You do, however, have to do some strategic planning and make some key decisions.

The crucial decision new grads need to make is "Do my long-term goals require acute care experience?" It's very important that you gain bedside nursing experience as a new grad if you think you may ever need it to achieve your career goals. There's a narrow window of opportunity (one year) for getting hired into acute care as a new grad. It is difficult to land a job in acute care when you are no longer a new grad and when you do not have acute care experience.

You can always look at investing 2 yrs at the bedside as a means to an end. You ask if hospital work is undesirable and therefore suitable only for new grads. It is not undesirable, and that's too broad of a generalisation. I love acute care (for the most part!). Many of us find acute care rewarding and challenging when it's the right fit. Hospitals hire new grads because there's a shortage of experienced nurses.  

You describe yourself as slow, and that may mean that you perform better when there is not constant stress, urgency, and interruptions. All jobs have some level of stress, but acute care nursing is high stress and involves cognitive stacking. You might be happier in a job that is more linear, where you can thoughtfully approach one task at a time.

You are interested in public health, behavioural nursing, teaching and outpatient. The good news is there are many opportunities to work outside of acute care in your identified areas of interest. 

If you plan to go into teaching and academia, you will need acute care nursing experience. You could start as a clinical instructor after you gain 1-2 years of clinical experience, and advance from there.

Public Health

Public health nursing is very broad, offering the opportunity to work in different clinics and with different patient populations. It includes a lot of patient education, and resources can be scarce. Counties in So Cal (San Diego, LA, Orange counties), do hire Level I Public Nurses. The ability to speak another language (Spanish, Farsi, Tagalog) is advantageous and if you've done any volunteer community work, be sure to include it on your resume. 

There are migrant clinics, immunization clinics, free clinics, and more. The work hours are great, Monday through Friday with weekends and holidays off, and the benefits are usually good. 

Public health nurses can work in community settings that include homes and public health centers. You may be assigned to various programs such as Tuberculosis, Maternal Child Health, Sexually Transmitted Diseases (STDs), and Foster Care.

A California Public Health Nurse Certificate is required, and you can usually obtain that when you apply for your licensure through your nursing school. If you haven't already done so, you should start applying for that right away (go to the CA BRN online). You may have to complete an online child abuse reporting course to obtain your certificate.

Also, look at federal and state jobs. The US Department of Veteran's affairs hires RNs for clinics and considers a new grad RN with a BSN but no experience as a Nurse I, Level II.  Experience is preferred, but not required.

Behavioural Nursing

Behavioural nursing, also called Psych and mental health nursing, also has a lot of opportunities for you. There's acute care psychiatric, there's outpatient settings and there's the private as well as the public sector. 

Behavioural nursing meets your concerns about being weak with clinical skills and Behavioural nursing doesn't routinely require heavy physical work.

I recommend you take a look at Indeed. com, using the filters to find job postings in your areas of interest and preferred locations. You will quickly gain a feel for the types of jobs, settings, and qualifications. Note if a job listing specifies "experience required" then you should not apply. If it says "experience preferred", then you should apply.

Best wishes ? This is a very exciting time for you, and I wish you the best in your decisions.

Be sure and check out the Speciality Psychiatric Nursing and Public Health Nursing forums here on allnurses as well as the allnurses Nursing Specialties Guide (ebook).

Specializes in Psych, Corrections, Med-Surg, Ambulatory.

I'll tell you a personal story, for what it's worth.  I started out in psych and worked there 15 years.  The thought of med-surg put me off.  When I got tired of psych, I went to corrections for another 5 years.  I had a bit of a learning curve for the non-psych issues, but I catch on pretty fast.

Twenty years into my career I decide to give med-surg a shot, with no prior experience.  But I did have nursing experience, so I had critical thinking skills, common sense and assertiveness.  I ended up loving that job, even though it was very hectic.  It was the only job I truly missed after I left.

There's nothing wrong with starting out in psych or anywhere.  You will still gain a lot of valuable skills that you can apply to the next thing that strikes your fancy.  As Nurse Beth said, career choice is a definite upside to our profession.  Don't sell yourself short.

If you want to have all future doors open to you (I.e. travel nursing), try to get at least one year of med surg under your belt.

Clinic nursing is definitely not linear (lots of interruptions). There is also a steep learning curve to outpatient nursing and many times you are the only RN there. You'll find that policies are loosely followed (if at all) d/t no JCAHO involvement. The commonly provided inpatient resources (pharmacists, skills training, other colleagues) are not available in the outpatient setting. Charting is charting whether you're working inpatient or outpatient. I've worked in three different outpatient specialties and had to do a large amount of self study to get myself up to speed. Many inpatient nurses who move to the outpatient setting are shocked at the amount of in basket messages and phone calls required. You will make a lot less money working outpatient too. As far as not getting a med surg job in the future... there is a big shortage around here. I could easily land one if I were willing to take a 3rd shift position.

Specializes in ICU/ER/Med-Surg/Case Management/Manageme.
On 4/19/2021 at 4:43 PM, TriciaJ said:

I'll tell you a personal story, for what it's worth.  I started out in psych and worked there 15 years.  The thought of med-surg put me off.  When I got tired of psych, I went to corrections for another 5 years.  I had a bit of a learning curve for the non-psych issues, but I catch on pretty fast.

Twenty years into my career I decide to give med-surg a shot, with no prior experience.  But I did have nursing experience, so I had critical thinking skills, common sense and assertiveness.  I ended up loving that job, even though it was very hectic.  It was the only job I truly missed after I left.

There's nothing wrong with starting out in psych or anywhere.  You will still gain a lot of valuable skills that you can apply to the next thing that strikes your fancy.  As Nurse Beth said, career choice is a definite upside to our profession.  Don't sell yourself short.

Much like you, TriciaJ!  Spent years working ICU and ER.  In the last few years of my hospital work, I took a med-surg job with another goal in mind - thinking it would be short-term.  Loved it.  Whole different can of worms on a med-surg floor.  It's where I was at that point in my career.  Frankly, I think it takes a bunch of confidence, self-motivation, and certainly different skills to be successful on a med-surg floor.  Could I have done it fresh out of school?  Probably would have hated it.  So for the OP...give yourself time, find your place in the nursing world.  And as you "wander about" over the years, you'll be amazed at how your thoughts and attitudes change.  But of course, that's true of aging no matter who or what is aging.  LOL

Specializes in Wiping tears.

I'm not a nurse, but my family friend started in home health/SNF/LTC. She became a DON for 12 years. A total of 28 years of being an RN. She became an ICU nurse for the past few years. She stated that she loves it!

(I was a kid when she met me. Small world. We're a few minutes away from each other today.)

Specializes in ICU, Med-Surg.

Feel free to PM me if you want.  I did healthcare administration and some government affairs on the side straight out of school and enjoyed it for a time.  Went to bedside this past year after 9 years (but had to make significant sacrifices to do it) and burn out with that side of the healthcare world.

Mind you, it has taken a lot of hard work (and a lot of sacrifice from both me and my family) but has given me a better appreciation for what I do than what I would have had straight out of school.  This ended up being a great choice for my family.

My advice-  make sure that not going bedside first is actually what you want to do.  Be sure that should it not be, that you are willing to find humility and sacrifice if you find out you do want to get back to the bedside.  It is extremely difficult to get back.

I agree with nurse Beth that it depends on your goals. If your goal is to work in a specialty or path that requires acute care experience, then you should get acute care experience. If it’s not, then you don’t need it. I disagree with nurse Beth that it’s impossible to find work as a new grad RN after a year. I got an acute care new grad job recently, but before covid, and I had been out of school for 5 years. I didn’t last long there, though, and if I had not quit, I likely would have been forced to transfer units. I quickly found something else. That program, though, wasn’t good at training. 

Acute care is very stressful, and you need to find a friendly hospital that won’t throw you to the wolves. The reason I didn’t endure in the hospital was that it didn’t align with my long term personal goals and dreams, but if it had, I would have toughed it out and transferred units. 

I don’t work in acute care , nor do I plan to go back anytime soon. Jobs are out there, and are respectable and pay decently or well. The trade off is that unlike nurses with acute care experience, I can’t just pack up and find a job anywhere at any time— nurses still find work wherever they go, even without acute care experience, but a nurse without acute care experience will need to plan for a longer job search than a nurse with acute care experience. 

Specializes in Neuro/Stroke, Staff Development.

The need for nurses in all areas is huge right now, so I think it is possible to start in a setting other than acute care.

That being said, there is a lot that can be gained by getting acute care under your belt, even if only for a year. The opportunity for skill development is best in a hospital setting, and it will help with critical thinking skills.

I spent more than 20 years doing bedside nursing and I loved every minute of it. I especially enjoyed the many opportunities I had to help inexperienced nurses go from "Novice to Expert". 

I am often sorry I chose to leave the bedside for more administrative roles, so don't count it out entirely. You might find out it is really a pretty great job!

Good luck!

Amy Cooney RN,BSN,SCRN

Specializes in Emergency Department, Rehabilitation.

I don’t agree with Nurse Beth about the getting into acute care after a year. I currently work in SAR and I do the exact same job I did in acute care but with a higher patient load. Patients get discharge from the acute care hospital a lot quicker than when I was in med-surg and SAR nurses have to continue the care started in the hospital. Oftentimes we receive the patient fresh from surgery and we have to deal with doctors, mid-level practitioners and families and somehow coordinate communication between all while giving the patient the care they deserve. 

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