Does senior practicum placement matter?

[hopefulrngsu]

I was placed in postpartum for my senior practicum, even though I have no interest in OB as a new graduate nurse. I was hoping for something not as specialized, like med-surg, or what I eventually want to do, which is ICU. I was wondering if, because i'm doing something so specialized like OB, will it affect how hospitals place me, like especially nurse residency programs? I feel like i'm going to have to do a lot of extra work to explain that i'm not interested in postpartum even though I was placed there and convince hospitals in my interviews for a job that my postpartum skills can carry onto med-surg. So basically what i'm asking is that does senior practicum really make a difference? I'm in the Atlanta area if that helps.

[Party_of_five, BSN]

Can you ask to switch? I know a lot of people who would want a coveted PP spot (who want to to work L&D, NICU, PP etc post grad) and it seems like it would be a "waste" on you, iykwim. If you can't change then I guess you will have to make the most of it. You won't typically have a ton of meds, but maybe you can do some blood transfusions. You will get to do baby assessments and a lot of teaching. I don't think it will matter if you want a med-surg job when you graduate. Sure, it might have helped you get your foot in the door, but I think you'll be fine without a M/S preceptor.

[Lev, MSN, RN, NP]

Postpartum is a not a place to learn skills, however, you can practice doing patient assessments, teaching/discharge instructions, communicating with doctors, time management etc. Also, you get the bonus of adult and pediatric experience.

[SaltySarcasticSally, LPN, RN]

I would also ask about switching sites. I have three kids and have NO desire to work in L&D, mother-baby- anything of the sort so that would not be my first pick at all. If you can't, just try to make the best of it and request to start IV's etc to get some experience.

[hopefulrngsu]

Thanks for the response guys. Unfortunately I can't switch. It sucks because there are people in my program who actually want my spot, but the professor isn't willing to make changes. I guess i'll just have to make the best with what I have been given. I'm annoyed that I will not have much experience with meds and won't be able to use skills that I would on a med-surg floor, but there's nothing I can do about it. At least I will gain some really good assessment and patient teaching skills.

[Double-Helix, BSN, RN]

In my opinion, the most important part of practicum is learning how to manage your time, balance a full patient assignment, prioritize, delegate and multi-task. A postpartum unit will have plenty of opportunities for you to practice and refine these essential skills. You will be performing assessments on newborns and postpartum mothers (your unit may also have antepartum mothers being monitored for potential complications, such as premature labor or pre-eclampsia). You'll be administering many medications (pain medication, anti-emetics, antibiotics, vaccines, to name a few), providing lots of education, keeping track of intake and output, possibly performing newborn screening tests, lab draws, giving newborn hep B shots, erythromycin, etc., and performing catheterizations. For women who had cesarean sections, you'll be assessing their wound, performing dressing changes for open or dehisced incisions (maybe even a wound vac or two), assisting with mobility, and assessing for s/s of hemorrhage.

Keep in mind that not all postpartum women are healthy at baseline. You'll likely encounter patients with pre-existing conditions like diabetes that requires insulin management, asthma that may be exacerbated after labor, or mental health conditions. They may also have had pre-natal complications such as eclampsia, HELLP syndrome that require platelet transfusions, antihypertensives and other special medication and monitoring.

There's a lot more to postpartum nursing than meets the eye. And even when the acuity of your assignment is low, there are plenty of opportunities to learn the skills you need to be a good nurse. The other clinical skills can be practiced in the lab.

[jj224]

It might hurt for a couple of reasons. I got a job offer from the ICU where I did my practicum / internship. Also, if you're applying for a med surg position, they might think you're just getting your foot in the door before ditching to go to OB.

[tjmnurse]

There were quite a few people in my graduating class who did not get job offers where they precepted, and then there were those, like you, who really had no interest in applying where they precepted. It really didn't seem to matter because most managers know that preceptorships are assigned. The units (TSICU, CVICU, Neuro ICU, MCC) that were hiring at UT in Knoxville actually do a peer interview with 3 staff nurses, without the manager present, to see if you are a good fit with the existing nurses. They never even ask where you precepted. One classmate had a very impressive resume including healthcare experience of more than 10 years, excellent grades, and was not chosen for the unit that he precepted in. That same unit chose a girl that precepted at a completely different hospital on a telemetry unit. He was offered a position in a different unit at the same hospital. Your interview will probably weigh more heavily than your preceptorship assignment so I wouldn't stress about it.