Requirements for new nurses - page 2

After having been in nursing for twenty years I feel that there should be some requirements for new nurses. It is nice to work in specialized areas such as ICU but you need to have an overall... Read More

  1. by   Enabled
    Nurs2b, having a short time in med/surg is not a prison system but a chance to acquire skills that aren't practiced on a regular basis in a nursing program. It is different if you are working in a hospital and have some experience in the chaos and the controlled chaos. I would have loved to go to Peds as it is physically less demanding and usually the patient load is smaller than 7 to 9 of which 6 are total care. Having a patient in multiple failures can be challenging when evaluating labs as well as tele patterns as to whether or not there has been a significant change. It is not a prison sentence but a place one can gain experience before going into the field one thinks they may like to specialize in. I also agree that med/surg can be at all levels and peds is one as there are plenty of respiratory and diabetic children that have the same as adults only smaller in size. It is only a suggestion to do some time in med/surg for those who could benefit by it. I don't know why so many people get so hot under the collar when it is suggested. Good Luck in your education. Remember that you must be in an area for a minimum of 3 years to become an expert witness in a court situation. So use your time wisely and learn all you can.
    We frequently had peds and ob nurses float to our unit as there census was low in those areas for a large portion of the year. The adult med/surg units of a facility usually are the ones that make the $$$$$$ for the institution.
  2. by   MishlB
    "If all the new grads go to specialty units who is suppose to staff the floors that are already far to understaffed"

    I can't believe this comment!!!!!!!! Whose responsibility is it to hire for different departments??? NOT the new grads.
  3. by   NICUNURSE
    Originally posted by Enabled

    Studies have shown that those who go into specialty areas do have a calling but many do it because of a lessen work load and a higher salary. I am not denying they deserve the higher salary. But what about the resentment that seems to happen when the med/surg units need techs and the unit nurses vote them out because they don't use them because of the one on one or one on two.
    First, I would like to clarify that being in an ICU DOES NOT necessarly mean a lessened work load. True, we don't have 10 pt. like on a med surg floor, but I can say that there have surely been days where my 1-2 pt. have kept me on my feet for all 12 hours of my shift. And second, not all hospitals pay ICU nurses more (mine sure doesn't)! And third, if your hospital doesn't consider the needs of an individual unit when staffing, I would definilty find a new employer!

    Enabled, I find it really sad how you seem to regard new nurses who choose to do anything other than what you did. You said yourself that many who choose to go into specialty areas do have a calling. So I'm confused as to why you would expect them to do anything other than what they feel called to do. I'm sure (and I hope) that I'm reading you wrong, but it sounds to me like you're not very happy with what you do. You continually complain about the conditions on med-surg units (the number of pt., the physical work) but don't want new grads to work anywhere else (I'd be willing to bet that it's nurses like you who aid in convincing new grads that med-surg is a place that they DON"T want to work). Someone else wrote that they felt that med-surg was a specialty, and others here have praised you for what you do...But I have yet to hear you say one positive word to anyone who doesn't sound as unhappy as you do. Although I do believe that different areas of nursing require different skill sets, I don't believe that one area is HARDER or should be held in higher esteem than another. I think we should all be praised for what we do, whether we started there as a new grad or did med-surg first. I really believe that along with the lousy pay and the long hours, negative nurses who "eat their young" play a big part in why we don't have enough nurses today. Why don't we try welcoming new nurses and telling them how happy we are that they've decided to join us, before we tell them what they should do and where they're not qualified to work!
  4. by   AmiK25

    I am not saying this to be rude, but it seems to me that you have a problem with ICU nurses in general, especially those you work with. I feel that you are encouraging students to go into Med/Surg b/c you do not like the ICU nurses you have encountered.

  5. by   Enabled
    Love-A-Nurse, that is where there is a difference. You already have experience in med/surg. You have done procedures such as IVs and NG tubes and other procedures and treatments. You have EXPERIENCE in med/surg and you should go right to the ER. I wish you well and good luck in the rest of your academic program. I know several LPNs that do a wonderful job and have a great respect for their contribution to the floor.
  6. by   Enabled
    New CCU RN, there is the difference right in your posting you have had exposure and experience prior to becoming a CCU RN. The majority of new grads only have the experiences of school and even then they only hear about some procedures and don't have the opportunity to even observe or preform those procedures. On the other hand as I have said it is mostly the nurses who have had prior experience who are shouting the loudest about new grads not getting right into it. A couple of weeks is not going to take away from their ICU experience. Many facilities have an orientation specific to their respective units. It can be altered to be shortened or extended which ever is necessary. Any facility not taking more than six weeks or so and expect a new grad to function independently is putting their patients, new grad, and the rest of that unit at risk
  7. by   Enabled
    Mish1B, two of my friends and colleagues have become nurse managers on med/surg units. One has a neuro focus to it. They both had enough staffing for all shifts with the occasional use of an agency nurse or tech. Well, the facility decided to open another floor that had been renovated and drew heavily from the staff of these and orthos floor. Now they have been told that they can have additional travelers in their budgets which are not all that many in the area or they have to work. They even established a staffing office and they were for the most part aware of the needs of the floors. Two supervisors were found to have told the office not to bother looking but to have the managers come in and staff the floor in addition to their already full week. Also, staff was said to have been called and refused and when asked they said they had never been called. These are nurses who have been there for years. Then the facility offered an additonal stipend for RNs to work extra shifts. Well, the LPNs were working extra shifts and they were not even offered an additional stipend which caused hard feelings on the units and administration didn't care and said that the RNs were milking the facility in overtime when they had just authorized it. Both friends want out of management as they have been lied to repeatedly about people being called for interviews and then the applications go to them and the individuals with follow up calls had never been contacted.
    The facility is about to open a 50 bed satellite facility with an ER and ICU. They expect to hire around 400 for all positions. Well, those individuals are all going to be part time so the hospital doesn't have to pay benefits. Also, the 50 beds that were closed to open the new facility were petitioned to be opened by HCA and it was approved because of the need.
    I agree that it is the responsibility of administration to hire but the remaining staff doesn't get a good feeling when nurses who have been there for years are told their position is no longer and are escorted to the front door when there are open positions which they qualify for. The facility has a history of late of dissolving positions or offering early retirements so that they don't have to pay. Unfortunately, when nurses move into administration they quickly forget what it is like in the trenches and are more of a burden than an assist as they are now a "company" person
  8. by   Enabled
    First of all, all nurses have a calling. I am not so sure about those who are now entering with the shortage because one school is now on probation as they were accepting students on the basis of being able to pay privately and not need financial assistance. With the programs the Governor has signed it will make it easier for nurses to pay back most if not all of their fianacial aid as well if they so choose to become nursing instructors. I believe some may go into nursing because of opportunity and not desire. HOWEVER, it will also give individuals who would not have had the opportunity who really wanted to go into nursing the chance.
    Okay, I DO NOT dislike, hate, despise ICU nurses. I have several friends and frequently when my mother was ill she ended up in ICU and recieved good care. Those who have had prior med/surg experience at any level have just that EXPERIENCE. If a new grad is unsure of where they want to go then maybe set up a program where they would go and spend some time on each unit. Med/surg, OB/GYN, ICU, CCU, SICU, OR, PACU, NICU, PEDS. If the grad has an idea of where they think they might like to go I am all for it. In that instance, after the general hospital orientation, they have some time doing skills and this would be a limited time as many only hear or see a few things while in school. Here the community college gives more clinical time as well as lab hours. I have had to do the few weeks following a hospital orientation after having been an RN for several years so it isn't necessarily for new grads. Each facility has to determine what they want. Many are cutting orientations to all units in order to save funds. This is a major error as it is setting the nurse, staff, and facility for something to happen.
    Not everyone belongs in med/surg and not everyone belongs in a specialty unit. If one works and has any type of additional education and certifications they should be compensated. Those who are not might check with the state nurses association. I know where I worked we had FNA with a union for collective bargaining. I am only out of nursing because of a disability caused by a patient and hope to return as I truly miss my patients as many have become friends as they are what I called "repeat offenders" as they have chronic illnesses.
    The only time I have a problem with other units is when floated to the other units a med/surg nurse doesn't prn but takes patients. I have been there and done that. It is not reciprocated when a specialty unit nurse comes and doesn't even take a team of say 4. Some will prn but won't go into isolation. I thought that ICU, tele, OB had isolations also or at least could set up for them. I have had post partum moms on the unit as they needed isolation. Most of us have not had that experience since nursing school. Besides they should not be on a floor where there are many contagious situations and then go back to the baby for feeding. I have had OB nurse not even want to prn as they might have to return to their unit. PRN come on that is usually something all nurses should be able to do or cover the LPNs for pushes or blood hanging. In Florida, an RN must do the prior, hang the product and do the 15 minute vitals. This would be something a float could do. An admission or the desk would also be helpful but then again many times we have been called by the super to say that no one would be coming after all as the nurse had decided to take paid time off. We can't do that if we are floated to other units. Then I think I have a reason have concerns about my colleagues and their willingness for care of the patients. I consider that abadoning them even though by legal terms it has not happened. We are all suppose to be there for the patients but some feel apparently that the floors don't need their help. The specialty units and tele are staffed before the floors which is right. However, there should be reciprocity when the situation arises. Maybe then there would be less hostility between nursing specialties.
    Maybe my time limits were too long and those that have prior experience in med/surg should go to specialty units if that is what they think they are called to do. But a new grads unsure of where he/she wants to practice can get some of the skills they need that could be taken to any unit. Maybe a planned rotation to all units for the new grad who is unsure might be beneficial. Let's face it the grads of today are the ones who will possibly be caring for us "oldies" I always give the care and respect to others as I would expect the same in return.
  9. by   jnette
    I am a newRN grad... have worked in Dialysis for the past 5 years as a tech.

    I feel that the decision should be left up to each individual. A new nurse focusing on a specialty area will become a proficient nurse in her area because this is where her INTEREST lies. If I go to school and work my butt off to materialize my dream and goal, I believe I should then be able to choose what I do with my practice..go where I feel I would be best suited and be able to give ALL.

    Personally, I am one who is seeking to expand my knowledge and enhance my skills by finding a nearby hospital where I can also work some part time or PRN in medsurge. As much as I love dialysis and my patients there,and have no intentions of leaving it... it IS very limited and dialysis specific... I miss doing all the various things I did as a medic...and want to refresh ALL my nursing skills to become,as Enabled says, more "rounded". There is so much I still want to do and be exposed to... many things yet to learn and improve me, medsurge is the place to gain this experience and knowledge, and utilize the other skills. If you don't use it, you lose it...

    So while I DO believe it should be left up to the individual, I just happen to be one of those who can see the benefits of working medsurge to enhance my OWN knowledge base and experience.
  10. by   Enabled
    I have reread all the posts and if you look at those that posted they are mostly nurses or soon to be RNs in "specialty" units. I don't have a problem with any nurse as long as he/she carries their own and hopefully improves that patient's status or at least maintains it during their shift. It doesn't seem like there can be a solution as each specialty has their own set of standards and regs. The patients need to be our focus. Not "I don't want to float there" Would that be that the 'specialty unit nurses have a problem with med/surg units. I say this as the reverse was said to me And it is usually the general floor nurses that float more often than not leaving their units short. In a class, I did research on just that issue That is placing patients in danger which the recent studies have now shown. With the increase in mortality within months of discharge many of the floor nurse now believe that they are actually part of the problem as there are not enough to have a 5 to 1 ratio. Patients are asking what staffing levels are and the staff is told to keep it quiet. The patient has the right to know. Patients can ask all kinds of questions that can be very uncomfortable for the institution such as mortality rates, how many times have they had malpractice case and its outcome
  11. by   megmermaid
    I work in an SICU and have since I graduated one year ago. It blows my mind when you talk about the nurses that float and will only take what they want, no isolation, etc. Usually when one of the nurses float from my unit we are given the usual pt assignment of that floor, be it 8 patients on med surg, and just get thrown to the wolves. My unit has a reputaton and other floors almost give us harder pts than their own nurses because they figure we can handle it.
    My unit is the hardest worked in the hospital (in my opinion). We accept all pts and don't consider ourselves as having the option of turning anyone down. The other day I admitted an 11 year old trauma. Yes, we have a PICU but the nurses there thought they were too busy to go down to help with a trauma (we respond to ADULT traumas but usually have to cover peds too)-then complained when the doctors decided to send the patient to us instead. We also admit medical patients and cardiac patients- but if a crani, CABG, transplant, or any other major surgery happens, no other unit would even dream of taking it even if we're full.
    Also, don't try and say my job isn't physical. I'm on my feet the full 12 hours, which often turns into13 or 14. I have to do more of the work of lifting and turning my patients when they are semiconscious. When I send a post-op heart to the tele floor they've been out of bed a few times and trust me, the first times require much more work on my part than the later ones. My back still hurts from my 300 lb pt yesterday, and I use proper techniques when pulling her up in bed, turning her, and dangling her on the side of the bed-and she was on a ventilator and vasopressors.
    Nursing is hard work no matter where you go in a hospital. There are different types. Many are equal, so one may not necessarily be a stepping stone to the next--
  12. by   Enabled
    I know that there are a lot of specialty units that are more than willing to float and take a normal assignment on different units. Our unit always gave the lighter load to the float so that when they went back they could tell their colleagues that we were good to them. Most of the time it is older nurses who have their own standards of not going into isolation or radiation. implant patients. I was greatful for all the help we were able to get. Many times we would take an extra patient so that the float ended up with a smaller team. Nurses need to be appreciative of the staff that floats as they would be in a worse predicament if they didn't come. We want to be a friendly unit to others. We also in addition to the usual med/surg hell that we also do tele on the med/surg floor. We have 12 monitor beds with a screen in the nurses' station which many times we don't even have time to look at and rely on a tech on another unit. We have additional beds that are monitored by that tech.
    I am disabled at this point in time and would love to be pounding the floors as that was what helped to define who I am. I have even suggested using disabled nurses to fill in some of the blanks like patient education, preps, admissions leaving the remaining staff free. We may not have the phy sical abilities but we still can think critically and could be a resource for new nurses as well as seasoned nurses to look something up or call a physican for a needed stat or routine orders so that there isn't a delay in treatment. Also, mom/dads who want to continue working have them do short shifts to pick up some of the slack. Both these categories do not need to be added as staff so that the nurse patient ration includes them. The parent can work after the child is in school and leave before the child has to be picked up or met at a bus.
    The healthcare industry has physically and mentally abused nurses to the point they are unable to work. Then when we can't work they toss us away when infact we can be an asset. Physicians do not take nurses as patients because many times as been said we know too much and intimidate them. Or they treat us as individuals without any knowledge.
  13. by   Mito
    It constantly amazes me that experienced nurses have suggestions for "new grads" that they never had to deal with. I am about to start my consolidation (final rotation as a student) on a med/surg floor. This was my choice and I see it as an area to work in the future

    But, as another poster put it : it is our choice and whatever specialty area our choice and our right. I agree that med/surg offers alot of learning opportunities but so does LD, but I won't be working there anytime soon (its no something that appeals to me). Forcing students or anyone else onto a med/surg floor will not make for a good learning enviroment for anyone involved.