what is the best area to start with

  1. hello. i'm a new RN and will be applying soon. What is the area you would recommend for a new RN like me?

    i also noticed that most of the new Rns are working in med/surg/tele...

    any advice?
  2. Visit kathy_bear profile page

    About kathy_bear

    Joined: Oct '05; Posts: 24


  3. by   ykostoc1
    BAck in school they told me that med surg is a good place to start because u get a lot of different patients with different problems as opposed to a specialty which narrows the field a bit. I dont know if this bit of info helps but hopefully it does. The bottom line is you have to enjoy what you are doing therefore good luck with the search
  4. by   Daytonite
    My first recommendation is a surgical unit, general surgery, ortho, gyn, any of those. My reasoning is because these are units where you tend to see the same types of patients day after day, week after week. You need that routine to help you settle in to the new job of learning to be an RN.

    Second recommendation would be a medical unit. It's not as routine as a surgical unit. However, it can be a bit hectic. In some hospitals the medical units become the catch-all units that get patients that can't be put anywhere else in the hospital. An exception would be a specific type of medical unit, such as GI or neuro. Then, you tend to see the same kind of routine that you get on surgical units.

    I say NO, NO, NO to telemetry or stepdown units. I worked on one for 5 and 1/2 years and I saw a number of new grads go down in flames, even with good backup and preceptoring. It's a highly stressful and sometimes intensive area. It's an area of high nursing burnout. I've seen too many posts on this forum to indicate that many hospitals are short staffed on their stepdown and telemetry units. These hospitals will put new grads there and then leave them to sink or swim. I blame this on the managers of these units who are just not using their common sense and failing to assure these graduates are receiving adequate supervision and support. You really need to have med/surg experience under your belt before tackling a stepdown or telemetry unit. To give you an idea of how dreaded other experienced nurses see these units. . .when I was a supervisor, it was like pulling teeth to get experienced nurses to float to stepdown for just one shift. They would threaten to walk out of the hospital, beg, plead, and try to bargain for another solution other than go to the stepdown unit for a shift.

    There are always the specialty units such as ICU, CCU, NICU, OR, ER, and OB. As long as they put you in an extended training program that is going to last months, you might also consider these. But, make sure it is clear that you are going to get the specialized training and preceptorship that will be necessary.
  5. by   Daytonite
    Here is a thread currently on this very forum of a new nurse working on a stepdown unit. You might want to read about the problems she is having three weeks into her orientation.

  6. by   bigmona
    Quote from Daytonite
    I say NO, NO, NO[SIZE=2] to telemetry or stepdown units.
    Yes, tele does suck for new grads. That's where I am. It is extremely stressful even with good supportive staff and a helpful preceptor (which I do not have most of the time). That said, I made it through my first 2+ months by the skin of my teeth and now, according to everyone, am doing very well. People tell me I do not seem "new" and even the docs have told me they like it when I have their patients. You learn a lot- good assessments, a wide variety of pharm, patho, you learn how to be aggressive (or mean sometimes), not be afraid of docs or surgeons, etc etc. It was definitely trial by fire, though. A lot can happen on a tele/stepdown unit, and you have to be willing to jump through the flames to survive it, otherwise I believe you will get burned quick. I wanted to start on a floor where I would really nail assessment skills and nursing techniques and be exposed to a bunch of different things- and I got all that where I am. You need to ask yourself what you want to get out of your first job, and go from there. good luck in your search!
  7. by   SillyLilly
    I am getting nauseas reading this!!!

    I had a good chance to get a position at a hospital close to me that sounded enticing. But i had my heart set on 12hr shifts.

    Now I have 2 interviews for tele units. 12 hr shifts. 1 is nights, the other is days.

    Now I dontknow if it is worth it to start on tele.....

    Oh my I am freaking out.
  8. by   healer27
    I have to agree with daytonite; I am also a new grad, the first floor I was on was tele. (maybe you've seen some of my earlier posts) in any case I was excited that I had gotten on tele first (on my orientation they move us to different floors every couple weeks). IN any case I'm starting on a med/surg floor next week and glad to be OFF tele. I know med/surg is just as crazy BUT my impression was there was a higher acuity of SICKER pts on that floor. As a new grad I didn't feel prepared to care for these pts when I am also learning protocols for different things, who the docs ARE, reading orders, learning new skills etc.. There's a big enough learning curve to deal with when your new and when people are that sick; there is NO room for this learning curve. (at least in my opinion.) Of course it didn't help that I didn't mesh with my preceptor.

    And finally, everyone is different I'm sure some new grads could handle it but not me - maybe when I've got a little more experience but not now. Good luck..
  9. by   kathy_bear
    thanks for the info

    by the way what do u think about hemodialysis unit?
  10. by   GrnHonu99
    Im a new grad on a Neuro ICU floor. I am still in orientation but I like it so far. It is very busy but I think that helps me, there is a lot of structure. Also the acuity of the patients really helps me learn. I love the ICU. I didn't like the MS floors in clinical while I was in school so I really had no desire to start there, but everyone is different I love working nights too, I would reccoment it for new grads, I feel as though it is more laid back, less people, calmer, gives me more room as a new grad to learn without all the pressure Good Luck!
  11. by   CarVsTree
    Quote from Daytonite
    I say NO, NO, NO to telemetry or stepdown units.
    Not all tele units are stepdown units. In my hospital, all medical, surgical, and Med-surg floors except for one have telemetry. So, I wouldn't say no to a unit just because it has telemetry. I definitely agree with Daytonite about step down units though. I have a friend who works on a cardiac stepdown, has five pts, many of which are on multiple titratable drips. That is a lot of pressure, time-consuming calcs, etc.

    The only titratable drips we have are insulin and heparin. NO cardiac drips. My ratio is 6:1, granted trauma can be very challenging esp. on night shift when the drunk, high ones are still drunk and/or high. Or in a couple of days are going through ETOH w/d... but... it is doable. Glad I didn't start out in ICU or a cardiac step-down.

    We do have 4 step down beds (4 beds in one room). That can be a great night or your worst night depending on your 4, but at least its not every night.
  12. by   AB_NormalRN
    Prior to obtaining my license and subsequent employment approx 65-70% of nurses said go to Med/Surg floor, get your background and then specialize. But oh no, did I listen? I listened to the 30% who specialized coz I didn't wanna do Med/Surg. After 6 weeks with a preceptor in the ER who basically left me alone, didn't teach me anything, etc I became so overwhelmed...like others I was having nightmares....I went to see my boss and told them I didn't go into nursing to become a psych patient. So at present I am in limbo, but going to a Med/Surg floor to get my basics and learn to be a nurse first.

  13. by   traumahawk99
    it doesn't seem to be easy anywhere. i've been working in long term care with 30 patients and an unfathomable med pass. the money has been fantastic though. on a good week i can make $2700 or so, not bad at all for florida. after 3 months of this now i'm going to go on a tele unit in a hospital. i've learned a lot in terms of handling patients and doing anything from intervening to medicating someone for comfort only while they die.

    i'd suggest that long term care is a good place to get your feet wet. then you can go to a hospital, and though you'll have to take a pay cut, you'll be in a situation where you can learn. tele seems great for me, but then again the learning curve isn't so hard since i'm a paramedic and already acls certified.

    i'd suggest tele at nights, until you are comfortable. i think it's not as hectic as days.

    however, everywhere in nursing time management skills are at a premium, and all of it sucks when you get right down to it. it's stressful, and i'm counting the days till i'm off the floor (maybe 6 more months, at most). i couldn't fathom doing this for years.
  14. by   AB_NormalRN
    It took me three months and two preceptors to come to the conclusion that Med/Surg is the place to start. I had one preceptor who had 30 years experience who just left me on my own all the damn time, not able to answer questions except "thats just the way it has always been done," almost caused me to perform a med error until I refused, got frustrated when she had to help me out, was on the phone to her husband all the time, etc. I ended up with an outstanding preceptor, but the foundation had already been layed. The intial 6 weeks were a waste. The last 6 weeks in the ER was not gonna be enuff time to be prepared to be on your own. The stage had already been set for me to realize the ER is NOT the place at the moment...so I am transfering up to Med/Surg to get my basic background like 70% of nurses say you should.

    Why is it that no one wants to take responsibility for -their- actions? This is NOT high school anymore! But for the life of me it always comes back to 'you' being the one at fault. You didn't ask, you didn't burp right, you didn't curl your tongue the right way....And then everyone looks at you like you are the one screwed up when some place doesn't "fit". Why is it that?

    Then everyone wants to tell YOU what they think you wanna hear and then gets upset because you tell the truth? AND slam you for it? Oh and don't stand up for yourself! SO it is Catch-22. If you stand up for yourself and let your NM know they things are not going well you are causing problems and if you don't stand up for yourself you are considered weak?!

    Why is it that everyone goes behind your back, thinks they know what is right for you, gets involved into your personal affairs, treats you like garbage, etc.? No wonder places have issues finding people to work and there is a nursing shortage! Nothing in life should be this hard. Hell, Marine Corps bootcamp was not this damn hard! But you know what? I'll be darned if I will not become an outstanding nurse!

    Without a schedule and waiting to be transfered to Med/Surg!

    PS: Seriously contemplating moving to another hospital, but owe time or money for a scholarship.