Insight & advice on Critical care(ICU) VS. general Med-Surg floor? - page 3
New here and just seeking some advice... I'm a third-year nursing student who's in the process of getting an externship at a hospital. Currently I have a choice between either University of... Read More
Feb 14, '07Occupation: FNP-BC, retail setting Specialty: 6 year(s) of experience in retail NP ; From: US ; Joined: Dec '06; Posts: 313; Likes: 100Quote from mcedhahaha, right though?I guess it is a good thing you live in Canada then.
Feb 14, '07Occupation: RN Specialty: 4 year(s) of experience in Tele, Med-Surg, MICU ; Joined: Sep '05; Posts: 145; Likes: 156It's my understanding (as a new grad on a med surg floor) that US hospitals take new grads in ICU's and ER due to competition from other hospitals.
I.E. you will lose a good candidate if you require a year of med surg experience because he or she will just apply at the competitor up the road who DOES have critical care internships.
Back to the original question, an externship is a great way to find a first job. You'll be familiar with the unit, your co-workers, the hospital. You'll feel more confident starting as a graduate nurse than walking in cold. And you won't worry about finding the job you want your last semester of school, you'll be all set. So do give the externship some careful consideration.
You could also find out the floor isn't for you, which is a good thing also - better sooner than later!
Feb 15, '07Occupation: pulling patients back from The Light Specialty: pulling patients back from The Light ; From: US ; Joined: May '05; Posts: 10,813; Likes: 25,306Rabid Badger, I'm sorry you're experiencing such rudeness from some of these posters. I'm proud to be an American, but hardly proud of the attitude I'm seeing here. Really shameful.
Feb 15, '07Occupation: pulling patients back from The Light Specialty: pulling patients back from The Light ; From: US ; Joined: May '05; Posts: 10,813; Likes: 25,306Quote from TazziRNNo apologies neededMy apologies. I am an older nurse and in my younger days "specialty" meant critical care. You're right, medsurg is a specialty.
It does strike me as odd, though, when I read (and I OFTEN read) that people should "do time" in med-surg before "going into a specialty". Particularly when I know what kind of intense orientation is needed to be competent as a new nurse on an acute med-surg unit today. After five months at it, I'm still learning something new practically every single day. A remarkable array of ailments and surgical procedures, tests and treatments. I'd never consider this work as 'doing my time' as some others think; the experience I'm gaining is worth a truckload of gold! If I decide to take it elsewhere, I'm sure I will have no problem. But I actually plan on staying put, and being a great m/s nurse
Feb 15, '07Occupation: pulling patients back from The Light Specialty: pulling patients back from The Light ; From: US ; Joined: May '05; Posts: 10,813; Likes: 25,306Quote from RUcon08Ah, there it is! I hated respiratory, too, LOL! There are different types of med-surg units, to be sure. In my hospital alone we have three that are labeled "med-surg" but couldn't be more different from one another. Mine has both acute and chronic medical issues, as well as anyone going to or coming from surgery. It's never boring! There are an amazing assortment of things that go wrong with the human body, and they are bound to hit this floor at some point in that process....
--I'm in my medsurg rotation right now, and to be honest I really don't like it. It's not really what I expected, but it could also be due to the unit among many other factors(I'm on a respiratory care unit.) Honestly I can't picture myself being a floor nurse for an extended period of time; I definitely feel like I'd grow bored of it rather quickly. To some extent from what I've seen, it almost reminds me of being a waiter, but providing a totally different service, lol.
There's another m/s unit in this hospital that you couldn't hope to pay me enough to work on: it features primarily pts on ventilators, pts with trachs....essentially, chronic respiratory issues. Definitely not for me. And if you told me THAT was "med-surg", I too would run screaming from it
Look around, and see exactly WHAT the med-surg option you're looking at entails.
Feb 15, '07Occupation: ED RN Specialty: ED ; From: US ; Joined: Jan '05; Posts: 1,312; Likes: 1,099I remember when I was in clinicals for med/surg I didn't think I would ever like it as a profession, never went to search it out, it kind of found me. I always thought it was boring and the same thing every day. Its really not like that.
I was just thinking the other day of how much of a variety of pts we see where I'm at (generic med/surg no tele). I have had ob/gyn with fetal demise, psych patients that are "too dangerous" for our psych floor :smilecoffeeIlovecof (a whole nother thread in itself), one pt just reciently had a kidney and gall bladder removed, drug and alcohol addicts, gunshot wounds and of course the pneumonia's, lapcholey's, and bowel obstructions. When the nursing supervisor calls the floor on the weekend its like rolling the dice, who is it going to be next lol. And that part is exiting to me.
I still want to transfer to the ER, just something I always wanted to do. But I'm really glad I had the chance to do med/surg. Wish I could give you some info on the critical care side but havn't been there yet.:smiletea:
Quote from RUcon08New here and just seeking some advice... I'm a third-year nursing student who's in the process of getting an externship at a hospital. Currently I have a choice between either University of Pennsylvania Hospital or their sister hospital, Presbyterian Medical Center. UPENN hosp currently has no critical care externship positions, but PMC does.
My question is if anyone has any insight to shed on critical care and med-surg(specifically, surgical telemetry for example) particularly when it comes to an externship. I'm currently in my med-surg clinical rotation, and really haven't found it to be anything great/appealing. As for my future I think I'd eventually like to do OR or ER, but one goal I've considered pursuing would be to eventually become a CRNA.
ANY advice anyone could spare would be appreciated. Thanks!
Feb 15, '07Occupation: RN Specialty: 8 year(s) of experience in ER,med-surg, LTC, psych, dialysis ; From: US ; Joined: May '02; Posts: 338; Likes: 43I wanted to do critical care as a new grad, but for different reasons chose Med-surg. I have learned SO much from working on the hardest unit in hospital. I feel much more confident right now about entering critical care.
Feb 15, '07Occupation: ER nurse Specialty: 5 year(s) of experience in critical care, emergency ; From: US ; Joined: Feb '07; Posts: 8; Likes: 2Not to get into the whole "should ICU's take new grads" debate...but having recently quit my job as a new grad in an ICU (and currently working in med surg) I just feel like I want to emphasize that anyone considering ICU as a new grad really look into the orientation and training the hospital provides. At my job I was told during the interview process that orientation was 6 months for new grads and this was also stated on the nursing recruitment portion of the hospital web site. In reality I was on my own after 3 months and due to a high census (and not enough nurses) barely had the opportunity to get a question answered if I had one. I can't believe I lasted a month on my own without killing anyone. 3 of the 4 new grads I started with also quit, 2 didn't even finish the orientation. Even when I was still on orientation, my preceptor frequently had her own assignment and I was kind of fending for myself.
I absolutely think with a longer orientation, or a little more support after the 3 months, I could have been successful. On the other hand my time spent in the ICU really made me think critically all the time and developed my assessment skills...so I bet that externship would be great! I guess my story could really apply to any area of nursing and not just ICU so maybe I typed it out for nothing, but just thought I'd throw in my 2 cents. Good luck
Feb 16, '07Specialty: 2 year(s) of experience in Medicine ; From: CA ; Joined: Feb '07; Posts: 64; Likes: 8Quote from RNsRWeDon't be sorry. I don't think it reflects on Americans as much as it does on the new grads who think they are infaliable. I feel sorry for the patients who will be put at risk. An overconfident student or grad nurse is a serious safety risk who doesnt belong on any ward, especially an ICU. If I had a student/grad nurse such as these, they'd be mopped up in a hurry on our ward. Overconfidence kills patients and poorly prepares the student/grad for real world nursing, and sets them up for losing their jobs and licences in a hurry.Rabid Badger, I'm sorry you're experiencing such rudeness from some of these posters. I'm proud to be an American, but hardly proud of the attitude I'm seeing here. Really shameful.
I'm proud of the fact that we require a minimum of 1 year acute nursing experience plus 8 MONTHS of ICU training and practicum prior to being qualified to work there. It seems our province has its head on straight when it comes to patient safety. More education and more experience do make better ICU candidates than new grad nurses with an extra 14 week training course. Period. And the patients are safer for it.
Feb 16, '07Joined: Dec '06; Posts: 14You are Funny, Canadian Friend. Don't let everyone get your blood boiling-we all understood what you were saying the first time around. Your ideas on the benefits of more training and experience before acceptance into an ICU are duly noted, and appreciated.
OP (original poster)- Have fun on your externship, whichever you decide. Any option will be helpful in helping you figure out what it is you DO and DO NOT like about a specialty. You will be more informed, and beter able to make a good decision later, regardless of which path you choose.
Peace and Blessings...
Feb 16, '07Joined: Feb '07; Posts: 20Thanks all for the great posts; they were definitely taken into consideration.
At this moment I'm basically leaning towards taking the CC position, which unfortunately isn't at the #1 hospital I wanted, but ah well. Thanks again!
Feb 16, '07Occupation: Professional Kiteboarder Specialty: 5 year(s) of experience in ER, OPEN HEART RECOVERY ; Joined: Apr '06; Posts: 45; Likes: 2"no brand-spanking newbie nurse is going to be ready for the full on assault that is our tertiary care ICU wards. It would simply be unsafe". Are there any solid nonbiased studies that back up these kind of statements being made on this thread? I have not been able to find any.
Feb 17, '07Specialty: 2 year(s) of experience in Medicine ; From: CA ; Joined: Feb '07; Posts: 64; Likes: 8Quote from mcedI don't think it takes a rocket scientist to figure this one out. Benner's "Novice to Expert" theory and research is widely accepted and incorporated into schools of nursing and licencing bodies. Novice nurses are not equipped for the independent and quick problem solving required for ICU work."no brand-spanking newbie nurse is going to be ready for the full on assault that is our tertiary care ICU wards. It would simply be unsafe". Are there any solid nonbiased studies that back up these kind of statements being made on this thread? I have not been able to find any.
- Stage 1: Novice
- Stage 2: Advanced Beginner
Graduate nurses are widely accepted to work on at the Novice stage of development. Reaching the competent level was found to require approximately 2 years of experience. Personally, I've finally reached the competent stage, and I know this by introspection and reflection. A grad nurse who is unable to realize their limitations is clearly at the novice stage and requires closer supervision. If you've ever worked with students or been one yourself you know full well that when you first start out you need plenty of guidance, help with prioritizing, and have greater difficulty recognizing changes that require intervention. It also doesn't take a million studies to know that overconfidence kills patients.
Cross research in any field and the evidence solidly points to greater experience = better outcomes. If the nursing research lacks publications on such matter, let me know, and I will be more than happy to conduct the first study. I honestly have a little difficulty understanding how we are even questioning the veracity of this.
I honestly think the US idea that grad nurses can head into ICU with 14 weeks of training is based on widespread ICU staffing shortages. If you require experience and 8 months of additional unpaid training, it is more difficult to staff such areas, understandably. Our ICUs are short staffed as well, but despite that, our health authority has sought to aggressively recruit using incentives for experienced nurses, while maintaining a standard of care and minimum expertice requirements.
I've gone online and researched ICU positions in the US, and I've seen that I can hop right into an ICU position, without further training. That my dear, should frighten us all. I guarantee you don't want your family members cared for by a novice overconfident nurse. Don't get me wrong, I love working with students, I love teaching, I'm precepting a senior student nurse currently. So I'm more than fully aware of their capabilities.Last edit by Rabid Badger on Feb 17, '07