Specialization after Graduation???

[mspringer]

Hello everyone!

I am posting this question and poll for a group nursing project. We are just a few months away from graduating and this information would be very helpful for us. You participation is greatly appreciated!

Question: What are your thoughts about a nurse going straight into a specialized nursing field after graduation? Please give examples of successes or failures with regards to this type of transition.

[gwenith, BSN, RN]

Marc This is an Aussie example so I don't know how much use it is to you.

I have recently worked two different ICU's within this city -

ICU A - routinely employs new graduates - up to 25 at a time as "warm bodies". The staff of this ICU never "float" (we say pool - guess both terms are about being in deep water) Few will work agency or outside of thier own unit and those that do have a poor reputation for being very intolerant of different methods and approaches to practice. The practice in this unit is very prescribed i.e. eye care is done second hourly regardless of the patients ability to blink and the condition of the eyes.( they will even do 2nd hourly care on patients who are post -op high dependency "baby-sit type patients) The staff on the whole are very insular and have major knowledge deficits i.e. they did not know about bladder scanners or alcohol withdrawal assessment because they had never used them within that unit.

ICU B Smaller and mixed ICU/CCU staff with rare exceptions must be 12 months post-grad (does not matter where). Staff float/pool reasonably regularly. Patient care is individually tailored to requirements i.e, if the patient is more comfortable sleeping in a recliner chair then they are allowed to. It must be THE most proactive unit I have ever had the pleasure of working in as far as showering ICU patients. Staff go out of thier way to do "special" things such as taking a long term vent (e.g. Guillian Barre) outside.

If you are familiar with Benners theories (Novice to Expert) what can be seen happening is that ICU A due to the large number of junior staff with a narrower focus of experience and the tendency to promote (preferrentially) those staff teh overall expertise of the unit declined. Instead of operating at an expert level they are now operating at the level of "competant"

ICU B due to the wider experience of the staff are operating at expert level.

If you need me to elaborate please post and I will try to do so

[fergus51]

I certainly wasn't trying to be rude or anything BarbPick, just pointing out the other side of the coin. I didn't think I was violating the TOS or anything

[bluesky, BSN, RN]

My only issue with the "go to medsurg first" discussion is as follows. Most medsurg floors are specialized themselves these days (onco, ortho, neuro, etc). So it is very possible NOT to see a wide variety of illnesses there either. With my final destination as the ER, I don't see how going to see adults in Medsurg is really going to help me with but one small portion of the ED population. What about the kids, the vag bleeds, the critical care patients? Do I need to do a year in all those units too before going to the ER? I know that I shouldn't be responding to this post because it was addressed to experienced nurses only however... I just don't know if I can handle a whole year in medsurg- I really REALLY disliked medsurg clinical whereas I absolutely ADDORE ER practicum!

[Catma63]

As a second semester nursing student, I can repeat what I've heard from my nursing instructors and the hospital administrators who were spoke on the day of mine and my classmates orientation. Every single one of them said new graduates should work at least a year on a med-surg floor before progressing to other areas. I sat there and listened attentively...and I agreed. On a med-surg floor you get every illness imagineable. COPD, peripheral vascular disease, diabetes, renal failure, mastectomy patients...well heck, you guys know. Seems to me it makes perfect sense to hone one's nursing skills in caring for such diversity in patients. Is it not that diversity that makes nursing skills stronger? Is that diversity present in every single specialty...at least as encountered on a med-surg floor?

Several times already I've heard nurses who are working in the Annex, the adult home that's a part of both hospitals I do rotations in, say they wish they'd put in that year in med-surg...working with the elderly and only the elderly has made a lot of them feel weak in their skills.

I'm not sure I see how there's a real comparison.

[shodobe]

barbpick, I will agree with 100%. I have my reasons and don't want to get into a heated discussion with anyone, but I feel a little time on a M/S floor, no matter what area that floor concentrates on, is good for your confidence. Everyone should know or realize that your nursing experience doesn't begin until you have complete responsibility for patients without an instructor holding your hand. There is nothing wrong with going into a specialty area if you have complete confidence in your skills and knowledge. I see to many new grads that are completely lost on the floor and only go through the moves to get through their shift. It's the little things they miss and should pick up but only when they have spent some time taking care of patients that don't need specialized care. I don't know what I am trying to say, but still feel strongly about some good-old nursing on the M/S. I also agree that even the M/S floors are becoming much more specialized and I know how tough it is to work these floors, I did it for about a year. So long ago, so much different now. Mike

[BarbPick]

I sincerely thank you.

barbpick, I will agree with 100%. I have my reasons and don't want to get into a heated discussion with anyone, but I feel a little time on a M/S floor, no matter what area that floor concentrates on, is good for your confidence. Everyone should know or realize that your nursing experience doesn't begin until you have complete responsibility for patients without an instructor holding your hand. There is nothing wrong with going into a specialty area if you have complete confidence in your skills and knowledge. I see to many new grads that are completely lost on the floor and only go through the moves to get through their shift. It's the little things they miss and should pick up but only when they have spent some time taking care of patients that don't need specialized care. I don't know what I am trying to say, but still feel strongly about some good-old nursing on the M/S. I also agree that even the M/S floors are becoming much more specialized and I know how tough it is to work these floors, I did it for about a year. So long ago, so much different now. Mike

[Erin RN]

Shodobe and Barb

Count me in..This of course is based on my own career path but I did subacute LTC for several years...I got know the drugs "everyone" was on inside and out..I learned much about decubs, CVAs,vents, foleys, tube feedings, COPD, HTN, Dementia Diabetes Then I went to the hospital did a couple of years of float between med/ onc and surg/ortho. There I learned many different skills like IV medications, surgical wounds, post op protocols for various procedures, . Then on to Home IV infusion where I learned how place PIVs manage picc lines, jugular lines, epidural lines, accessed ports and passports and filled implanted synchromed pumps. I brought all of that knowledge with me to ER and I believe it was invaluable..I still had to learn trauma and cardiac stuff but I knew the basics very very well so it wasn't near as stressful. I knew the most common illnesses inside and out, etiology, what the "standard" treatment was and also what complications to look for. Could I have went to the ER right out of school? I am sure I could have and I probably would have done ok but learning skills, organization, developing confidence and maturing as a professional (I feel ) is better accomplished in a less stressful environment than critical care. As far as OB? I have never worked it so I can not comment on it..it is a very different area of nursing. But ICU, CCU, ER are "mostly" MS patients gone bad. For me the progression worked..:) Erin

[gwenith, BSN, RN]

Our practice is more "competency based" than yours and emphasis is placed on achievement of competancy as per Benner's model. Here is a link showing a list of basic competencies.

http://www.anc.org.au/02standards/_docs/Other/competencies.pdf

Each specialty such as ACCCN - Australian College of Critical Care Nurses has competencies that go "above and beyond" those of the ANC

Because of this the emphasis is on accelerating a new grad through novice level to expert within the chosen field. Inherent in the model is the acceptance that expertise in one field does not grant expertise in all fields and that progressing from one field to another may put an experienced nurse back to novice. However expertise in one field will often accelerate skill aquisition in another field esp if it is allied.

Here is an example of how that may be achieved

http://www.health.nsw.gov.au/quality/healthawards/2003/entries/competence/pdf/competence_csahs_2.pdf

Here is the same basic idea applied to a sexual health course

http://www.shinesa.org.au/pdf/shinesa_nurses_course_clinical_component.pdf

http://www.aare.edu.au/96pap/coull96.200

this one might be less useful

http://www.wch.sa.gov.au/research01/pdfs/nursef.pdf

Have I given you enough hints about looking up and reading Patricia Benners book "From Novice to Expert:?????

[BarbPick]

Shodobe and Barb

Count me in..This of course is based on my own career path but I did subacute LTC for several years...I got know the drugs "everyone" was on inside and out..I learned much about decubs, CVAs,vents, foleys, tube feedings, COPD, HTN, Dementia Diabetes Then I went to the hospital did a couple of years of float between med/ onc and surg/ortho. There I learned many different skills like IV medications, surgical wounds, post op protocols for various procedures, . Then on to Home IV infusion where I learned how place PIVs manage picc lines, jugular lines, epidural lines, accessed ports and passports and filled implanted synchromed pumps. I brought all of that knowledge with me to ER and I believe it was invaluable..I still had to learn trauma and cardiac stuff but I knew the basics very very well so it wasn't near as stressful. I knew the most common illnesses inside and out, etiology, what the "standard" treatment was and also what complications to look for. Could I have went to the ER right out of school? I am sure I could have and I probably would have done ok but learning skills, organization, developing confidence and maturing as a professional (I feel ) is better accomplished in a less stressful environment than critical care. As far as OB? I have never worked it so I can not comment on it..it is a very different area of nursing. But ICU, CCU, ER are "mostly" MS patients gone bad. For me the progression worked..:) Erin

You get it cuz you lived it !!!!!!!!!!!!!!

[Erin RN]

Yes Barb..I just think that I had a lot of general knowledge backing me up. I was the code nurse within 3 months of hire in the ED and asked to charge after 4..according to my NM the Docs all thought I would be good at it..I declined, I did not feel comfortable enough at that time. I saw many a new grad gobbled up by both RNs and Docs..I remember one doc saying to a new grad as myself and another nurse walked in, "Thank god ..now there are some real nurses here"...There is the exception and I know that but I still say broad exp will make you a better nurse...on a MS floor one has the advantage of being exposed to so much..assessment wise, skill wise and medication wise..although MS is busy there is time to assimilate the information and ask yourself why, how what when and incorporate what your answer is..Many times, esp in critical care, there is just not time to do that..basics need to be second nature..:) Of course this is just my opinion..:) Erin

[fergus51]

That's really interesting to see Gwenith. It's probably because I work OB and NICU that I don't feel med-surg is necessary. The areas are just too different to really share much... I noticed in Australia and the UK, it's often midwives in these areas and they are not med-surg nurses first (or ever) but their system runs just fine.

[heatherbless]

This is not 40 years ago, as you are comparing to a nurse in the 60's. This is recognizing when a patient becomes ill very quickly. I will not get into an arguement.

It amazes me how quickly some are to use someone name in their reply, when they disagree as if to dress them down for having their own opinion. Making it so personal when it is something to just discuss. I have sent these posts to the moderators. This was written by Ted after I sent the posts.

No wonder Ted the moderator had to post this:

Is is a full moon outside? Are we all just in a cranky mood?

Or maybe it's just me. Maybe I unreasonably wish that we can have debates and discussions that do not spiral down to mud slinging.

Honestly! I don't care what you choose to discuss or debate. But I do care how you respond to one another. I know that not every post can be perfect example of polite debate. But, GEEZE FOLKS, there's been more debate about each other than on the topics at hand.

Here's a few suggestions (Note: JUST suggestions, not rules!):

1) If the debate starts to get heated, count to ten before posting.

2) If the debate gets too heated, avoid addressing each other by name. Instead, just write more in general terms. . . again focused on the topic. (Honesty time: I actually hate it when people address me by name during a recognized debate. It is a pet-peeve of mine!)

3) Stick to the topic at hand. (Am I beginning to sound redundant?)

4) Write to those as you would like to be written to. (Does that make sense?)

5) Do NOT debate like "they" do on television. What's usually seen on those "Point/Counterpoint" type debates is entertainment, NOT constructive discussion/debate! We're better than that, folks!!

Feel free to add any Constructive advise on respectful debating. I'm sure many of us have taken debate classes (or something along those lines). Share your knowledge. What have been your postive experiences in a healthy, respectful debate?? Share!

Finally, this is a "Current Events" forum. Any type of current events can be posted here (just as long as it's kept in the PG-13 realm.) In other words, it's "O. K." to post topic that's not necessarily political. No one is going to discourage the type of topics posted here. But variety is the spice to life. There's a whole world of current events happening out there. Some interesting. Some not so interesting. But all fair game for this forum!

With only my deepest respect to you all!

Ted

P. S. Again, if you see a post or member who is violating a TOS, report that post or member to the moderators/administrators.

I AGREE WITH BARB--SOME PEOPLE SHOULD QUIT TAKING THINGS SO PERSONALLY. I MEAN WE ARE ALL ON THIS BB HOPEFULLY BECAUSE WE HAVE COMPASSION FOR HELPING PEOPLE , ETC. PEOPLE CAN HAVE DIFFERENT OPINIONS, WITHOUT BEING DISRESPECTED. PLEASE! HTY/