how to get started in specialty i.e. OR, ER, ICU, etc

Platypus · Jun 9, 2009

Great questions "thekid" !

I am a new RN wondering the same. I guess I always assumed you would start working and find this stuff out as you go LOL

For those of us new RNs who cannot find a job, would it be worth going out and get the specialties or are you expected to be working in the area you specialize?

Thanks!

Lisa

sbyramRN · Jun 9, 2009

I just applied, and got accepted into the ER at a pediatric hospital. I think with the PACU you need experience before you can go there. People do get hired into the OR, but I know they only hire a select few new grads because the training is so labor intensive, lenghty and expensive. Good luck.

njedrn · Jun 9, 2009

After graduation I started directly into an ER. I spoke with MANY nurses looking for advice and input. I received a mixed response - some said go ahead, some said to do med surg first.

What I can say, is that I made the right choice for me. It was a hard road going from a brand new graduate to a competent ER nurse. Many skills to learn, practice and master, along with a crash course in assessments and critical thinking made the first 6 months challenging.

I attribute my survival to my excellent preceptor. She spent so much time teaching, showing and practicing with me that I would have been lost without. Hope this helps.

patwil73 · Jun 9, 2009

I started off in ICU - had about a 6 month residency program with clinical and classwork (but got paid for them which was a kick after school). Specialty units I think really require great preceptors (you might ask where you apply how they find their preceptors, train them, etc). Also you have to be really willing to say "I don't know" when confronted with something new - faking it can be very detrimental to both you and the patient.

I don't think you really need a year of med-surg (I didn't at least), nursing is difficult enough without having to spend a year doing something you really don't want to be doing in the first place.

Search http://pesihealthcare.com, they have a lot of classes and daylong seminars. You can usually find something to increase your knowledge base. Also most specialties will require some sort of life support classes, whether ACLS or PALS or the trauma one for ER (or all 3).

Good luck

Pat

Spacklehead, MSN, NP · Jun 9, 2009

Before I applied for an ER position, I worked on a tele floor, did urgent care, then worked on a progressive cardiac unit. This was all in a time span of about 3-4 years - the reason why I jumped around was because my husband and I relocated to another state in the middle of it all.

When I applied to the ER, I think the manager was very impressed with my cardiac knowledge, and liked the fact that I already had ACLS. Also, having a good working knowledge of several different drips (NTG, Lido, Amio, Cardizem, Heparin, etc.) also helped.

Although I don't think working on a med/surg floor should be absolutely required before specializing, I truly believe it can only help you and make you much more marketable if you do decide to change specialties. I have to thank the experience I received on the tele floor for providing me with a huge advantage when I transitioned to the ER. I was very competent at recognizing rhythms, handling chest pain patients, placing foleys, operating TC pacers, code situations, starting and titrating drips, etc. The ER can be so fast-paced that already being competent in such skills can only help you to focus on other important details such as focused assessments and minute changes in a patient's condition. Gaining experience on a med/surg/tele floor will also help you to develop great time-management skills, as well as helping to improve critical thinking skills while not having to constantly deal with such a fast-pace and quick patient turnover (not that med/surg/tele can't be fast-paced, but at least there is usually some down time most shifts when compared to how the ER has been lately). I also think that learning how the floors function first before landing an ER job can be an asset because it provides you with a better understanding of why a floor RN can't accept your ER admission right away; and helps you to understand what factors of the report you give are most important to the floor nurses and why.

trixie · Jun 9, 2009

I started out and did Med-Surg for a year. Then I worked L&D 14 years. I think the time management skills that I learned doing Med-Surg and the basic skills I learned are invaluable.

The best way to move into a specialty is to apply when there is an opening. Keep your attendance rate high (nobody wants to hire someone that calls off a lot), be an excellent team player, and do not apply for too many jobs within your organization. Keep applying for those in the area of specialty in which you would like to work. This will make you not seem desperate to leave the area in which you are working.

RNperdiem, RN · Jun 9, 2009

I started in med-surg for lack of other options.

It was the 1990's and getting any nursing job was hard enough.

After my med surg year, I had learned a lot and applied for an OR job.

The job was only for internal candidates and was offered an ICU job instead.

Here I am 10 years later.

I saw a trend after I was hired of the creation of lots of new grad programs and structured preceptorships, new grads were being hired into almost all specialties, there were lots of sign on bonuses and plentiful employment. That all ended with the economic downturn.

The new grads then didn't know how lucky they were.

Dalzac, LPN, LVN, RN · Jun 9, 2009

Take a couple of classes like EKG interpretation and definitely take ACLS. It would also help if you worked on a telemetry floor.