How to be a new grad office nurse?

Nurse Ratched, RN · Aug 25, 2004

Personally, I think it would be challenging to get hired as an office nurse as a new grad. I hired into one after 3 years as a nurse and love it, but I wouldn't have been terribly effective as a brand new nurse.

It's a fast-paced setting with a great deal of autonomy, and a lot of it is prioritizing, a skill that you hone as you go. There is also a great deal of working around the health care system/messing with insurance, etc.

A lot of nurses I know who work in office settings hired in after getting to know the doc in another health care setting like a hospital and developing a rapport/trust. I actually hired in in response to an internet posting.

I will note a recent instance where a friend of mine was getting her shots at her allergist's office and had an anaphylactic reaction. Epiniephrine took care of things, but there was a situation where a code could have ensued. This is just one example of where a bit of experience under your belt is useful.

I don't mean to be discouraging - just offering up my thoughts :).

angel337, MSN, RN · Aug 25, 2004

acute care experience enables you to strenghthen your assessment skills and critical thinking abilities. even if you do a year of hospital nursing you will see the difference in your confidence level and decision making. and since you are considering working for a specialist office this is very important. i have seen ads for specialist office hiring new grads, but they usually prefer people with some experience. good luck with school! you have plenty of time to explore options.

indynurse#2 · Oct 26, 2004

I graduated with my BSN in May 2003 and began working on a med/surg unit. In January I will begin working in a Peds Clinic and I am really looking forward to it!!! However, I would strongly encourage getting those one or two years of experience in the hospital. Even if you don't really enjoy it, just realize that those first few years out will build the foundation for your entire career and you will always be thankful for the broad experiences that only a med/surg floor can give! Good luck in school, you're almost done!

Walrusinc · Mar 9, 2005

I am an office nurse in an ambulatory setting. I went in straight out of school. I'm not saying this was a mistake but I do have to admit that I have limited myself. I do not have a broad range that I would have developed If I had done med-surg for at least the first year. Now after 11.5 years I am moving up to nurse manager and am scared to death. I am not sure I am truly qualified because use of my lack of experience. Not just with patients but also in observing my superiors in different situations. I have had great experiences but not like I would have received in a hospital setting. Good luck in your decision. :

teriadn2004 · Jun 3, 2005

I am a new grad and I started 2/21 in a primary care outpatient clinic - basically a doctors office. I had no choice but to be in this position as I went to school with a scholarship and I was assigned to pay back my time here. From the first day, I have been miserable. In this setting, I am expected to assess patients and decide if they need to see the doctor, triage them over the phone, do lots of patient teaching concening medications, new diagnoses, pre-procedures and basically, "catch any mistakes or missed f/u" made by the doc. I must act on my own, as it is impossible to stop and ask another nurse what to do in every instance - and EVERY instance is different. After 3 and 1/2 months, I still feel VERY insecure and I haven't made it thru a week yet that I haven't been in tears at least once. And I am not "inexperienced" - I was the Lab Supervisor in the clinic where I work and I have worked in more than 10 other doctors offices in the lab as a relief, as well as hospitals. I am "mature" nurse, so I have "life" experience to draw from as well. As soon as I can, I plan to get out of here so I can get some "real" experience. I'm concerned that even after I have been a nurse for over a year, I will not know how to do anything besides take VS, do EKG's and give injections - not what I went to school to be! Get that good basic foundation before you imprison yourself in a doctors office - I don't think you will regret it! :crying2: :uhoh21:

darla80 · Jun 3, 2005

nanaRN

I am sorry you are having such a difficult experience.. I felt sad for you as I finished reading your post ..

advice to the nursing student

I agree with all the others .. One to three years in the hospital setting is what solidifies many if your nursing skills.

So My advice is the same

NanaRN.. is there a nurse in your clinic that can be your mentor? Are your previous medical experiences helpful to you in any way?

There are so many wonderful things about a clinic job, it breaks my heart to read those words imprisioned in a clinic

maybe it is b/c of your repay comitttment??

Working in a clinic affords so many opportunities to learn from the docs and the one on one with the patients is the highlight of my day

I hope things get better for you.. wish I could offer you advice that would be helfpul

Anytime you want advice or a listening ear..come here and share... we will all be glad to help you if we can

Joy and Smiles * Darla

CrunchRN, ADN, RN · Jun 3, 2005

I worked in hospitals for 10 years as a ward clerk/monitor tech and then went to nursing school. When I graduated I was sick of hospitals/shifts/holidays, and RN's were being layed off everywhere. Most of my class went to nursing homes, but I got a job at a clinic. I have done that and some other non-hospital stuff for 12 years now. I love it - especially the schedule. However, I sometimes wish I was a "real nurse". Now I am a real nurse, but you probably understand what I mean. I have not started an IV since the 1 I did in nursing school. I have never drawn blood. Do lot's of assessment, injections, a foley every few years.................

For myself, I do feel it was a mistake. I wish I had gotten some medsurg experience first. I would have a lot more options now if I had done that. I am crazy enough to think I might love working in the ER or the OR, but I am too intimidated now by the lack of technical skills and the length of time from school to try it. I have lived in several different states and no hospitals want an experienced nurse who lacks those skills.

Nursing shortage? Blah, blah, blah. They don't want to sponsor refresher courses or give you a new grad preceptorship. I am a person with a professional resume, and a very professional presentation and interviewing skills. I have glowing recommendations from all previous employers and a solid work history.

My point is that if you think you will ever want to do anything other than be an office nurse you should take advantage of the new grad hospital programs and get some experience. Then you will have more options open.

teriadn2004 · Jun 4, 2005

:confused: :banghead:

nanaRN
I am sorry you are having such a difficult experience.. I felt sad for you as I finished reading your post ..
advice to the nursing student
I agree with all the others .. One to three years in the hospital setting is what solidifies many if your nursing skills.
So My advice is the same
NanaRN.. is there a nurse in your clinic that can be your mentor? Are your previous medical experiences helpful to you in any way?
There are so many wonderful things about a clinic job, it breaks my heart to read those words imprisioned in a clinic
maybe it is b/c of your repay comitttment??
Working in a clinic affords so many opportunities to learn from the docs and the one on one with the patients is the highlight of my day
I hope things get better for you.. wish I could offer you advice that would be helfpul
Anytime you want advice or a listening ear..come here and share... we will all be glad to help you if we can
Joy and Smiles * Darla

It's so nice to read that someone feels sorry for me - most of the staff that I work with just tells me that I am having "reality shock" - just like any other new grad - as for a mentor, unfortunately, I have a mentor - she was a staff nurse when I started nursing school, but by the time I finished, she had been promoted to nurse manager -now, I feel like I would be "laying myself out for the slaughter " if I tell her much. Most recently, when I tried to tell her how I was feeling, she told me, "I told you that you needed hospital experieince, but we had no choice but to keep you here". So - I just do my best, watch my back and drive all the other nurses batty with all my questions.

I will keep coming back to this post - I need to know what others are feeling -you know, "misery loves company".

By the way, this week has been a little better - I just made up my mind that I was not going to hide the fact that I need help. I take my time and if the providers complain, maybe it will get someone's attention.

teriadn2004 · Jun 4, 2005

I worked in hospitals for 10 years as a ward clerk/monitor tech and then went to nursing school. When I graduated I was sick of hospitals/shifts/holidays, and RN's were being layed off everywhere. Most of my class went to nursing homes, but I got a job at a clinic. I have done that and some other non-hospital stuff for 12 years now. I love it - especially the schedule. However, I sometimes wish I was a "real nurse". Now I am a real nurse, but you probably understand what I mean. I have not started an IV since the 1 I did in nursing school. I have never drawn blood. Do lot's of assessment, injections, a foley every few years.................
For myself, I do feel it was a mistake. I wish I had gotten some medsurg experience first. I would have a lot more options now if I had done that. I am crazy enough to think I might love working in the ER or the OR, but I am too intimidated now by the lack of technical skills and the length of time from school to try it. I have lived in several different states and no hospitals want an experienced nurse who lacks those skills.
Nursing shortage? Blah, blah, blah. They don't want to sponsor refresher courses or give you a new grad preceptorship. I am a person with a professional resume, and a very professional presentation and interviewing skills. I have glowing recommendations from all previous employers and a solid work history.
My point is that if you think you will ever want to do anything other than be an office nurse you should take advantage of the new grad hospital programs and get some experience. Then you will have more options open.

This is EXACTLY what I am afraid of - I became an RN at 49 (hence, my screen name) because I want to work in hospital - preferably in L&D or maybe ICU. I'm terrified that I will never be able to do this because it will be expected that I should have gotten my experience my first year out of school. I sure hope that I can get a hospital job as soon as I get through with my obligation. Thanks for sharing. I needed to know this. :crying2:

darla80 · Jun 6, 2005

My sister teaches refresher course for RNs

Depending on the hospital you choose to work for you may be pleasantly surprised at the courses available to you.

IN the meantime

.. think of all the skills you are gaining at the clinc ..you are learning how to asses.. organize... chart... and your people skills are honed time and time again as you interact with each person

Also you can learn alot about disease processes and medication management.

recently a hospital nurse with very little medication experience made this huge med error..she wrote out instructions for the pt

Digoxin 0.125 take four times daily ..after working in the clinic you would have had bells ringing seeing that dose of dig ( the pt came back to the hospital dig toxic)

When you work in the hospital you will understand alot more about the patient b/c you shared some of thier lives in the clinic setting. Also your discharge instructions will be phenomonal as you know from experience the kind of thing pts need to hear to help them cope at home.

I am glad you had a better week..wish you were working with me ..I would love to share my years of experience.

keep soaring with the experienced ones and eventually you will be more comfortable solo

Hang in there !!

Joy and Smiles * Darla

teriadn2004 · Jun 7, 2005

:) Thanks again Darla - I think most of the nurses that I work with probably would like to share their experience with me too, but they are all so rushed just to get their own work done - I know it's hard for them. I'll keep you posted...