I am graduating in May. I have visited 3 hospitals and will have interviews with all 3. I am getting very different stories. My local hospital where I have done my clinicals starts all graduate nurses with at least one year in Med-Surg. They say this is the way it is always done.
The other hospital, which is working for magnet hospital status and seems very progressive, starts their graduate nurses in "career pathways" linked to what they are interested in. I am applying for critical care pathway and will interview with telemetry. They say the the med-surg idea is outdated and a new nurse is better off in the area the nurse wants to work in.
I haven't visited the third hospital yet, so don't know what they do.
Any ideas which course is best? Is my local hospital out of date?
I agree Med-Surg give you a solid foundation in skills and time management. I have found in the hospital I work in, new graduates who start in the icus are limited. When the are burned out or just want a change they find themselves in a position of only having icu experience. It's a difficult place to be.
This really does not make sense to me. Why would a manager not higher someone with 5-10 years of ICU experience for a M/S position?
I have found in the hospital I work in, new graduates who start in the icus are limited. When the are burned out or just want a change they find themselves in a position of only having icu experience. It's a difficult place to be.
So when nurses get burned out they turn to the med-surg??? After I gain my years of ICU (only) experience and I desire a change-it won't be towards the floor, it will be towards advanced practice. It doesn't make sense that people who don't want to go there now will want to after years of critical care.:uhoh21:
This really does not make sense to me. Why would a manager not higher someone with 5-10 years of ICU experience for a M/S position?
They wouldn't.
Having only ICU experience is hardly a "difficult" place to be as someone stated earlier.
Having only med/surg experience? That's another story.
That has it's limitations as well, and there are a number of positions at my hospital that require prior ICU experience. I know several nurses trying to get out of med/surg but getting turned down for internal transfers due to having only med/surg experience.
There is no question that an ICU nurse could (if they really wanted to but I think it's rare) land a med/surg position with no med/surg experience much easier than it would be for a med/surg nurse to break into ICU with only med/surg experience.
A large part of that, however, is the fact that floor nursing is undesirable to many so many more positions are available.
It's not that one experience is better than the other. Just two different specialties.
Having ICU experience on my resume opened a lot of doors for me.
I definitely wouldn't be working in the PACU if I didn't have it.
I'm not going to get involved in the debate, but rather would love to share my experience in making my decision and how I feel about my decision.
I graduated in Dec. 2005. I accepted a position in the Critical Care Internship the preceeding May. As I was working as a tech at the time on the Transitional Trauma Unit (Trauma step down unit w/ 4 Step Down 4:1 Observation beds and 24 trauma med/surg beds). I was strongly encouraged to stay on TTU for at least a year to better serve my CC patients. The arguments were that you can't learn experience. There have been times that new grads have made terrible errors of omission in CC due to lack of experience. Report from a new grad in ICU is often missing important factors. I decided to follow that advice and stayed on TTU. I am sooooo glad that I did. Our ratio is 6:1 and I've only had to take 8:1 once. Staffing is almost always adequate at my institution. I find that I am learning every day and I find that my job is always interesting. I feel that when I am ready to go to CC I will be better prepared. I also will have a better idea of what type of patients I like/dislike. The unit I work on is very difficult and many nurses hate coming to this unit. Trauma can be heartbreaking in addition to the HUGE numbers of dysfunctional drunks, addicts, idiots, etc. In addition, PA has a "no helmet" law so we take care of plenty of Perm Veg. State heads or Frontal Heads (there a joy if you like cursing and combativeness, etc.). Bottom line, its very difficult to make a decision on area you want to work in when you've never been a nurse. I had even thought of NICU, but I'm a Trauma hound. I think after the enormous learning curve in NICU that I would be bored. I love my crazy traumas and the stories that go along with them. As hard as it is, I enjoy comforting a mom who just lost her daughter after she and her two daughters were hit by a car. Or listening to the pt. who lost her husband in a motorcycle accident and having to tell her over and over again because her short term memory was affected by the accident.
At the same time, I enjoy catching an ileus, before it becomes a dangerous situation for pt. Talking with my patients and meeting tons of people all the time. Bottom line, I thought I would hate med-surg and for right now it is the only place I would want to be. I am learning everyday and most of all, I am learning that I can do this. I also am learning that I am not an experienced nurse and to ask my peers when I'm not sure.
My hospital keeps med-surg areas staffed by offering an EVE/Night bonus of $4000 for one year commitment of $12000 for 2 year commitment. They don't force people into these areas, they encourage nurses who like it to stay. The bonus is offered after orientation so you already know what you're signing up for.
Bottom line, I think that med-surg is a great place to start and is a great place to stay if you decide you like it. If you don't than give your 1-2 years and move on. Good luck in whatever you choose.
Specializes in Nurse Leader specializing in Labor & Delivery.
And finally, there are some specialty areas in which adult med-surg experience is not only unnecessary, but undesirable. Pediatric and neonatal patients are not little adults, and many things have to be "unlearned" by mes-surg nurses transferring into these areas, making such a transition difficult for some.
I agree with this. I've worked in OB as an extern for the past year, and will continue working there as a new grad next month. OB is just a whole other world than med/surg. Our hospital prefers to "grow their own" and hires new grads and students into specialty areas all the time.
I agree with this. I've worked in OB as an extern for the past year, and will continue working there as a new grad next month. OB is just a whole other world than med/surg. Our hospital prefers to "grow their own" and hires new grads and students into specialty areas all the time.
But peds is just a good a primer for those areas.
My floor time was invaluable to my critical care training. And, because I worked on the floor for 3 yrs, I'm versatile enough to work just about anywhere in a hospital environ.
There's too much that nursing has to offer for you to 'pigeon-hole' yourself in a specialty without first laying the groundwork that will allow you the flexibility to move around later in your career. And there's too much 'burn-out' not to protect that viability. But, if you don't learn the time management and organization skills of a general floor, those skills will forever be too daunting for you. And even if not, your 'experience' will not allow you the orientation/learning curve to learn those skills for the first time as an experienced nurse.
I know it's fashionable to say that nobody has to put their dues in anymore. But those dues served a valuable purpose. It's not that I'm afraid to work with a new grad in a specialty area: specialty skills are taught skills, even if the learning curve is steeper. No, I feel sorry for the new grad - because they gave away something valuable because it's fashionable to dismiss such value these days. The thing is, those skills are like a parachute: when you need them, those skills are priceless.
Specializes in Nurse Leader specializing in Labor & Delivery.
But peds is just a good a primer for those areas.
My floor time was invaluable to my critical care training. And, because I worked on the floor for 3 yrs, I'm versatile enough to work just about anywhere in a hospital environ.
There's too much that nursing has to offer for you to 'pigeon-hole' yourself in a specialty without first laying the groundwork that will allow you the flexibility to move around later in your career. And there's too much 'burn-out' not to protect that viability. But, if you don't learn the time management and organization skills of a general floor, those skills will forever be too daunting for you. And even if not, your 'experience' will not allow you the orientation/learning curve to learn those skills for the first time as an experienced nurse.
Our hospital doesn't have a peds department. Secondly, I'm a "second career" nurse who went to nursing school specifically because I knew I wanted to be an OB nurse and lactation consultant. The past year, working in OB as an extern, has only solidified my choice and desire. OB is where I want to be, I KNOW that. I'm not "pigeon holing" myself. One can just as easily learn time management in postpartum or the nursery, where they have a 5-patient load (5:1 is the maximum ratio in ANY unit in our hospital, including med/surg).
Anyway, my point is that everyone's situation is different, and "one year of med/surg" doesn't fit everyone across the board.
There are a few areas that I think should be "off-bounds" to new grads; the biggest one IMO would be home care. People try to paint home care as a cake walk. "If you find (insert your specialty) too stressful, try home care. It's M-F, etc., etc., etc."
Wrong. And a new grad simply does not have the clinical and assessment skills to be out there alone.
I know it's fashionable to say that nobody has to put their dues in anymore. But those dues served a valuable purpose. It's not that I'm afraid to work with a new grad in a specialty area: specialty skills are taught skills, even if the learning curve is steeper. No, I feel sorry for the new grad - because they gave away something valuable because it's fashionable to dismiss such value these days. The thing is, those skills are like a parachute: when you need them, those skills are priceless.
Well said Timothy.
I'm glad and proud that I chose to go to a med/surg floor. I'm glad it is a trauma med/surg because I LOVE trauma, but I am learning the great skills of juggling many problems simultaneously and getting it all done.
i'm a 3rd year nursing student in canada, about to enter my last clinical of the year (med/surg of course). i don't particularly enjoy med/surg, and i've read countless posts about the debate for new grads to enter med/surg first or some other specialty area. my question is this: if going to med/surg is supposed to hone time management and prioritization skills, along with assessment i'm assuming, what makes people think nurses in the er or icu or some similar situation don't need (and therefore develop) these same skills? i can't imagine any of these nurses claiming they don't have a need for these skills, so if a new grad learns them in the er or on a med/surg floor what difference does it make? just my 2cents! :wink2:
i'm a 3rd year nursing student in canada, about to enter my last clinical of the year (med/surg of course). i don't particularly enjoy med/surg, and i've read countless posts about the debate for new grads to enter med/surg first or some other specialty area. my question is this: if going to med/surg is supposed to hone time management and prioritization skills, along with assessment i'm assuming, what makes people think nurses in the er or icu or some similar situation don't need (and therefore develop) these same skills? i can't imagine any of these nurses claiming they don't have a need for these skills, so if a new grad learns them in the er or on a med/surg floor what difference does it make? just my 2cents! :wink2:
I agree with you. I learned organization, prioritization and time management skills quite readily caring for critically ill patients. I believe it is inaccurate and misleading to state that med/surg is the only or best place to hone these skills. The best place for any new grad to learn is in a unit which INTERESTS him/her. For some that is med/surg. For many, it is not.
i'm a 3rd year nursing student in canada, about to enter my last clinical of the year (med/surg of course). i don't particularly enjoy med/surg, and i've read countless posts about the debate for new grads to enter med/surg first or some other specialty area. my question is this: if going to med/surg is supposed to hone time management and prioritization skills, along with assessment i'm assuming, what makes people think nurses in the er or icu or some similar situation don't need (and therefore develop) these same skills? i can't imagine any of these nurses claiming they don't have a need for these skills, so if a new grad learns them in the er or on a med/surg floor what difference does it make? just my 2cents! :wink2:
They are different skills in the specialty areas.
Look, A year of med surg fine tunes all the skills you spoke of above, plus the 'basic skills' of nursing. Placing foleys, ngts, starting IVs, basic knowledge of routine meds, basic knowledge of routine procedures/orders, etc.
I consider all those skills 'necessary' before learning specialty skills. It is possible to come straight into a specialty skill - but my experience is the demands on learning the specialty without first getting 'down' the basics is that many (I didn't say all or even most) such nurses have serious difficulties in any and all of the above.
Your observation isn't accurate because it doesn't take into account that every area has a different focus. My chief argument for 'putting in your dues' is that it will re-enforce your nursing training and make you a well-rounded nurse: instead of a nurse 'pigeon-holed' into a specialty.
I can go work med/surg tonight if I so choose - and thrive - even though I've been in Critical Care for 10 yrs now. It's like riding a bike. Not only that, my critical care experience is built on that foundation; it remains part of my nursing practice.
But those that go straight into the specialty areas: they tend to be 'deer in the headlights' when they have to float. Not to mention, they have lots of trouble moving to other areas not directly tied to the specific 'specialty' skill set that they learned.
The skills that make you a nurse: use them or lose them. If you decide never to use some of those skills - don't be surprised if you don't have them when you need them someday.
mrigas
73 Posts
This really does not make sense to me. Why would a manager not higher someone with 5-10 years of ICU experience for a M/S position?