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 They say the the med-surg idea is outdated and a new nurse is better off in the area the nurse wants to work in.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 Is my local hospital out of date?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 posted a similar reply elsewhere, but make the nursing shortage work in your favor...You will learn valuable skills anywhere and they are so desperate for nurses now that you can easily go back to med-surg(there are nursing refresher courses) Med-Surg does not treat its nurses well, they are overworked and underpaid and until this changes, I would not inflict that upon myself. Your local hospital is behind the times....Also, depending on what specialty you work and what hospital you work for, you won't get floated...That being said, I have seen OR nurses floated to floors or even the ER and they did fine...I have never seen a med-surg nurse float to the OR....A lot of the specialties prize thinking on your feet and being able to handle a crisis. These are very valuable skills. The other skills(foleys, asessments,IV's) are taught in nursing school and used in practically every specialty(Yes, even the OR). I would keep in mind that the hospital that told you you "had" to do med-surg is probably so deperate for help because of poor working conditions. On a personal level, I've known quite a few nurses that wished they had specialized right out of school. Ultimately, if you know where your interests are, go for it. I think the year of med-surg is good for students who have no healthcare background and don't know exactly what they want right away. If you have a passionate interest in a specialty though, don't waste valuable time in an area you don't have interest in. It's your career-do what makes you happy and excited. Just my 2 cents...
I posted a similar reply elsewhere, but make the nursing shortage work in your favor...You will learn valuable skills anywhere and they are so desperate for nurses now that you can easily go back to med-surg(there are nursing refresher courses) Med-Surg does not treat its nurses well, they are overworked and underpaid and until this changes, I would not inflict that upon myself. Your local hospital is behind the times....Also, depending on what specialty you work and what hospital you work for, you won't get floated...That being said, I have seen OR nurses floated to floors or even the ER and they did fine...I have never seen a med-surg nurse float to the OR....A lot of the specialties prize thinking on your feet and being able to handle a crisis. These are very valuable skills. The other skills(foleys, asessments,IV's) are taught in nursing school and used in practically every specialty(Yes, even the OR). I would keep in mind that the hospital that told you you "had" to do med-surg is probably so deperate for help because of poor working conditions. On a personal level, I've known quite a few nurses that wished they had specialized right out of school. Ultimately, if you know where your interests are, go for it. I think the year of med-surg is good for students who have no healthcare background and don't know exactly what they want right away. If you have a passionate interest in a specialty though, don't waste valuable time in an area you don't have interest in. It's your career-do what makes you happy and excited. Just my 2 cents...
Well said and I agree. Why torture someone with an area they know they don't want to work. Why should a unit invest a year in someone to watch them leave to where they wanted to be all along. Not everyone is cut for nor remotely interested in med-surg.
They can become experts and competent and gain skills in their speciality. Even med-surg nurses get the "deer in the headlight" look when they have to float.
There are compelling arguments both ways. But I lean towards providing proper training and orientation no matter which area you go into.
Timothy as you say in the BSN vs. ADN debate: "experience is the great equalizer" in the end. One year down the road both who just started in a specialty (one new grad and one with a year of med-surg) hopefully will be standing on equal footing. Both probably will have the "deer in the headlight look" the first time they float.
One new grad and one with a year of med/surg on equal footing. Explain that to me PLEASE.
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If you read, they said
One year down the road both who just started in a specialty (one new grad and one with a year of med-surg) hopefully will be standing on equal footing.
Instead of jumping all over a post without reading, slow down and figure it out before you post.
One new grad and one with a year of med/surg on equal footing. Explain that to me PLEASE.
A house has a concrete basement. Doesn't mean the whole house is made of concrete.
Take two inexperienced L&D or ICU nurses for example. One did a year on med-surg, one starts fresh out of school. A year from now, I would venture to say that they should be on equal footing. Time and experience in takes care of the lack of med-surg training the new grad had and both had better be performing their jobs in a competent manner.
Perhaps the new grad needs a little more attention to some of the details and assessment skills. But someone with one year of med-surg isn't ready to come out running on their own either, they need plenty of training too. Heck, I've been a med-surg nurse for 15 yearsr, you'd better give me the same orientation a new grad gets if I specialize. :)
Take two inexperienced L&D or ICU nurses for example. One did a year on med-surg, one starts fresh out of school. A year from now, I would venture to say that they should be on equal footing. Time and experience in takes care of the lack of med-surg training the new grad had and both had better be performing their jobs in a competent manner.
Perhaps the new grad needs a little more attention to some of the details and assessment skills. But someone with one year of med-surg isn't ready to come out running on their own either, they need plenty of training too. Heck, I've been a med-surg nurse for 15 yearsr, you'd better give me the same orientation a new grad gets if I specialize. :)
In my opinion.
And that's what people don't get who argue toward mandatory med/surg beginnings.
As an experienced nurse who moved to ICU years later after med/surg, here are the differences:
Me, the med/surg nurse, sailed through much of the basics of the "new grad internship."
The time management and prioritization skills were a big challenge to most new grads. No matter where they went to school, most really had a hard time figuring out what was most important and which patients needed to be seen first.
In addtion, most new grads still needed practice in the basics such as foley insertion, NG tubes, and IV starts.
So what?
By the time it's all said and done, we should, in fact, be on equal footing, after a year or so in ICU.
I know that's not always the case, but most of the time I believe that it's true.
My internship was much shorter and more concentrated toward ICU specific things, but that doesn't mean that my fellow interns/new grads aren't good or even great ICU nurses today.
It's just that they were learning everything related to ICU nursing all at once, rather than one step at a time like the way I learned.
I didn't read all the replies, so I apologize in advance if this question has been addressed. Are the long, in-depth orientations that I hear new grads get in some disciplines i.e. NICU, ER, offered to more experienced nurses who wish to venture into these areas later in their career? ~ Diane
I didn't read all the replies, so I apologize in advance if this question has been addressed. Are the long, in-depth orientations that I hear new grads get in some disciplines i.e. NICU, ER, offered to more experienced nurses who wish to venture into these areas later in their career? ~ Diane
Probably not.
And that is MY point. Going straight into a specialty without taking the opportunity to tune your general skills will ALWAYS make you a 'specialist'. Look, most hospitals have all but given up on asking for general experience first. You CAN get a job directly into ER/OR/CCU/NICU/L&D, etc. That is true. We have 4 new grads coming into OUR CCU this summer.
No, it's not the hospitals that will suffer from this decision; it is the nurses that choose not to cement their general nursing skills before going down the roads they choose.
Bottom line: nursings schools don't teach you how to be a nurse. Those schools arm you with the education SO THAT YOU CAN LEARN to be a nurse OJT. In that regard, a year on med-surg is like the third year of clinicals that is REQUIRED for you to be a general all-around nurse.
I'm a CCU nurse. But, thanks to my 3 yrs on medical, I'm also a nurse; not just a 'CCU' nurse. I can hit the ground running on practically ANY hospital unit.
I know nurses that came straight into CCU. When they got burned out, I've seen them try and fail at ED because the 'Critical' part of ED is too mixed with the 'Clinic' part of ED. Then they try Cath Lab, but that is also a 'different' world, etc. etc. I've seen such nurses bouncing back and forth trying to find a 'niche' that fits without having the opportunity to expand to more areas because they don't have the 'experience' of that third year of clinicals: OJT.
The skills that you are SUPPOSED to learn and hone AFTER school: use them or lose them forever.
NO, once you have a year or two under your belt, do not ever expect to get the long orientations of new grads in ANY area of nursing. You were supposed to learn some of this stuff, already.
Can you learn how to drive just an automatic? Yes. But ten years into driving, when the sporty car you really, truly want is a standard: don't be surprised if you're so used to driving an automatic that learning to drive a 'stick' is too daunting a task at that point.
I'm teaching my son to drive a standard from the start because it will give him more opportunities as a driver as an adult. I think nurses need to learn how to drive a 'stick' also. Not for the cars'/hospitals' sake; but for their own.
Timothy, I see your point. But it's not just critical care nurses going from department to department, job to job. Don't you find this true in nursing in general. Nurses don't tend to stay in the area they start off in, or even the 2nd area you go into.
I was just talking off the top of my head. I'm confident if I went to ICU I would not need the full orientation they give new grads. But I would need some orientation, the same as a speciality nurse would need some orientation after coming out of a speciality.
The agruement that new grads shouldn't go into a speciality because one day they may want to leave and then flounder when they do isn't a good one in my opinion.
Also, I'm not understanding what you mean by skills you are supposed to learn. Can one not learn these skills in a specialty? Other than managing a greater number of patients, what "nursing skills are you talking about that you can only get in med-surg and not in a specialty?" It's rather flattered that you consider my speciality the only area where one can learn to be a nurse, but I disagree.
Bottom line is you make a very good argument and I agree with the idea. The problem is there is a shortage in some specialities, and many nurses are itching to get into those and are tortured "doing their time" in med-surg, aren't interested in med-surg and daily make it know they hate it and really want to be somewhere else. It's not fair to them, to the managers orienting them, etc.
I didn't read all the replies, so I apologize in advance if this question has been addressed. Are the long, in-depth orientations that I hear new grads get in some disciplines i.e. NICU, ER, offered to more experienced nurses who wish to venture into these areas later in their career? ~ Diane
Absolutely yes. Any hospital that would hire any nurse into a specialized area and NOT provide a 3-6 month orientation/internship is not a reputable facility. I have worked in 5 hospitals in 5 different states in OB/NICU, and have NEVER encountered a situation where a nurse with experience outside of the maternal-child area was given a shortened orientation.
Furthermore, I simply don't buy the argument that specializing right out of school robs one of the opportunity to hone basic skills. Let me give you a rundown of what I learned in my first few years as a NICU/OB nurse:
Nursing assessment, care planning, implementation of medical and nursing plan of care, evaluation of patient's response to care. Coordination of care with other disciplines including family members, medicine, pharmacy, lab, PT,OT, social work. Prioritization, organization, and time management skills. Networking and hospital politics. Knowledge of normal A&P, disease management, pathophysiology, pharmacology. (Sounds a lot like what new grads learn on med/surg, doesn't it?)
Nursing skills such as vital signs, admission assessments, IV insertion and maintenance, care of central lines and PICCs, administration of TPN and lipids, administration of blood products, phlebotomy including finger and heel sticks, venipuncture and arterial sticks, insertion and maintenance of og, ng tubes and gastrostomy tubes, management of ventilators, insertion and management of Foley catheters, developmental care of patients and families. (Sounds a lot like what new grads learn on med/surg, doesn't it?)
I was required to be skilled in the care of high-risk ante-partum patients (diabetics, asthmatics, heart and kidney patients, pre-term labor, incompetent cervix, placenta previa, substance abuse, trauma and post-surgical patients). I cared for normal and critically ill newborns, healthy and sick post-partum mothers, healthy laboring women and those with serious medical conditions. I was required to circulate in the OR, and recover C-section patients in PACU.
The nurses on my unit were given a maximum of 2 years to obtain the following certifications: NRP, ACLS and fetal monitoring.
I am not trying to downplay the value of med/surg nurses. THEY HAVE MY GREATEST ADMIRATION! But I seriously doubt that they have a wider range of skills and abilities than I do.
I also disagree with the argument that I have pigeonholed myself and limited my future job options by specializing in OB. I have skills and experience that would carry me to numerous settings, such as adult med/surg, OB, peds, OR, PACU, ambulatory surgery. If I am unable to work OB in a hospital setting, I will consider office nursing, clinic nursing, school nursing, OB or peds home care, care of developmentally disabled individuals, etc.
Bottom line, I firmly believe that new grads should pursue the area of care that interests them most. That may or may not be med/surg. But the idea that a year of med/surg makes one more flexible or valuable is non-sense. I've yet to see a med/surg nurse able to function in NICU or L&D and better than I can function on their home unit. That has nothing to do with skills or abilities, and has everything to do with functioning in a familiar environment.
ortess1971
528 Posts
I posted a similar reply elsewhere, but make the nursing shortage work in your favor...You will learn valuable skills anywhere and they are so desperate for nurses now that you can easily go back to med-surg(there are nursing refresher courses) Med-Surg does not treat its nurses well, they are overworked and underpaid and until this changes, I would not inflict that upon myself. Your local hospital is behind the times....Also, depending on what specialty you work and what hospital you work for, you won't get floated...That being said, I have seen OR nurses floated to floors or even the ER and they did fine...I have never seen a med-surg nurse float to the OR....A lot of the specialties prize thinking on your feet and being able to handle a crisis. These are very valuable skills. The other skills(foleys, asessments,IV's) are taught in nursing school and used in practically every specialty(Yes, even the OR). I would keep in mind that the hospital that told you you "had" to do med-surg is probably so deperate for help because of poor working conditions. On a personal level, I've known quite a few nurses that wished they had specialized right out of school. Ultimately, if you know where your interests are, go for it. I think the year of med-surg is good for students who have no healthcare background and don't know exactly what they want right away. If you have a passionate interest in a specialty though, don't waste valuable time in an area you don't have interest in. It's your career-do what makes you happy and excited. Just my 2 cents...