Need honest opinion. Best area for new grad to start

[ijuanabhappy]

I need some honest opinions. What do you think is the best area for a new grad to start out in? I have heard that there are some areas/specialties where it would not be prudent for a new grad to start out in. Initially I wanted perioperative, but I did not get in to that internship. I was offered a position on the cardiology floor. My only worry about med-surg is that in clinicals, I was conscientious but felt slow and overwhelmed. I worked in the medical field for years, just not with patients... I pushed paper. Will the skills and time-management just take some getting used to, or is it sometimes just not a good fit for certain people? I am very caring and good with patients, but I am nervous about having to take care of 5 to 6 patients when I felt so overwhelmed in clinical. Any advice on how I can prepare myself for this position, or are there other areas for new grads that might be a better fit for me. I know this experience would certainly be great. Thanks.

[JustEnuff2BDangerous, BSN, RN]

I went into Med-Surg straight out of nursing school (I graduated May 2009) because I did not feel I was experienced enough clinically to be able to save lives in a specialized area such as ICU or ER. While it is true that you probably will initially feel overwhelmed anywhere you start out at, its also true that there's a reason why they make you do orientation/preceptorship rather than just throwing you into the deep end.

On an average day on my med-surg floor, I'm the RN in charge of 12 patients. I have a LPN and a CNA on my team and together the three of us take care of these 12 patients' needs. Over the past year I've worked there are only a handful of days I have felt overwhelmed, but I have never said to myself, "I can't do this, its too much for one person." Time management and prioritization are skills that you learned in nursing school, and they are skills you will hone on the floor as a nurse. On days when I feel overwhelmed (usually when I have a mix of things going on that -I- -have- to attend to, such as pts getting blood, getting chemo, going bad, etc, all at the same time) I have to stop and make a list of things I have to do right now, things that need to be done before the shift is over, and things that need to be done but not necessarily by me (these pts want pain medicine - hey, dear sweet LPN, can you do this for me please?). When you feel overwhelmed the best thing to do is get organized, go down your list, don't get panicked, and ask for help. There's no shame in asking for help, ever!

Starting out in a "non-specialized" area like med-surg will help you fine tune all those skills you breezed over in nursing school. You'll see a little bit of everything.

[Yosemite, RN, ASN, EMT-I]

I have to go along with Med/Surg. You'll get a taste of almost everything there... it is like an extension of nursing school... a bit of this, a bit of that, and like most areas of practice (unfortunately) a "sink or swim" survival training. What skills you learn/practice there will serve you WELL no matter WHAT specialty you go into!

[MsBruiser]

I am going to put my neck out. Go for the area that you want to work in - but take any job you can get (given the economy). I have never worked Med-Surg nor have I ever wanted to nor did I ever not gain some mythical set of organizational skills by forgoing Med-Surg. Heck, I'd sooner slam my finger in a car door than work Med-Surg. I couldn't think of a worse, run yourself ragged for nothing job. Nothing but crap rolls downhill on you all day long. I would only do it if I was absolutely desperate for a job - otherwise being a Starbucks barista would be more appealing. If you have somewhat of a brain you will acquire good skills - no matter what specialty you choose to work.

[Doc Lori, R.N.]

Hya. I'd have to say med-surg. It is well rounded. You will obtain lots of experience in alot of different things. Then with 1-2 years of this under your belt, not only are you more marketable to specialties, but you will be drawn to a specialty that resonates with you, based upon the knowledge that you have acquired, not just speculation.

Good luck!

[ijuanabhappy, ASN, RN]

Thank you all very much. I appreciate all of your replies. When you talk about LTC do you mean nursing homes basically? Not that I am opposed to that, I was just not sure. There is actually a very nice nursing home facility down the road from me. I also think the med-surg cardiac experience in the teaching hospital would be excellent, I am just hoping I will swim and not "sink"! I had so much anxiety in clinicals. I am not too fond of the learning curve, but I know it is unavoidable. I get 8 weeks for this med-surg orientation and I hope that is enough time. I only did one Foley and one IV in nursing school. The hardest part seemed to be juggling everything that needed to be done, like the computer documentation. I guess it all comes with time. Thanks!

[MsBruiser]

In nursing school they sent me to an outpatient surgery center to start IVs. I had a chance to do 7 in a day. I missed 6. SIX IN A ROW. Now I can do them. The mechanical skills of nursing will come with time and practice. Try and develop (instead) that little voice in the back of your head that tells you something just isn't right.

There are 3.5 million nurses in the US. Many with an opinion about what is best. You have to pick the field you truly enjoy. A twelve hour shift is a long, long time to be at work. Make sure the specialty you choose is something you can feel passionate about. This stuff isn't rocket science. If you want the ICU or the ED - go for it. There is a reason why they give you a 16+ week orientation. No one is going to turn you loose to kill a patient. If Med-Surg is your speed, or even (God forbid) LTC, then go for it. Just don't assume Med Surg will give you an unbeatable base of skills. Pick an area you can feel passionate about and you will become a competent nurse.

[AOx1]

I would consider a intermediate care or stepdown unit. It gives you a broad med/surg base, you have fewer patients (typically 3-4 depending on the acuity of the floor and the patients), and you get to know your patient better than in med-surg. This is helpful when you are trying to learn so many new meds and your organizational skills. At least in the units I have worked in, the patients have drips, but you are not frequently titrating them.

The most important thing to consider is actually the unit itself. What is the manager like? Do you feel immediately comfortable with the manager? What is the turnover rate? When you are a new grad, the orientation you receive will be key to your success. Too little or poor orientation sets the stage for future problems. You should have supportive colleagues and management. I would rather work in an area that wasn't my true nursing goal but with great support and management, than in my "dream" area with no support and bad management.

[JenniferSews]

Thank you all very much. I appreciate all of your replies. When you talk about LTC do you mean nursing homes basically? Not that I am opposed to that, I was just not sure. There is actually a very nice nursing home facility down the road from me. I also think the med-surg cardiac experience in the teaching hospital would be excellent, I am just hoping I will swim and not "sink"! I had so much anxiety in clinicals. I am not too fond of the learning curve, but I know it is unavoidable. I get 8 weeks for this med-surg orientation and I hope that is enough time. I only did one Foley and one IV in nursing school. The hardest part seemed to be juggling everything that needed to be done, like the computer documentation. I guess it all comes with time. Thanks!

LTC is, yes, a nursing home. I work at a subacute rehab wing in a popular and busy facility that is part LTC and part subacute. I got 2.5 DAYS of orientation as a new grad with no experience. The 1/2 day was my very first day, since my preceptor worked overnight and the poor thing was ready to keel over! Everything I've learned has been on the fly. I will be precepting another nurse in a few days, and she will get the standard 3 days. New or experienced, sink or swim it the LTC rule. If you're thinking about the nursing home, call them! Ask them if they are hiring, then as them how long orientation is and how much support you will get, what your patient load will be, what shifts are available and what what would be your responsibility, etc. Then call other LTC facilities in your area, and visit the LTC forum here. From what I've seen 3-10 shifts of orientation is pretty much the norm. With a little bit of questioning I'm sure you can figure out their intentions. Good luck!