New grad with NO CLUE about specialty

TigerGalLE, BSN, RN · Feb 14, 2007

Start out in Med/Surg.. Once you can tackle the complexities of a hard med/surg floor.. You can go anywhere and do anything .. With confidence!

Med/Surg will also help you develop time management and prioritization... not to mention team work...

I was like you.. I just graduated not knowing what in the world i wanted to do... So I figured I'd do something generalized untill I could figure it out

MrsWampthang, BSN, RN · Feb 14, 2007

Start with medsurg. You will get great experience for getting your clinical skills honed as well as your time management. You will see a variety of patients with different problems and you will learn so much that you didn't have time to learn in nursing school. You will also get comfortable with skills that you didn't have time to get comfortable with in nursing school. As for specialty, I don't know if medsurg is considered a specialty, but it is a good base for anything else you ever want to do. That's my two cents. Good luck.

Pam

Rabid Badger, BSN, RN · Feb 14, 2007

None of the shortfalls you listed are any different from the rest of us when we began our practicums. Even as a new grad you will struggle with prioritizing and understanding the application of theory to practice. It comes with time.

Med surg, all the way. Preferably on a very busy ward. You will gain exposure to every imaginable skill, disease, assessment and change of events. The fear of codes you have is natural but goes away quick with practice and exposure to codes. You might even start to enjoy them.

The most important thing about starting in med surg is that you always retain your portability. All specialities like to see a year or more in med/surg. If you start out in a specialty you may pigeon hole yourself and limit your adaptability.

llg, PhD, RN · Feb 14, 2007

I agree that if you really have NO CLUE as to a specific specialty, then a good general med-surg might be the best choice for you.

However, as part of your thought process, you might want to ask yourself the questions below:

1. Are there certain types of patients that you enjoy working with more than others? (Age, gender, diagnosis, etc.)

2. Are there certain types of nursing skills or situations that you prefer over others (teaching vs psycho-motor, heavy lifting, talking, dressing changes, death, acute injuries, chronic illness, short-term patient stays vs long-term patient stays, etc.). Sometimes new nurses don't take these types of factors into account when choosing a work place. Even within the broad field adult med/surg, there is variety from unit to unit about the type of patient typically found on that unit. Some units do more teachig than others: some units have more goopy dressing than others: some have more acute illnesses or injuries: some have more long term patients dealing with chronic illness: etc.

3. What can you imagine yourself doing 5 or 10 years from now? What are your long-term fantasies and dreams? Which opportunities will contribute most to helping you make those dreams happen?

Roy Fokker, BSN, RN · Feb 14, 2007

I too, recommend a good med-surg floor. Med-Surg floors generally see a good "mix" of patients with a variety of ailments affecting many different organs/systems.

Yes, this demands flexibility and a good act of 'juggling' priorities - but it builds core skills in nursing and helps you hone them: time management, assessment, delegation and critical thinking.

Things I consider not so good about me:
1. Not too comfortable with skills. (only experience is in NS)
2. Don't feel very comfortable with time management/prioritizing (YET).
3. Have trouble understanding complex systems such as Cardiac and Neuro but not so sure this wouldn't change if I had more time to devote to learning only those topics (can't in nursing school, so many other things to learn)
4. I have high anxiety levels, low self confidence (pretty sure related to lack of experience).

Sounds like me when I was (and in many ways, still am! :uhoh3:

) a new 'lamb' sent out into the big wide world of nursing!

Second guessed myself - often over seemingly trivial things that I would not have had trouble with in school, sweated over cath insertions, drove myself crazy over charting, trembled while delegating tasks to aides and other RNs, barely made it to report on time each day....

Boy! My first few weeks were almost as bad as nursing school!

I won't lie to you - your first few weeks will be BRUTAL. Each time you sign "thrashej, RN/LPN/LVN" - not only will you feel a gush of pride, but also a deep sense of responsibility! No more "professor/instructor" who needs to 'sign off after you' -- the BUCK stops with YOU! You're it! :)

I also hope you have preceptors like the kind I did - constantly pushed, prodded, poked, questioned, quizzed, assign hard cases to... but also oversaw, guided, helped, assisted and tirelessly answered my 1001 questions over and over and over and over....

all the best!

cheers,

a n00bie nurse

Curious1alwys, BSN, RN · Feb 14, 2007

Ok, so med-surg, what does that encompass?

Neuro, renal, pulm? is that any floor other than an ICU/OB/PEDS, etc?

I am so afraid that with 6+ patients (or whatever) I'll just sink. Fast. It was hard enough for me to tackle 2 in school, how will I ever adjust??

peds4now, RN · Feb 14, 2007

I feel the same as you. I would actually like to work peds, but if I don't do that, I'm thinking of starting out on a telemetry/monitored unit. I know it is supposed to be important to learn to have 5 patients, but everyone complains at the same time that even being restricted to 5 RNs neglect crucial parts of care all the time. That's experienced nurses. I know tele patients are higher acuity (I always think that means they're smarter, I guess because I also speak english, not just nurse), but at least I'd only be pulled 3-4 ways, not 5-6. Does this make sense anyone?

P.S. Is is wrong to start in Peds? I mean, you see variety on a Peds floor too, just with children.

Curious1alwys, BSN, RN · Feb 14, 2007

I'm externing on Tele and don't really care for it. Maybe it is just the floor, but I don't know. The pressure to hurry up and make sense of an EKG is tremendous when I feel I don't even know enough about cardiac anatomy! :lol2:

Can you all give me an idea of the different types of Med-surg floor and nurse-pt ratios...

Rabid Badger, BSN, RN · Feb 15, 2007

I'm externing on Tele and don't really care for it. Maybe it is just the floor, but I don't know. The pressure to hurry up and make sense of an EKG is tremendous when I feel I don't even know enough about cardiac anatomy!
Can you all give me an idea of the different types of Med-surg floor and nurse-pt ratios...

What you'll see on a med/surg floor depends on the actual hospital and floor you ultimately choose, which is why it is important to research where you are going. In smaller hospitals, you will have mixed medicine and surgery patients on one ward, you will likely have patients who are not as sick and therefore you will carry a higher patient to nurse ratio.

I work in the busiest medicine ward in the city, in a tertiary care facility. That means we get the sickest of the sick, short of going to ICU. Often we will get patients who are sick enough to be in ICU but it takes time to convince them to take the patient. We have patients who are so sick they code, despite essentially one-to-one nursing and heavy intervention. We have patients who are teribly sick but have been deemed not candidates for ICU. We also house the high-observation unit wherein all the sickest medicine patietns who cannot be managed on a one to 5 ratio go.

Essentially our ward gets patients with multisystem illness. Most of our patients are bedridden. If they're well enough to walk, they're too healthy to be on our ward. I have used every imaginable skill that I learned in nursing school. I have to make frequent indepth assessments on these sickies and be able to notify med service if I note changes, what I suspect is happening and what interventions I want done. Usually they confirm and order the interventions I told them needed to be done. At times this means you have a patient who is tanking and you are on the phone telling service to get their a$$ down here, and btw I've already ordered a chest xray, ekg, bloodwork and called for screening medical resident.

jamonit · Feb 15, 2007

thrashej!

come work with me at phoenix children's!!!!!! work in peds ed, picu, hemeonc, or endocrine floor! new grad class is extensive 14 week class/preceptor 1 on 1. the benefits are great, the everything is great. pm me if you are interested.

next new grad program "gapp" program starts in july. if you are interested, apply soon! let me know!

:coollook:

Curious1alwys, BSN, RN · Feb 15, 2007

Thank you for all your help everyone. I truly do see the value of starting in med surg but not sure if I'll be able to hack it. Nervous about ICU too. Actually, nervous about EVERYTHING, lol.

I've got a lot of research to do! Off to pass my classes first!

Thanks again!