New grad, don't have what it takes to work in a hospital?

[Newtons]

I've just graduated from nursing school, and I'm very unsure of where to work. A part of me wants to work on a med/surg floor and get my "basic nursing skills" foundation, and another part of me (a huge part btw) is telling me to skip the hospital and work in some type of outpatient setting. While I do really kinda want that basic foundation of nursing, I'm really scared that I won't be able to handle working in a hospital.

My senior practicum in school was in a good setting, I had an instructor who worked in the float pool and as such I got to experience a few different floors. HOWEVER, I hate to admit that even by my last day, I honestly wasn't that much better than how I was at the beginning. I'm an extremely awkward, shy, and introverted person, so hearing me talk to patients is a cringe-worthy experience. And I don't know if it was because of the system of the hospital in place for capstone students, or if I'm just trying to find something to blame other than my own incompetency; but I literally had no idea when patients had diagnostics tests to be done or labs to be drawn, I had no idea what orders were put in, or what to do with orders, I talked to a physician twice in the time I was there and both times I looked like a complete idiot because I had no idea what the hell I was doing. In my defense, as a student I couldn't access or even see the orders put in, I also didn't have an iPhone the staff in the hospital used to communicate with each other and other departments. But even with that I feel like I should have had some more understanding of everything going on with the patient, my nurse did tell me what was going on with the patients.

Giving report at the end of the shift is when I realized how bad I actually am at nursing, which was a bit of a shock to me, as someone who was a low A student during school, I thought I should have been in a better position to be able to practice nursing, and I'm not. Grades very obviously don't correlate to physical nursing performance, as evidenced by my peers who were on the brink of failing but flourished during their capstones. Giving report I basically just read off a handoff report that was required for each patient, and I couldn't put together what happened that day with the patient and understand it and tell the next shift what was going on or what to expect.

So now I'm stuck, I don't want nor can I afford a really low paying clinic job, but I'm scared I'll be having anxiety attacks if I try to work at a hospital and even worse I won't be able to practice as a safe and competent nurse. What's even more annoying is that there are no nurse residency programs open at the hospitals I'm wanting to apply to, which I don't even know is a blessing or curse, at least I wouldn't be stuck in some commitment. I also went to nursing school out of state, now that I'm back in Washington state I have no idea of how the work culture is in certain hospitals, nor do I have friends I can ask, and online research is turning out to be very biased.

Someone just help me, where should I apply for my first job? should I just apply to hospitals and pray I don't end up killing myself or ruining my career, or can I start in an outpatient setting and work my way up to a hospital, even though all the advice I've ever been given tells you to work med/surg in a hospital first.

[Nurse SMS, MSN, RN]

I would apply at acute care (hospital). None of the things you mentioned stand out to me as huge barriers to your ability to be successful as an acute care nurse. You are a student. If you didn't know about tests and orders or where to find them, your preceptor failed to give you the experience you should have been having. Introverted, shy and awkward is comforting to patients who are themselves introverted, shy and awkward. There is no one-size-fits-all to nursing. Yes, you are going to have anxiety. Even the most cocky of new nurses do. It is how you handle it that matters, not the fact that you have it.

As an educator in acute care who does a fair amount of onboarding of new grads, I encourage you to give it a go. Do not let the fact that you are afraid hold you back. You will regret not trying.

[traumaRUs, MSN, APRN]

Moved to first year after licensure.

[cleback]

I think at this point in your career, there are a few things more important to consider than just inpatient vs outpatient:

1) orientation length

2) support by management and senior nurses

You may have a harder time finding these in an outpatient setting. In my experience, clinics generally hire more ancillary staff (MAs, techs), and you may be the only nurse on shift. So, they may not have a lot of experience orienting a new nurse. They may not have a formal program. None of those things would be ideal for a new nurse. You need to have a structured orientation with another nurse and then have senior nurses available for questions during your first year. You are more likely to find this in acute settings, imo.

But some outpatient centers may very have this (chemo, dialysis, large primary care offices, urgent care). And some smaller acute units may not. Apply to what interests you and then see what they offer. Good luck.