New grads in specialties without the basics

[Emergent, RN]

We have several new grads in our ER. I'm starting to think that most nurses should have at least a year on a more general ward before learning a specialty.

I'm seeing some clueless mistakes, and lack of basic skill in pt care. That includes things like how to clean a pt and roll and change bedding. Basics about IV med administration, dose calculations, prioritizing, and realities of inpatient care. They have no idea how the rest of the hospital functions.

On top of that, some of them seem to harbor elitist attitudes, as if they are already big hotshots. Yet, they themselves seem to lack the above mentioned skills.

Thoughts?

[Rose_Queen, BSN, MSN, RN]

I think it says more about how nursing schools are teaching. Med/surg is a specialty of its own; to say that everyone needs to start there kind of seems to disrespect that status. However, schools need to have students prepared at the basic level of functioning; instead, it seems that nursing grads need to be taught how to be a nurse after graduation, regardless of the specialty in which they work.

[BeachsideRN, ASN]

I think it says more about how nursing schools are teaching. Med/surg is a specialty of its own; to say that everyone needs to start there kind of seems to disrespect that status. However, schools need to have students prepared at the basic level of functioning; instead, it seems that nursing grads need to be taught how to be a nurse after graduation, regardless of the specialty in which they work.

I agree. We spent 2 weeks on those basic skills and that's it. Now med calcs we do constantly. But the basic CNA type stuff we never did outside of skills lab

[cracklingkraken, ASN, RN]

I think it says more about how nursing schools are teaching. Med/surg is a specialty of its own; to say that everyone needs to start there kind of seems to disrespect that status. However, schools need to have students prepared at the basic level of functioning; instead, it seems that nursing grads need to be taught how to be a nurse after graduation, regardless of the specialty in which they work.

This is why I am set on doing a new grad residency program! I don't feel nearly as prepared as I would like (clinically speaking). The theoretical knowledge is there, but I still feel extremely under prepared.

[Purple_roses]

When I'm a new grad, I actually would not want to start on ER. I would like some more experience first because I don't trust myself. I imagine myself looking like a five year old wobbling on a bicycle after a parent lets go.

[Caffeine_IV]

I think it says more about how nursing schools are teaching. Med/surg is a specialty of its own; to say that everyone needs to start there kind of seems to disrespect that status. However, schools need to have students prepared at the basic level of functioning; instead, it seems that nursing grads need to be taught how to be a nurse after graduation, regardless of the specialty in which they work.

This is true. Eventually it will get old with new nurses passing through med/surg and disparaging it along the way.

As far as thinking that they are hotshots. I've said before there is an acute care nurse hierarchy with ER/Critical care being at or near the top (IME).

[dudette10, MSN, RN]

I could barely set up an IV when I started, but I also caught two strokes (one pt was tPa'd) pneumonia (because I was the only nurse who had had the patient before during his stay), and prevented a more experienced nurse from giving a med the patient was allergic to (and because I did it quietly, she thanked me) within the first 6 months.

While I am not downplaying the need to learn skills, they are easily and quickly taught. Medicine is see one, do one, teach one, and nursing could be the same. The other day, a newer nurse asked me to help her deaccess a port, as she had never done it. I verbally told her the supplies and steps, then walked her through it on the patient. Boom, she's ready to do it on her own. Assessment and monitoring for deterioration (pathophys, s/s, etc.) is much more important.

[NurseSpeedy, ADN, LPN, RN]

This reminds me of a trainee that I had the pleasure to work with on the med/surg unit of my floor years ago. She had been an LPN for a few years prior, working at a primary care physicians office. When she graduated with her ASN and got her RN, she applied for a job at the hospital. At this time LPNs and RNs were both widely used in my area and on this particular unit there wasn't much that I couldn't do. Well, that went over well. "I'm training with an LPN???!!!" Um, if you have a problem with it we can arrange for you to train with a COB instead:sneaky: (Many did not warm up to new nurses). She had told my manager that she wanted to work in ICU. She told her that she needed to train on the floor first and work for at least six months to prove herself. Wouldn't you know she called our manager the next day asking again if they could train her in the unit. She again told her, "No". She then said, "I'd hate to think that I educated myself out of a job" (referring to her clinic job as an LPN)...thankfully, she was a no call, no show and never returned.

[klone, MSN, RN]

I think it says more about how nursing schools are teaching.

Exactly what I was going to say. I, as well as many of my nursing school cohorts, went directly into specialties without a year of M/S, and it did not detrimentally affect our skill level and knowledge in any way. We were well-prepared by our school, which encouraged us to do externships or work as CNAs.

[Susie2310]

I think it says more about how nursing schools are teaching. Med/surg is a specialty of its own; to say that everyone needs to start there kind of seems to disrespect that status. However, schools need to have students prepared at the basic level of functioning; instead, it seems that nursing grads need to be taught how to be a nurse after graduation, regardless of the specialty in which they work.

I agree with the OP.

Regardless of whether people agree on the status of med-surg as a specialty, I think the point is that basic nursing training on a med-surg unit does provide good training in the fundamentals of nursing care that one will use in a number of other units/specialties, and provides a good knowledge base that is applicable to other nursing areas. In the ADN program where I received my clinical training approximately 20 years ago, I completed several clinical rotations on med-surg units: oncology (2 half semester rotations), student work experience, and preceptorship; ortho/neuro (one half semester rotation); general med-surg (one half semester rotation). We provided total care from the second week of classes. Along with patient assessments, and monitoring patients, once we were checked off on skills in skills lab, we could perform those skills in clinicals' with our instructor present for the first time (for certain skills, such as IV meds, we had to have our instructor present whenever we performed the skill throughout the program). We learned how to bathe, move, transfer patients, make occupied beds, and provide incontinence care. We had a chance to work on developing time management, charting, working with other team members, and team leadership. I found everything I learned on my med-surg rotations relevant on all of my other clinical rotations: rehab; L&D; ICU step-down; pediatrics; psych; geriatrics. My med-surg training formed the basis of my nursing training. I was exposed to a large variety of diagnoses and medical problems, and a variety of patient ages.

Today, it seems as though many nursing students are barely trained to provide hands on nursing care any more. I have read numerous accounts of the lack of clinical training students have received, but I have never really read good explanations for the reasons why nursing training has changed so much. I remember when nurses who were hired into the ER/ICU were mostly experienced nurses. I don't really understand why facilities hire new nurses into specialties such as the ER, when the nurses can't even function at a basic level.

[chicookie, BSN, RN]

I somewhat agree unless we are talking about peds. To me peds is a different beast altogether. If you know you want to do peds, do peds. Personally I feel like 90% of what I learned on the adult side was completely useless when I started peds. They way you do everything is different, so the first couple months I had to rewire my thinking.

[BecomingNursey]

If I would have had to get a years worth of experience on the floor before specializing in the ER I would have been absolutely miserable. I worked for 2 & 1/2 years as a tech on the floor and felt that I had already had enough (not experience. Enough of the floor). I needed the change and I'm so thankful the ER gave me my shot when I graduated. I also had many references stating that I was a hard worker and had initiative.

Do I think every new grad should go straight to a specialty? Nope. But saying that every new grad shouldn't specialize until they've had experience isn't the way to go either. Every nurse goes a different path and I'm so thankful I was able to go mine.