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.
Consider me one of those new grads who will be going directly into a specialty as soon as I graduate. I know where I want to be (critical care) and I'm going straight for it. I'm lucky that I landed an internship in the CVICU in my last year of nursing school. The unit I'm on typically hires their interns if they are a good fit. With my desire for learning, drive, and ambition I have no doubt that I will make my goals reality.
I'm a newly-licensed new grad, and I have been told the same thing by several nurses, including my preceptor for my (med-surg) senior practicum. I think it's something all new grads have to hear: "A general med-surg floor job is the only logical entry position for a new nurse." While I know the floor is a great place to work on skills, I also know I would dread going to work most days with that kind of job. Med-surg is just not for some people, myself included.
I'll be starting a perioperative residency soon, which requires a one-year-long classroom and orientation/preceptorship period. Needless to say, I think I'll be very properly trained. The OR is where I've always wanted to be. But, had I taken a med-surg job, I would have had to work there to get my "one year of experience", then transfer to an ICU, then hopefully find my way into an OR after a couple more years. It didn't make sense to me to take extra steps to reach the same end result.
Call me young and dumb, but my theory is this: If new grads are willing to really work and learn, let them choose their specialty right out of school, as long as they are properly trained in orientation before being made to fly solo. New grads shouldn't be looked down upon for being inexperienced and starting out in a specialty area; hospitals should just be held accountable for providing adequate training/orientation if they are going to hire them.
This is why I said earlier that as an ER nurse I Love having med surg nurses come work with us. The majority of ER pt's are MS and a good MS nurse can turn over a lot of patients because of their awesome organizational skills and assessments. MS is very labor intensive, and I for one appreciate that skill very much.
I think every opportunity to learn no matter the area will only make a stronger and better nurse. Times have changed, some for the better, some not. When I worked ICU, if we needed to float, we floated where we were needed, and we didn't use the excuse we couldn't go to MS because we couldn't handle that many patients, I enjoyed the change and I kept those organizational skills to manage more than 2 patients, and this helped me a great deal when I went to the ER. It takes special skills to work in any area. That is the great thing about nursing is that there is something for everyone. I preferred to work in all different areas, rather than staying in one unit, I got bored and needed the challenges. As a per diem ICU nurse, I floated every where, it was one of my favorite jobs, and I learned a great deal from many awesome CNA's, LPN's, ADN's, BSN's, housekeeping, maintenance, dietary you name it. There is something to learn from everyone. When anyone starts thinking they are elitists they are closing their minds to learning.
Probably not true at all, since the BoN that accredits a school of nursing specifies the same number of clinical hours for each. But it makes SUCH a great sound bite ...
Each state is different and not all specify hours, some are based on outcomes and suggest setting program clinical hours to be similar to other similar programs. Check each states BON requirements to see all the differences.
@hillaryinscrubs, I am a nursing student and I too dislike med-surg even though I am on my first rotation. I don't think I'll ever be happy working med-surg. I have always been interested in OR nursing, which is very specialized. I've met many nurses who love OR nursing and dislike med-surg nursing. I highly respect Med-surg nurses for having multi tasking skills, managing many pts at once.
@hillaryinscrubs, I am a nursing student and I too dislike med-surg even though I am on my first rotation. I don't think I'll ever be happy working med-surg. I have always been interested in OR nursing, which is very specialized. I've met many nurses who love OR nursing and dislike med-surg nursing. I highly respect Med-surg nurses for having multi tasking skills, managing many pts at once.
You're not alone! I dreaded going to just about all of my med-surg clinicals. I was stressed out during them 90% of the time and rarely found them interesting or enjoyable. Toward the end of nursing school, I felt more comfortable with them, but I definitely knew my heart wasn't in it at all. My practicum was the icing on the cake; I worked night shifts on a post-op ortho floor (plus a lot of pre-op and general med-surg patients). It wasn't a bad experience by any means, but I decided then that I needed to do some other kind of nursing.
I started looking at jobs about two and a half months before I graduated, which happened to be the perfect time to apply for residencies. My preceptor was not a supporter of new grads doing anything but med-surg, so it was hard telling her that I was looking for jobs elsewhere. I know I won't regret my decision, though. :)
You're not alone! I dreaded going to just about all of my med-surg clinicals. I was stressed out during them 90% of the time and rarely found them interesting or enjoyable. Toward the end of nursing school, I felt more comfortable with them, but I definitely knew my heart wasn't in it at all. My practicum was the icing on the cake; I worked night shifts on a post-op ortho floor (plus a lot of pre-op and general med-surg patients). It wasn't a bad experience by any means, but I decided then that I needed to do some other kind of nursing.
I started looking at jobs about two and a half months before I graduated, which happened to be the perfect time to apply for residencies. My preceptor was not a supporter of new grads doing anything but med-surg, so it was hard telling her that I was looking for jobs elsewhere. I know I won't regret my decision, though. :)
i loved pre-op and PACU when I volunteered at an orthopedic outpatient center. unfortunately, we don't have a senior preceptorship but we have a leadership class. i'm also in a state saturated w/ new grads, so if I have no choice I might need to go into med-surg, especially if I do not want to relocate.
Call me young and dumb, but my theory is this: If new grads are willing to really work and learn, let them choose their specialty right out of school, as long as they are properly trained in orientation before being made to fly solo. New grads shouldn't be looked down upon for being inexperienced and starting out in a specialty area; hospitals should just be held accountable for providing adequate training/orientation if they are going to hire them.
In theory this is OK. However, go to any nursing school and you'll find lots of students who think they will specialize in (ICU, ER, PACU, L&D...). If somehow they got the idea that anybody could specialize right out of the box, we'd have bazillions of complaints about "My grades were just as good as hers and she got to go to an ICU residency and I'm in LTC. Wah!" Or perhaps, "I always wanted to be an ICU nurse but the CI's pet is the only one that got the capstone in ICU so now I am ruined forever!" Or whatevs.
I guess the unhappy and clueless will always be with us. Perhaps this whole thread will be a cautionary tale about really working in school if you don't want to be disappointed at the end of it.
[COLOR=#000000]"hospitals should just be held accountable for providing adequate training/orientation if they are going to hire them. " [/COLOR]
[COLOR=#000000]I agree somewhat to the above statement , however new grads also need to be responsible and take ownership for their own learning, just like all of us who know when we entered healthcare it was a life long learning career.[/COLOR]
Call me young and dumb, but my theory is this: If new grads are willing to really work and learn, let them choose their specialty right out of school, as long as they are properly trained in orientation before being made to fly solo. New grads shouldn't be looked down upon for being inexperienced and starting out in a specialty area; hospitals should just be held accountable for providing adequate training/orientation if they are going to hire them.
I don't think anyone is looking down on new grads because they are inexperienced. The point that some people on this thread are making is that while hospitals should ideally provide adequate training/orientation when they hire new grads, training, while necessary and valuable, still does not take the place of experience. An experienced nurse will far more readily recognize abnormal assessment data, interpret the data correctly, and take the appropriate action in a timely manner. Already having nursing experience, for example in med-surg, is valuable when one changes to a specialty such as the ER, where the nurse's assessments are crucial, where the patient's diagnosis is yet to be determined, where the patients are often unstable or critically ill, and where the ability to perform care rapidly and to be able to change priorities rapidly matters. Knowledge of medication administration is important too; there is value in learning administration of many common medications, and related assessments, such as lab values, vital signs, etc., on a less fast paced unit. The OP gave two examples on this thread, if I recall correctly, of new nurses without experience in the ER incorrectly administering medications, with adverse consequences for the patients. I don't understand the aversion, where patients lives are concerned, to beginning on a less fast paced unit, learning the basics thoroughly, and then moving on to a faster paced specialty.
16mm
357 Posts
Consider me one of those new grads who will be going directly into a specialty as soon as I graduate. I know where I want to be (critical care) and I'm going straight for it. I'm lucky that I landed an internship in the CVICU in my last year of nursing school. The unit I'm on typically hires their interns if they are a good fit. With my desire for learning, drive, and ambition I have no doubt that I will make my goals reality.