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.
I think it depends on the orientation. New grads in specialties seem to do much better when they're placed in a new grad program, instead of your standard orientation. They usually learn the basics while learning their specialties, and their orientation is much longer than a nurse with experience.
Med/Surg experience can be helpful, but I don't think it's necessary. What I think most people really benefit from during a year of Med/Surg is how to interact with patients and family members without feeling like you're going to have a heart attack. But there's no reason you can't do that on a specialty unit too.
I have to respectfully disagree with the idea that nurses need one or two years of M/S before specializing. In fact, I think it can be detrimental to their career path, and I've always encouraged my students to seek a position in the area they're most interested in.
Consider basic disease processes in a variety of clinical settings (clinic, OB, M/S, ICU, ER). Diabetes, heart conditions, seizures, and hypertension, for example, are treated radically different depending on care setting and require nurses to respond differently. As an OB nurse, I paid close attention to patients with a BP of 138/95. As an ER nurse, I had patients with BPs of 180/110 that concerned me far less. I haven't ever worked M/S or ICU, but a M/S approach to managing HTN (observe, assess, medicate, report) wouldn't have helped me learn to titrate drips in an ICU setting. As an OB nurse, I may have prepped for an emergency c-section or started mag on a seizure patient depending on the situation. As an ER nurse, I simply protected airways and administered meds to seizing patients. A med surg nurse, depending on unit, may need to call a rapid response team to help with an actively seizing patient.
My point is that while each clinical setting is important and serves a purpose, they are also unique. A med surg nurse may not be able to function efficiently in the ER because of a different nursing approach, time management skills, triage 6th sense, etc. At the same time, if you put me on a med surg unit right now with a full patient load, I'd be a scrambling mess trying to recall information or some clinical skills I haven't needed since I was an undergrad nursing student.
Does the ability to make a pretty bed make any difference to one's competence in the ER? No, and, to be honest, I haven't made a bed with nursing school corners since nursing school. Many hospitals now use fitted sheets. I also think it's unfair to M/S nurses to imply they must be bed making experts because it makes them sound like their primary focus is on completing task oriented basic skills instead of professional nursing.
I'm glad to hear that your new graduates are coming in confident and not crippled by fear. That's what we should be promoting- confident but cautious. As experienced nurses, we should be looking after and encouraging our young, not looking for ways to belittle them or make them feel inadequate. No nurse, new or experienced, should act elitist or like a hot shot. We should be acting like kind, compassionate, competent professionals instead... so if you have new grads who are demonstrating attitudes you don't like, lead by example. Be a role model who helps them understand the value of ALL nurses. Most likely, they're just excited to have passed NCLEX and earned their dream job, and they may not realize how they are coming across.
Specializes in Allergy/ENT, Occ Health, LTC/Skilled.
I am going to be real here for a second and this only pertains to my geographical area, not sure if this is how it is other places: If you attend a for profit school, one of those get your RN in 18 months if your already an LPN or no pre reqs etc etc: they will pass you if you have the money to pay, whether you earned it or are ready for it. Granted, they cannot take the NCLEX for you but I have know my fair share of nurses who could pass NCLEX and not figure how to draw blood (I work mostly in clinical settings, we do labs ourselves), even after being showed multiple times. I went to a for profit LPN school, it was a terrible education, clinical skills included. People were graduating who got kicked out of clinicals for a bad attitude. I am not lying here. I visited many for profit LPN to RN bridge programs before I decided on a community college. Their clinicals were mostly done in a nursing home, where you would see 5 student nurses to one nurse, how the hell are you supposed to learn anything?! I was an STNA for two years prior to graduating, when I got on the floor at my first job, I was scared ********. All the sudden I was responsible for a hall of 25+ patients without much training. Thank the heavens above I had a nice DON willing to give me time to get my crap together. I made a med error that COULD have been very, very serious. I was lucky my patient was fine. But I had to drove to my DON that in one months time that I could come up with an organization system so that would never happen again. I still use that system and have never made another med error. Because she allowed me to correct that mistake, I learned how to make sure it never happened again. It's all the base for what I have built my nursing skills thus far from - efficient but safe, organized but able to prioritize as well.
I could have been done with my RN at a for profit in half the time it will take me to get it at the community college because I was only able to go part time the first two years at my community college due to class selection. But our clinicals are in a university hospital, we have several instructors, a preceptorship, and they tell you from day one that this isn't the easy program but you won't be wanting to vomit your first day on the job. Perhaps pee yourself a little but since we are being given the ground work, I am certain I will be fine as long as I keep my ears open to how I can improve and learn from those who have years more of experience than me. I will believe in myself but I also know I have hundreds upon hundreds of small and big nursing nuggets to learn lol.
You can most certainly pay your way through around my city if you know where to go. And that's very unsettling and gives grads who have started from the ground up (STNA to LPN to RN etc etc) like me, a bad name. I can do a full bed change on a 300 lb comatose patient in my sleep but that will only get me so far obviously, I will need my peers to guide me the way of being a successful inpatient nurse. I pray daily for a job that will not eat me alive when I graduate! And trust me, this LPN has been knocked down a few pegs before, I am nobody's special snowflake...but I do understand what previous posters are saying.
Having years of experience under my belt before I moved into ER nursing was helpful in many ways. I believe that it's easier to develop basic clinical skills, as well as learn to properly interact with patients in an environment that's not quite as fast paced as an ER. It seems as if I'm called on quite frequently by my coworkers when patient's arrive in the ER with wound vacs, feeding pumps, ostomies, etc., which these newer nurses are not accustomed to dealing with. It's also difficult to have an understanding of how the others units function within the hospital if you've never worked anywhere other than the ED. However, when I transitioned to ER nursing I had a difficult time because of the different mindset that I had developed over years of floor nursing. I watched as some of the new grad nurses fell right into the flow of the ER as I struggled to keep up. I do believe there is much to be said about a well-run residency program, such as the one at my facility. Nursing, and healthcare in general, is becoming so specialized that I have to ask myself if it isn't better to build and develop nurses in their chosen field rather than re-training nurses who are established in another specialty. Having been on both sides I can see the merit in both.
Sometimes it depends on the person too. If you really want to become a critical care nurse, please work hard on it and actually put effort into becoming one and not just pulling things out of your a**. Stay humble and be open minded. Learn from others.
grad school, undergrad, they're mostly the same. this link has a list of nursing schools rankings (non-grad school)
my point is that no community college or get-me-thru-your-nursing-program-as-fast-as-possible school is listed here, it's the big name schools that are going to provide you with the best experiences.
So you found a study with some schools one it, and you think this info means only those schools give the best experiences? I graduated from a community college, and I can tell you it was intense. I learned more in my ADN than I did in my original Bachelors degree, and far more than I learned in my RN to BSN degree.
You cannot reliably draw conclusions from one article. Case in point: "On a number of different levels, many community colleges outperform their four-year peers."
I have zero desire to work in ANY other unit other than ICU. Time is of the essence considering the fact that I would like to enroll and finish CRNA school by the age of 30. I have 7 years to get this accomplished. Most CRNA schools require at least 2 years of ICU experience. I dont have 2-4 years to waste in med-surg, an area of nursing that I know for a fact that I am NOT interested in.
I have zero desire to work in ANY other unit other than ICU. Time is of the essence considering the fact that I would like to enroll and finish CRNA school by the age of 30. I have 7 years to get this accomplished. Most CRNA schools require at least 2 years of ICU experience. I dont have 2-4 years to waste in med-surg, an area of nursing that I know for a fact that I am NOT interested in.
Med-surg is the foundation of ICU, however. One must have a clear understanding of the issues that are addressed in any med surg unit.
That said, I support new grad residency programs 100% . If any new grads reading this have the opportunity to do a new grad program, I hope you jump on it!
I agree. I did a critical care new grad program and it was fantastic. I wish every new nurse could benefit from one, no matter their field.
Specializes in M/S, LTC, Corrections, PDN & drug rehab.
I have zero desire to work in ANY other unit other than ICU. Time is of the essence considering the fact that I would like to enroll and finish CRNA school by the age of 30. I have 7 years to get this accomplished. Most CRNA schools require at least 2 years of ICU experience. I dont have 2-4 years to waste in med-surg, an area of nursing that I know for a fact that I am NOT interested in.
Considering some of your posts, I think it would be best if you start out in med surg. Plus it's not guaranteed you will be a CRNA by 30 even if you land a job in the ICU straight out of nursing school. Since you live in Houston that will be a feat.
I agree. I did a critical care new grad program and it was fantastic. I wish every new nurse could benefit from one, no matter their field.
Im actually looking to apply for one at one of the hospitals Im interested in. They offer a year long residency and im really looking forward to it! Id be so intimidated and afraid to make the drastic jump from student nurse to floor nurse without some type of transition.
nursemcsleepy, BSN, RN
52 Posts
I think it depends on the orientation. New grads in specialties seem to do much better when they're placed in a new grad program, instead of your standard orientation. They usually learn the basics while learning their specialties, and their orientation is much longer than a nurse with experience.
Med/Surg experience can be helpful, but I don't think it's necessary. What I think most people really benefit from during a year of Med/Surg is how to interact with patients and family members without feeling like you're going to have a heart attack. But there's no reason you can't do that on a specialty unit too.