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.
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.
You are absolutely right. This is a great point. I'd just hate to have to spend so much time there when I'd rather be some qhere else. I know lots of new grads who have gone on to work in the ICU straight out of school and have flourished.
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.
So some ICU is supposed to take you from zero to sixty straight out of school, get you functioning, then you say "hasta la vista, baby!" and trot off to CRNA school?
Aren't they cute when they're young? I think I knew from grade 5 that I wasn't going to morph into a taller person, size 4. Doesn't mean that I gave up trying! You have be very young to think that life is planned and everyone else will conform to your idealized self. That med-surg job won't look so bad after no paycheck months. And well, if she moves on quickly, that'll be the whole unit's good luck.
Once upon a time I had it all figured out. I'd graduate nursing school - top of the class, naturally - and be hired at the best hospital in the city. In the ICU. Or ER, I wasn't picky because both will look good on CRNA school applications. Few years in critical care, then off to the local school.
Yeah. I graduated, in the top 15% of my nursing class. Top 25% of all the students in my school's graduating class. Was lucky to have been hired in my first ER position, at a small regional ER. Almost everything was transferred, and what was admitted to the ICU would probably have not been at just about every other hospital out there. (Redacted) years later, and I'm now thinking about going back to school. For something other than CRNA; what, I don't know. Maybe informatics. My dreams have changed to things that are more personal - better management of my chronic pain so that I can start running again, one day a marathon, keeping a few guppies alive for longer than a month.
Just remember, plans change. Constantly. It's not good to be so focused on a single thing that any change causes problems.
Specializes in M/S, LTC, Corrections, PDN & drug rehab.
To BSN-RNTEXN,
I can't PM you & the thread is closed. I didn't take the thread to heart, that's what happens when you post identifying information on a public forum. Live & learn, make yourself as anonymous as possible. Many people have brought up identifying information in many different posts.
What exactly is a ‘general' nursing job? Aren't they all specialties?
I mean I've known med-surg nurses that would crash and burn if they ended up in the ICU, and I've known ICU nurses that would have a stroke if they had to manage the patient load of the LTC nurses.
I started my career with the state in a niche psychiatric RN position. I would consider it a "specialty" but then again I don't really think there is a "general" nursing job - they're all different and all have different patient acuity, prioritization and time management needs.
I've been a new grad starting a new position and an experienced nurse starting a new position. I've worked forensic institutions and hospitals, medical and psych. I've oriented new grads and experienced nurses and I've been oriented as both a new grad and an experienced nurse. Honestly, everyone comes as an individual. Each person – experienced or new grad, has their own struggles and proficiencies when they come to a new nursing job. Every preceptor is different as well – and they too have their own strengths and weaknesses.
My personal philosophy as a preceptor is: This new hire will be my colleague and I want them to be as proficient as possible because I will rely on them to be a functioning member of my team.
I actually don't mind orienting new graduates. When I work as a Forensic Psychiatric nurse I understand that the majority of my new nurses have very little psych experience, need to work on their assessment and time management skills and most have no experience in forensics. In some ways it's awesome – most of them don't have bad habits, some integrate easily into the unit culture and they tend to be rather flexible.
I generally explain to all of my new nurses that I want them to succeed at the state hospital. I also explain that it's a very different position from almost anything they've experienced at school and if they feel like they aren't making it or that the unit isn't a good fit for them – that there are many other positions at the hospital that would be a good fit and they would succeed in. I also tell them that even if psych doesn't end up working out for them – to never give up because nursing is a broad field and they will find a position where they are happy.
I give all of my new hires a personal tour of the hospital and introduce them to individuals I've identified as resource people†(knowledgeable nurses) that are happy to provide assistance and help them if they don't know how to do something. I explain the patient populations of the different floors, introduce them to all the managers, and try and explain tips and tricks to working with certain doctors. I also encourage them to float to different forensic units to see what each unit has to offer (I really, really want them to succeed at my facility – even if they find out a different floor is their passion).
I've worked with all types of new grads. I have the ones that come in, totally excited to be there, pen and paper in hand – taking notes, networking with their peers and studying the policies. I've also had the new grads that come and think they know everything already, get defensive when I offer advice and find any kind of constructive criticism to be meanâ€. Both types can succeed or fail depending on different factors.
I've also oriented experienced nurses coming to a new area of nursing and I've been that experienced nurse on orientation. There are some jobs that just ‘click' with us. It's always hard to be an experienced nurse in one area of nursing at a particular facility and then move to inexperienced in a whole new area of nursing or at a brand new facility. Sometime we pick it up fast and it just works. I've had nurses come to me from corrections and ICU that just got it†and did really well. I've also had nurses that came to me from Inpatient psych and Med-Surg that never got comfortable with the time managementand prioritization of care for 25 patients, having to work the floor as a CNA!â€, or the level of dangerousness that comes with this specialty. And I've totally been that experienced nurse from one facility, in one specialty that came to a totally new specialty at a whole new facility and felt like a fish out of water and left during orientation because I knew I would never feel comfortable, that my personal strengths were not in that area and that I would be very unhappy if I continued with that position.
All nurses are individuals. Sometimes experience in one area will help you learn faster in a different area –sometimes it doesn't. Some new grads do great in some areas of nursing…sometimes they don't. Different specialties have different acuities, time management needs and overall cultures. Sometimes being an experienced nurse in a whole new area of nursing can be even more difficult (because we have to completely change our whole way of thinking) than being a new nurse. This is just my opinion though.
Maybe instead of bursting their bubble you could help train them. Be a mentor. I am a second career nurse and graduated when the economy tanked. I can't even count the number of jobs I applied for. Even though I was in the top of my class, I got ONE call, for a SNF. So needless to say I didn't have the luxury of 2 years MED SURG. I then moved to CA and got really lucky getting a job in an a infusion Center with ZERO IV experience. I knew nothing, but I had great nurses that I could ask questions who didn't treat me like I was stupid. I love my job and am awesome at it and am getting chemo certified.
I began my nursing career as a nursing assistant, got certified as a CNA, LPN, RN, and So on. Learning the basics as a CNA helped with general patient care, and skin integrity checks, wound care, and so on. The LPN job I started with was in a Skilled nurse facility and I had a truly awesome shift manager, an old wwII nurse, she taught me EVERYTHING. We had in house o2 rail systems and basically acted as a step down unit for wound care, trachs, vents, wounds, tubes, so on and so forth, lots of IVs, ABT's, And so so on Before I EVER became an RN I was an old pro at IV's and a few specialties of that realm. I worked as an agency (facility) nurse in a teaching hospital as an LPN, in PACU, Neuro, Transplant, ER, Psych, Women's medicine, Ortho SCCU,and a few others. When they started preventing LPN's from doing this work I went back and got my RN, and BSN, and MSN....I have never worked in a hospital as RN, but I can tell you EVERY single NEW nurse needs to start low and aim high. Learn the steps, like algebra; a=b, and so on. otherwise one gets caught up in the idea of a "specialty" and excuse me but all nurses are specialty nurses, we work with the human race, and they are very special indeed.
As a nursing student I happen to agree with you 100%. I too want to eventually work the ER on a regular basis. But have to learn the ropes first. If the ER was the only job I can get, then I guess I'd take it though.
One of the community colleges now requires completion of a CNA course before being admitted to the LPN/RN program. At first, I did not see the logic. Now, I do. I feel equipped to do patient care now, in a way I know that I wouldn't have in another program.
I started directly from nursing school in a pediatric ICU. BIG MISTAKE. I think it was a mistake for a little bit of many reasons. I could have benefited from some fundamentals in a more med surg like pediatric unit. My school could have/should have provided more hands on experiences (I did not have an immersion). I had preceptors that were woefully unprepared to teach a new grad. And I really probably don't have the right personality for the ICU. I lasted 11 months in the picu and now I'm at 11 months in a level 2 nicu. I STILL feel I could benefit from some basic hands on skill training. So I don't think there's an easy answer. I don't think everyone should start in med surg across the board. I think people need to learn to properly assess their skill and comfort level, and schools need to do more to adequately prepare us for the 'real world'
I went through a year residency program in which I rotated through different units. Med/Surg and Onc. I felt prepared after nursing school, particularly considering I had learned in depth basic "aide" skills in a CNA course. But I really do believe there is so much in nursing that can't truly be taught. Such as prioritization, time management, how to handle yourself in an emergency situations. SIM labs and clinical help, but I don't feel you really know how to do any of that without true hands-on working practice. To me you have that sink or swim feeling when you first start and people either figure it out or they don't, but I do feel my residency program was the only true way to go in feeling prepared enough to set off into a specialty. (I work on onc now) am I all the way ready? No, I still have far more learning to go. I learn something new everyday, subtleties in pt condition that takes time and experience.
2k15NurseExtern4u, BSN, RN
369 Posts
You are absolutely right. This is a great point. I'd just hate to have to spend so much time there when I'd rather be some qhere else. I know lots of new grads who have gone on to work in the ICU straight out of school and have flourished.