New Grads - The World is Your Pearl!

[RNegade]

So long as you can crack open the shell enclosing it! We have all heard what an exciting time this is for nursing. Our profession is advancing in so many ways, we are told - in importance, in scope of practice, in *prestige - but old habits die hard, especially when it comes to how veteran nurses view newly graduated nurses.*

I, a new grad RN, recently applied to an open position in a Labor & Delivery Unit. I e-mailed the hiring manager in order to introduce myself and to tell her about my clinical experiences and extensive research projects in women's health, basically explaining why I would be a perfect candidate for the open position. And what response did I get? " Thank you for your interest, but I am looking for nurses with lots of Med Surge experience," she wrote back.*

You see, like that newly graduated nurse on the TV show 'Nurse Jackie' - what is her name?- *we are often *seen as fumbling, potentially dangerous, disasters -waiting-to-happen. Basically, our lack of practical experience seems to make us a liability to the experienced nurses around us. But, what really does a Med/Surge nurse have that I don't? S/he certainly will have no special knowledge about women's issues or preparation in caring for a labor g woman that I won't have, but s/he will have lots of technical experience, pulling and pushing catheters, poking and prodding with needles.

So, is that what the value of a nurse really boils down to? Are we measured not by our passion and potential for sustainable success, but rather on our technical experience (preferably performed over ''1-2 years in an acute care setting") That is not only pitiful, but perplexing practice in a profession trying to fashion itself as a change agent in the new healthcare system. Can nurses really be the innovative dark horses of healthcare, as they are purported to be, when their view of their new grads (their future) is so decidedly old-fashioned?

So, give me a break nurse leaders; before we go changing the world of healthcare, let's take a good, long look in the mirror and first change how we think about ourselves. A profession that cannot mentor and inspire its young can be nothing other than stagnant and mediocre. So, as far as I a can see, there is no real pearl to be had here - at least, not until we bring some real change in the we look at all nurses, experienced and new-grads alike.*

[katyb213]

I very much agree with you. I think managers should be able to be open to real interest and love for that certain area of nursing. I know many new RNs who go into medsurg because they feel like they have to. I did not do that because I tried so hard to get into psych which I really enjoy. Luckily, the nurse manager on the unit said I got the job basically because of my cover letter. So do not give up! Someone will see your passion and believe in you! Good luck to you. :)

[RNegade]

Congrats, Katy. It is inspiring to hear your story. I think nursing would be much better off as a profession if we just let each nurse pursue his or her passion. Kudos to your for being determined to follow your dreams.

[Mudwoman]

I've been working med/surg for 4 years now. I have been a nurse for 17 years. This subject of med/surg experience comes up often and here is my theory on the issue. Because med/surg exposes a nurse to a wide range of patient ages, diseases, medications, and complications, the one thing it develops is your critical thinking skills. When I started on this floor 4 years ago, I had been nursing for 13 years, and I would have argued with anyone that I had excellent critical thinking skills. My skills were decent, but they weren't even close to what they are today. Med/surg exposes you to a wide variety of physicians----from family practice to specialists in internal medicine, psych, neurology, urology, gastrointerology to surgeons. You get patients with multiple disease processes going on at the same time and you learn a ton about medications and med interactions. I don't doubt that you have learned a great deal about women's issues and labor/delivery, but imagine how much more you would know if you had lots of experience with patients with cardiac problems, diabetes, and cancer and bowel problems-----all of which you could have with new mommies and babies. Finally, med/surg is often-----almost always the work horse/short staffed/sweat factory of the hospital. You learn how to get your work done fast and get it done right. The time management skills you will learn on a med/surg floor could be invaluable to you on those days that too many moms decide to have babies and it is crazy. Chaos is a regular event on a med/surg floor, but may only happen once a month on a labor floor. However, if you have that experience and it is part of your natural work ability now, you can function without getting stressed.

So, this manager is not just looking for someone with great education in women's issues, she/he is looking for someone that knows a lot about ALL diseases and issues that these women may have and knows how to work hard and fast and never sweat------someone that can juggle well and punt.

[hiddencatRN, BSN, RN]

But, what really does a Med/Surge nurse have that I don't?

Experience.

You don't know what you don't know. I don't think it's a requirement to work med-surg, but you need a unit that is equipped to train and handle new grads. Because there is so, so much to learn that you do not learn in nursing school.

[elkpark]

Because med/surg exposes a nurse to a wide range of patient ages, diseases, medications, and complications, the one thing it develops is your critical thinking skills.

And don't forget time management and prioritization skills! (As you suggest in your last sentence.)

Seriously, I'm not trying to be nasty, but it's very hard to believe (and I wouldn't have if I hadn't seen it with my own eyes) that a new graduate would even ask the question what does an experienced med-surg nurse have that a new grad doesn't (even in reference to a particular specialty area). As hiddencat noted, "you don't know what you don't know" ...

[Lunah, MSN, RN]

But, what really does a Med/Surge nurse have that I don't? S/he certainly will have no special knowledge about women's issues or preparation in caring for a labor g woman that I won't have, but s/he will have lots of technical experience, pulling and pushing catheters, poking and prodding with needles.

If this the sum total of what you think a med/surg nurse does, I think you need to spend some time in med/surg .... they can time-manage and critically-think circles around many other areas of nursing by virtue of daily/shift-ly necessity. I have never worked in med/surg, only the ED, but I have the utmost respect for my med/surg peeps. They rock. And for all we know, that experienced med/surg nurse that unit will hire might be a new-ish RN who is just as passionate about L&D, but was spending time in med/surg first to develop some solid nursing experience and skills.

Best of luck to you in finding your dream job!

[RNegade]

Thank you all for your responses. I completely agree that an experienced Med/Surg nurse brings valuable experience to the job - there is no question about that. What I am arguing against, however, is the pervasive mentality that Med/Surg needs to be a starting point for every nurse. There are 2 reasons why I think this should not be the case. 1.) Med/Surg is a speciality in itself, which requires special time-management and critical thinking skills (as each of you has noted); therefore, it should not be thought of as a training ground for building 'solid nursing skills' 2.) Med/Surg experience is not necessary for success in other fields of nursing.

I imagine point #2 will be a source of contention and controversy to some, but there are examples abound that support my belief. So here is a quick summation of my arguement: Will Med/Surg experience help a nurse starting in L&D? Absolutely! Is Med/Surg experience absolutely necessary for a nurse starting in L&D? Absolutely, not! What I believe is necessary, however, is knowledge and passion about the field one chooses--remember folks, 'Critical Thinking' isn't some nosocomial infection you can only contract in the hospital-- critical thinking skills are acquired through a variety of experiences, both clinical and non-clinical. It is the combination of these critical thinking skills, knowledge and passion that should be a hiring manager's primary concern when hiring a new nurse. And in this, there is no guarantee that an experienced Med/Surg nurse brings more to the table than a new-grad.

[hiddencatRN, BSN, RN]

Being a new grad on a specialty unit is challenging but possible IF the unit it equipped to deal with new nurses. It's certainly not, in fact, a universal belief that new grads require two years in Med surg because new grads are hired in to specialties all the time. This particular nurse manager is looking for applicants with experience only- maybe because they lack budget and staffing to train new grads, maybe because they've been unsuccessful training new grads, maybe because this is an employer's market and they have more experienced applicants than they know what to do with. And yes, maybe the nurse manager is one of those who believes that all nurses need to pay their dues in Med surg.

What you're arguing, however is not exactly groundbreaking or new. Many folks on allnurses can talk about their first job in a specialty, many of my classmates including myself got jobs in specialty areas and many nurse managers are willing to give new grads a chance on their units. Nursing doesn't need to "get with the times" on this issue- you need to realize that the economy has taken a major toll on the new grad job market. Nd you really, really came off as dismissive and hubristic in your OP.

Good luck in your job hunt.

[ILOVEnrsg2]

I am a new graduate, had one interview last week on a med-surg floor, and have one next week on a med-surg floor in a different hospital. I graduated this past May, passed the NCLEX in June.

I had a Nursing Externship last summer at a top hospital on a very specialized floor: Adult Bone Marrow Transplant/Leukemia & Lymphoma for 10 weeks, working a total of 360 working hours. I loved it, I know I want to do oncology when I grow up. Each person had a private room, with a computer for nursing charting in each room, and nurses never had more than 3 patients at a time. Basically, it was a dream!!

What I noticed is a lot of the nurses on this floor were new grads, older nurses that worked there for a long time, and I noticed a lot of basic skills were lost. Since peripheral IVs were basically very rare (most patients had central lines), that was always a struggle to find that one nurse that was good at it. Other skills, such as trach care and foley care was also very rare, but when there was that, it was apparent a lot of the nurses were not comfortable doing it (and usually asking for help). Not saying they were totally clueless, but I could sense lack in confidence in these tasks.

While I had a great experience, I decided I want to look for a medical-surgical job. I was hinted that I had a job waiting for me the next year when I graduated (around now) but I decided to pass. I really wanted to develop more critical thinking skills, time management (3 patients max is certainly a dream, but not on most floors), and most importantly, clinical skills. Even my preceptor in my externship suggested that. She was in her upper 50s, and she said it really helped her when whe was younger to get that experience. This was my personal decision, and I'm happy at the aspect of working on a med-surg floor.

OP, I totally understand your thoughts, it can be frustrating at times. It depends on the nurse managers, the new grads themselves, and if they fall into a mutual fit to want each other. While I know I want to go into oncology nursing when I'm older, I know that the skills I gain as a med-surg nurse will be invaluable to me later. But that's me.

[Work in Progress]

I am officially not a new grad anymore as of 2 days ago, but I had a similar experience to yours. I spoke with the L&D nurse manager right after I passed my NCLEX and she stated that she couldn't accommodate a new grad at that time and that I sounded like a great addition to the floor, and to reapply in 6 months to a year after I had some other experience.

I worked on a med/surg/tele floor. I resented it. I dreamed of L&D every day. But I learned what I needed to learn and did my best for my patients.

Recently I transferred to that same L&D that I applied to a year ago, and looking back I am extremely grateful for my time on med/surg. The other new person on the unit is a New Grad and is struggling a lot with basic skills, critical thinking and time management. She will get there. She has the support and she is an intelligent person. But I have it a lot easier.

I never believed the mandatory med/surg mentality. I still don't believe that is the only way, but having lived through it, I am happy for my experience. I am already the go to person when someone has an odd medical problem, etc as most of the nurses DID start as new grads on mom/baby or L&D.

I am sorry you are having a hard time getting into the area you have a passion for. But because of that passion, you will get there eventually! Just get the most from whatever job you do end up landing in.