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New RN, how to pick a specialty?

Hi everyone!

A little about myself... I have been an LPN working in an urgent care for two years now and am 60 DAYS from graduating from my RN program!

I have always envisioned myself working with trauma/critical care of some sort. At an urgent care you don't experience much of that (LOL)

I am thinking about doing a nurse residency program in either the ICU or the ER. (I am also very interested in cardiac)

My question is...

Do you recommend having 1 year of med/surg experience or diving straight into the department you like?

I am just aiming to be the best RN I can be. As this has been a long time goal and I'm so passionate about my career field.

Thanks for reading! ♡

- Nicole, LPN (soon RN 🙂 )

SilverBells, BSN

Specializes in Rehab/Nurse Manager.

In my opinion, this questions doesn't have an easy answer since it is based very much on the individual as well as the departments. How was your performance in clinicals? Were you shining in lower acuity departments or did you need a lot of assistance? Do you have emergency experience in other capacities such as working EMR/EMT? Also have you shadowed or interviewed any of the departments you are looking at? What is their plan for orientation such as length of orientation, number of preceptors, how fast they would expect you to progress? What is their success rate of new grads who enter these departments? I'm sure there are more variables to consider but these are just some thoughts. Some new grads do very well in higher acuity areas, but the support of colleagues must be there. That can only be known by observing and/or interviewing people who already work there. They would also likely expect that you learn at a relatively fast pace, so ask yourself how well you acquired new skills and knowledge in nursing school. Also keep in mind that you have worked in urgent care for a couple of years so jumping into a higher acuity, fast paced area may be a bit of a shock.

Anyway, I don't have the answer for you, but wish you well as you decide what to do. And congratulations on your RN degree! 🙂

You want the job that provides the best foundation for your career. If you have the opportunity to chose, pick the one with the best culture, staff and support.

My standard answer to this often asked question is: Apply for everything and see who calls back.

You need actual job offers before there's any decision to make.

Trauma ICU can be very difficult and stressful. What makes you interested in it? Do you have any idea what it entails?

I've been a trauma ICU RN for over 7 years. I love it but it has a huge learning curve and is very mentally draining with all the tragedy. Do you live in a major metro area? Are there any level one trauma centers near you?

7 minutes ago, LovingLife123 said:

Trauma ICU can be very difficult and stressful. What makes you interested in it? Do you have any idea what it entails?

I've been a trauma ICU RN for over 7 years. I love it but it has a huge learning curve and is very mentally draining with all the tragedy. Do you live in a major metro area? Are there any level one trauma centers near you?

Hi LovingLife123,

First, thank you for giving your input - it's exactly what I am looking for. Unfortunately, due to Covid-19 my clinicals have not been able to take place as normal. I have signed up to have my preceptorship in the ICU to see what it's all about. So, no I wouldn't say I know what it exactly entails. The reason I feel that I am interested in trauma/critical care/ICU is because I want to be able to perform life saving measures, and make an impact on those who are the most in need. I guess this can be naive to say since I have not had any experience in a department like this. (Please give me some insite if you have time and willing!)

I do live in the Tampa, FL area and Tampa General Hospital is a Level I. Although, the other hospitals I plan to apply to are Level II.

I guess my biggest question here, is how the heck do you make the decision of which department you want to work in?! I am interested in so much.

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development.

20 hours ago, Sour Lemon said:

My standard answer to this often asked question is: Apply for everything and see who calls back.

You need actual job offers before there's any decision to make.

This. Critical care/trauma is one of those popular specialties that some falsely believe gives them more clout as a nurse. As such, it is super competitive to get in and openings can be few and far between. Same with ER, OR, NICU, L&D, Mother/baby and pediatrics.

Apply for anything and everything. Any interviews you get, as far as you are concerned you are fighting to get your dream job. You can make decisions once you have offers to decide from. Prior to that, you are simply limiting yourself by limiting what you apply for. Given how hard it many times is to get your first nursing job, you can't afford to be picky.

LibraNurse27, BSN, RN

Specializes in Community Health, Med/Surg, ICU Stepdown.

I don't want to crush your dreams but want to provide a realistic perspective on critical care (only my opinion of course!). Sometimes you experience miraculously saving a life, hugging a relieved family, seeing a patient go from on the edge of death to walking out of the hospital thanking you. Other times, you prolong the lives of patients with no quality of life, get verbally/physically abused, see the same patients come in and out due to addictions they can't shake, and watch patients you have grown to love die.

I am in no way saying don't try it, some people love it! But it's not like in the movies and you won't always feel like a hero. Maybe I am jaded and frustrated, but the longer I work in critical care the more I think preventative medical and mental healthcare is just as heroic if not more so, even if not as "glamorous". So many of the situations I see could have been prevented. Anyway, everyone finds their specialty and the best way to do that is try different things. Luckily there is opportunity in nursing to do that once you have some foundational experience.

It is nice to hear someone so excited about nursing! Maybe if I worked with you you could renew my enthusiasm, LOL. I really wish you the best finding your first job and figuring out which specialty is for you. Keep that enthusiasm and motivation; it's contagious!

Many hospitals now have nurse residency programs(2-3year contract) they train you for certain specialities.

I do agree with one of the previous responses, apply for all/any position and get in first. I know many nurses who jas tried to get in the hospitals and can't. That being said interview and be interested in "all specialties" I did Med/Surg/Tele/Onc. I loved it! I always wanted to be an ER nurse but I love where I'm at now.

Best wishes

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

What matters most is the support you'll get from your manager, your peers and your preceptor. The type of patient doesn't really matter as much. Really.

As you learn and grow as a nurse, you'll discover things you like about your job and things you don't like. You may have your heart set on L&D, but find that ortho is your special place. You may be the only nurse in the ICU who is willing to take on that GI bleeder, or that AML patient who tranferred from hematology/oncology. You may be the only ER nurse who really hates getting children as patients.

Pick a job where the manager, peers and preceptor are supportive and nurturing. Learn all you can, and you'll be in a much better position to know what you like and dislike about nursing when you pick your second job in a couple of years.

canoehead, BSN, RN

Specializes in ER.

I started in pediatrics, and did OB, MS, ICU, ER, and night supervisor. I ended up in the ER for the last 12 years because I found a great unit and there's more variety.

I have to say that the base of my practice was pediatrics, and it served me well. I got really comfortable with assessing the scariest patients, so not much scares me any more. If you did decide to start with peds, go to a well known pediatric hospital to learn, not just a unit in a general hospital. Better to get your information from the horses mouth, and see how the best in your area do things.

HiddencatBSN, BSN

Specializes in Peds ED.

On 6/7/2020 at 1:59 AM, nikki1018 said:

Do you recommend having 1 year of med/surg experience or diving straight into the department you like?

Start in the specialty you’re interested in if it’s an opportunity you have. Med surg is its own specialty and while you will learn a ton starting there, you’ll learn a ton wherever you start. If you start in med surg you will need to transfer and then learn the new specialty.

If you want to start in med surg, or if that’s where you’re able to get a job, that’s fine too, but it’s not essential.

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