new RN's in specialty areas

[sunny261]

I have been noticing many posts of new nurses being overhelmed. Many seem to be entering specialty areas soon after finishing their RN programs. Does anyone else see that perhaps a trend here that going right into the toughest areas before getting comfortable in assesment skills or even just time management is not the wisest choice? I was an LPN for 10 yrs before I got my RN and I was offered a job right out of school in my hospital's SCU. I turned it down ...I felt that I needed to feel more comfortable in getting my skills down before I entered one of the most high stressed areas in the hospital. I worked on the Med-Surg floor and although it wasn't glamorous it made me a better SCU nurse... I learned charge duties and how to call miserable docs in the middle of the night and all sorts of valuable education that I might have felt overwhelmed in a high stress area while learning these other invaluable lessons......

[loriann, BSN, RN]

After the week I have had with a family member in ER, tele, then med-surg---I can easily say that the only good experience was in tele.

ER had experienced nurses....weren't vigilant....no urgency, even though critical situation.....didn't even know I was an ER nurse, and still acted that way. Only started reacting afterwards. A newbie would have been at the bedside concerned and attentive. Admitting dx: Aspiration of vomitus, possible cva, rapid afib and renal failure. Definately thought he was a goner.

Telemetry nurses were excellent, one just a new grad, the other new to the facility. Both had great assessment skills, and were on top of every problem, and had a plan. Re-evaluation, assessment, and care was on target. Looked great-sitting up, talking, thickened liquid diet-good to go.

Med/Surg a mix of experienced nurses and new grads-HORRIBLE EXPERIENCE! Father in law now has sbo, lots of problems, poor assessments, no bms charted, aspirated several occasions, sick, pain, misery for him, in restraints-pulled ng tubes all kinds of problems that could've been avoided with continued assessment. ESPECIALLY SINCE AWARE OF ABDOMINAL HX.

I don't know what the training is for med surg nurses---I do know that in my facility it's about half the training we get. My feeling is that a patient can become an emergency in a matter of seconds. You need to know what's going on at all times. When I walked into his room on day one of med surg time-in one minute I knew we were in serious trouble.

I think any nurse can be overwhelmed. I was when I started, and am daily. Patients are much sicker and really require alot of work. While some may say the ER isn't a learning ground, I'd say for the right person it is-no matter where they come from.

If it's your interest, go for it! If it's not a good fit, try on something else.

Maisy

I agree that Tele is an excellent place to start!!! I am on a telemetry unit and find that we get a mix of patients, both critical care and med/surg types. We obviously need to know our cardiac drugs, rhythms, etc., but we often end up taking boarders if we have open beds. We also get tons of post-procedure patients (PTCAs, EP, etc) and sometimes post-surgical. I would honestly move on to the CCU if it weren't for having to take a night position and the fact that I think my time management skills are really good having to juggle assessments, procedures, tele monitoring, plans, etc.

Good Luck!!

[futurecnm]

I seriously doubt "there are many experienced nurses who do unsafe things DAILY"!! If that's the way it is, it's the blind leading the blind when it comes to orienting/training new grads & I really hope I never get sick!!!!

I did not mean the SAME nurse doing unsafe things daily.

[tatarn2b2007]

I think it is tough for a new grad in ANY area and I also believe it depends on the staff working with the new grad. I started a specialty area after only 6 months of floor work and every single person on my unit has taught me something because they WANT to!!! I can't emphasize that enough. Where I came from, nurses were hostile and didn't care if you learned anything. They wanted someone with a pulse to fill the vacancy and didn't care if you sank with the stress. I have learned more in 3 months on my specialty unit than I did in the 6 months I was on the floor and it is all because of the great nurses and even doctors who care to teach. Good luck to all you new grads no matter where you choose to start!

[SillyStudent, ASN, RN]

I'm not bitter just concerned for the new fresh RN's who get into a high stress enviroment and then take a couple of months of crap from other nurses, docs or facilities and then quit the whole profession. Are we doing any one of these nurses any good?

And that's the big problem. Will new nurses feel completely overwhelmed, take a year of crap from their co-workers and go into a different field?

I am a new nurse. I took a SICU job. It is the hardest, and the most rewarding thing I have ever done. I feel like I have a lot to learn, but my fellow nurses are wonderful and take every opportunity to teach me something new. My assessment skills have grown 100% in 4 months...maybe 200%. I have to thank my co-workers for that. They coach me and take me into patient rooms to listen, look at, or feel things they want me to be able to identify.

I have many friends who took jobs on med/surg floors. They have 6-8 patients at a time and feel like they are drowning for 36 hours a week. I have a friend who called me the other day and said she is considering quitting her med/surg job. The nurses are mean to her, and frustrated when she does not immediately understand something. She can barely get her meds passed. Nobody helps. She is terrified she will miss something critical and a patient will become very ill without her noticing it.

Where I work, if the poop hits the fan...my coworkers rush to my aid. And, I rush to help them as well. I am sure that I would benefit from some med/surg experience. However, I do not ever intend to work on a med/surg floor. I would not trade my co-workers in ICU for a year drowning on a med/surg floor.

The bottom line is....I do not believe the grads are the problem. I think that nursing has long had a problem with bad or non existent mentors. The expression that 'nurses eat their young' has a basis in fact. Maybe we should concentrate more on finding/training and COMPENSATING mentors for new nurses...than on telling a new grad that a year of med surg is the only way to go.

[GadgetRN71, ASN, RN]

In my specialty(OR) often the new grads do better than the nurses coming from the floor. This is because they are a "clean slate" and don't have preconceived notions and bad habits. Med/surg is really not going to help you all that much in the OR. I went right to my specialty and I know my lab values, how to do assesments, etc. I really think we shouldn't generalize when it comes to this topic because everyone is different, with different strengths, weaknesses, and experience.

I see just as many posts here dealing with new med/surg nurses that are burning out already, due to the chronic understaffing and and politics that the floors often have. My grad nurse class had several people go to the ICU, ER, OR etc and the 2 people that ended up switching out were grads that went to med/surg. I think the argument can be made that the specialties often have a longer orientation period(mine was 6 to 9 months-and I had some OR experience!) whereas med/surg orientation at this hospital was 12 weeks.

I think some people, but not all, benefit from "doing their time" in med/surg.But, many people flourish in their specialty, even as new grads. Just my 2 cents..

[GadgetRN71, ASN, RN]

If you read my post, you will see that I never said ALL new grads, so you don't need to be defensive. What I object to is management expecting staff to train these people - I also had to go thru an intensive 3-6 mo program, which included classroom time, to work my specialty area- and that was after many years in other areas. I have worked 2 specialty areas & both times it was required to go thru their programs, obtain proper certifications, etc. despite the fact that I was already an experienced RN. I had a preceptor who did not take an assignment, which is preferable to a staff nurse taking a full load of patients & teaching a new person who has never done it b/f. Ideally you probably should have to work a pediatrics floor to first, and a year as a student is not the same as an RN- sorry, but there is much more liability as a licensed professional. I have worked hospitals in several states in my career, from large teaching facilities to small rural hospitals, and as I said, this seems to be a new trend that is happening due to management's desperation to fill vacancies. It may not be the same everywhere, but it has been true in the last 2 places I've worked- both large metropolitan areas in 2 different states. You're still a student, and if you're not too proud to ask questions that is to your benefit- it is much more preferable to over-confidence. NEVER be afraid to ask questions- nobody has all the answers, I don't care how much experience they have. Good luck to you.

IMHO, there is nothing wrong with expecting staff to teach-it's the concept of "paying it foward". I had some very experienced, competent nurses take me under their wings and I want to be able to do the same for someone new some day. If this concept were stressed more, we might not see so many "young" being eaten.

[jjjoy, LPN]

I agree with the comments that in many settings med/surg isn't any less stressful than a specialty area. The patients often aren't all that stable, they may have a much wider variety of conditions/meds/treatments for the nurses to know, and the nurses are being pulled in several different directions with several patients (& family members, and other hospital personnel) all needing attention at the same time.

[Wsmith16, ADN, BSN]

And that's the big problem. Will new nurses feel completely overwhelmed, take a year of crap from their co-workers and go into a different field?

I am a new nurse. I took a SICU job. It is the hardest, and the most rewarding thing I have ever done. I feel like I have a lot to learn, but my fellow nurses are wonderful and take every opportunity to teach me something new. My assessment skills have grown 100% in 4 months...maybe 200%. I have to thank my co-workers for that. They coach me and take me into patient rooms to listen, look at, or feel things they want me to be able to identify.

I have many friends who took jobs on med/surg floors. They have 6-8 patients at a time and feel like they are drowning for 36 hours a week. I have a friend who called me the other day and said she is considering quitting her med/surg job. The nurses are mean to her, and frustrated when she does not immediately understand something. She can barely get her meds passed. Nobody helps. She is terrified she will miss something critical and a patient will become very ill without her noticing it.

Where I work, if the poop hits the fan...my coworkers rush to my aid. And, I rush to help them as well. I am sure that I would benefit from some med/surg experience. However, I do not ever intend to work on a med/surg floor. I would not trade my co-workers in ICU for a year drowning on a med/surg floor.

The bottom line is....I do not believe the grads are the problem. I think that nursing has long had a problem with bad or non existent mentors. The expression that 'nurses eat their young' has a basis in fact. Maybe we should concentrate more on finding/training and COMPENSATING mentors for new nurses...than on telling a new grad that a year of med surg is the only way to go.

Enuff said!!! :yeah:

[allthingsbright]

I just graduated-have many friends from my class that went the med/surg route as new grads and many, myself included, that went specialty.

We are ALL overwhelmed--and guess what? The M/S people I know seem most overwhelmed due to patient ratios on those types of floors. One of my friends was 1week off orientation when she was slammed w/ 8 total care patients and no tech. Not an unusual story, as I am hearing.

IMHO, nursing is overwhelming, especially in the beginning, regardless of where you begin. I actually feel a little guilty as my days seem somewhat light compared to what my med/surg pals are doing.

Good question!

[Ann RN]

Do you have any idea what you are REALLY getting into? A year as a nurse apprentice is not the same as a year as a graduate nurse on a general peds floor. And I hate to tell you, but you WILL be working with adults - parents. They can be harder to deal with than adult patients. Orienting new grads has absolutely burned out the majority of the seasoned nurses where I work. It is extremely hard to do. You will not have the assessment skills you need to pick up subtle changes when your preceptorship is done, & IMHO that is not safe - for both children & adults. I believe a patient deserves the safest & highest quality care possible. And I'm sorry, but that is just not from a new grad in a specialty area.

[anononurse]

Do you have any idea what you are REALLY getting into? A year as a nurse apprentice is not the same as a year as a graduate nurse on a general peds floor. And I hate to tell you, but you WILL be working with adults - parents. They can be harder to deal with than adult patients. Orienting new grads has absolutely burned out the majority of the seasoned nurses where I work. It is extremely hard to do. You will not have the assessment skills you need to pick up subtle changes when your preceptorship is done, & IMHO that is not safe - for both children & adults. I believe a patient deserves the safest & highest quality care possible. And I'm sorry, but that is just not from a new grad in a specialty area.

AMEN & THANK YOU! You said it well. It is not a matter of not giving inexperienced nurses a chance, or of nurses "eating their young" it is a matter of what's best for the PATIENT. You need to be proficient in caring for general med/surg patients to develop those assessment skills, as well as time management & the ability to multi task; and it does not happen overnight. Management used to say that a good solid year or 2 on Med-Surg "separated the men from the boys" -- now it's 'fill any position w/a warm body'. We all cringe when we hear that we'll be training yet another inexperienced nurse & you're right, it is burning out the seasoned RNs bigtime.

[anononurse]

I agree with the comments that in many settings med/surg isn't any less stressful than a specialty area. The patients often aren't all that stable, they may have a much wider variety of conditions/meds/treatments for the nurses to know, and the nurses are being pulled in several different directions with several patients (& family members, and other hospital personnel) all needing attention at the same time.

All the more reason to hone your skills on a general med/surg floor b/f moving on.