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......

[HM2VikingRN, RN]

I think the whole process of nursing school admissions has raised the overall cognitive level for nursing students. When I graduated from HS in 1978 if people wanted to become nurses it was pretty much an open door for entry into nursing school. Now with admission criteria so high it is almost easier to enter medical school than become a nurse. At orientation for my accelerated RN class the prerequisite gpa for NS was 3.6. My adviser (with a PhD) commented that she would not be admitted to nursing school today as an undergrad with that gpa screen.

Look at the number of posters here on the site who are on 2 and even 3 year waiting lists to enter nurses training. I think the nursing school admissions process has literally selected for a group of graduates who have the cognitive skills and desire to enter specific nursing specialties. (Adding in BSN, direct entry MSN and accelerated BSN programs serving second career adults it acclerates this trend even more.) Thinking and training plans for new grads need to reflect this new reality.

[loriann, BSN, RN]

When nurses say "I did my time in M/S and so should you," the picture I conjure is one of a prison where a person is expected to x, y, and z before he/she can move on.

Seriously, I didn't start in M/S, never want to go there and never will. I don't think I'm a horrible nurse for not going and as long as a person continues to learn, ask questions, apply himself, I see no reason why a new grad can't be successful in a specialty area. Learning is something a person needs to continue to do throughout life, new or seasoned nurse.

If you want to go into a specialty area, jump in, embrace it, read up in your spare time, and ask questions.

[RNperdiem, RN]

Things were simpler once.

Hospitals simply didn't hire new grads for speciality areas.

The least popular shift on the med-surg floors were where you began since they were the only ones hiring.

[wooh, BSN, RN]

I think of it this way, I don't believe a patient on a med/surg floor deserves a nurse who is merely putting in his/her time, with a view of leaving in a year to do what they really want to do.

Not to mention, it gets old orienting new nurses over and over again on med/surg floors that are just doing their time until they can go where they really want to. Kind of like ICU nurses that don't want to orient nurses that are just doing their time on the way to CRNA school.

[futurecnm]

I have a question, why is med/surg not a specialty?? It has it's own set of skills and requirements. It sometimes seems to me as a harder area due to the vast differences in patients and acuities. Why is med/surg considered the place where nurses should start? Things can go wrong just as fast on a med/surg floor for a new nurse. Bad things can happen for a new RN on a med/surg floor also. I am not a RN yet, so maybe someone can give me insight as to why it would not be it's own specialty. It seems many are bitter about new RN's entering hospitals. This is why there is the phrase of nurses "eating their young". It is sad really. Why can't we all just work together to provide patient care. This involved a lot of learning, working together, and educating new nurses. I do not think that someone should be required to train a new nurse if they have hard feelings about a new grad entering their unit. Where I am going, only people who volunteer to mentor have to train in new employees. I specifically asked this, as I did not want to be put with someone who did not want to train. We can't change that new nurses WILL be entering every field of nursing. Due to the RN shortage, hospitals have to hire new RN's for every area, don't they? I'm sure they would LOVE to have people with experience for every new opening but just isn't happening. So, to make the best of it, why can't we all just work together rather than a "us vs them" type of atmosphere. We new RN's are not out to make your life miserable. We want to learn. We want to be the best we can be. We do not want to harm the pt or make mistakes. We want to do our job the best we can. Creating an atmosphere of acceptance would benefit everyone. Yes, we don't have as much experience but that doesn't mean we don't have potential to be good RN's and aren't able to learn what we need to know to do a good job.

[grantyRN06]

I agree working on a meg surg unit will enhance assessment skills since there aren't monitors to tell you what is wrong. A year or two would be great before going to a unit. AND HEY MED SURG IS A SPECIALTY TOO!!!

[GadgetRN71, ASN, RN]

We do not "trudge along". We are still learning, even after 30 years. We have to - things change. So please do not make the argument that we fall into a pattern. We take responsibility for our own education. And we do well. In no way do I believe that a new nurse getting experience on a med-surg floor is merely "putting in time". I applaud him/her for having the forethought to hone their time management & assessment skills while getting exposure to various treatments & procedures.

I realize that many experienced nurses, like yourself, do not just trudge along. But, there are many who do. These are usually the types who discourage others from becoming nurses,have no interest in learning new things, trying new ideas, or furthering their education.I believe we have to take responsibility for our careers. For me, this included realizing that med/surg was not going to be of any use to me. It is like this for many new grads. Actually, I think that year of med/surg can be detrimental if the new grad ends up on an understaffed, toxic unit. There are specialties where med/surg really has no beneficial effect.

I started my OR nurse training at the same time as 4 floor nurses from my hospital. One floor nurse couldn't handle it so they sent her back to her floor. 2 others did OK but still had a pretty big adjustment. The last one did awesome, but when she graduated NS she went right to ICU.(despite many people feeding her the old line about a year of med/surg)

Just like we can't paint all experienced nurses with the same brush, we can't think that all new grads are the same.

[wooh, BSN, RN]

I propose all nurses start in an ICU to work on their assessment skills. After all, that way they can have a year or two of assessing 1-3 patients in depth before they go to a med/surg floor and have to do focused assessments on 8 patients. That way they're better prepared to handle the hectic pace of the floor too.:)

[NursKris82]

I disagree to a certain extent. I do agree that hospitals that have little or no orientation for new nurses in an ICU area is incredibly scary. That is no fault of the new nurse though, but rather the hospital.

However, I will be working in the PICU when I graduate and I have to go through a 6 month orientation program that includes classroom and preceptorship. Will I come out with those skills that a 10 year veteran has? Absolutely not. But I will come out with the ability to practice safely and there is no shame in asking for help and asking questions if I am unsure of myself.

I will not work in a med/surg area when I walk out of nursing school -- I despise working with adults. If they wanted me to work on a general pediatrics floor, I would. However, I will have worked an entire year as a nurse apprentice on a general pediatrics floor when I graduate and move to the PICU.

And many experienced nurses refuse to move into the ICU setting and hospitals NEED to fill these positions -- the only way is to hire new grad's who are willing to at least try it out. And you speak as if every new grad wants to go into a specialty area. In my class, there are only about 10 or 15 out of 40 who want to go into a specialty area. Otherwise the rest have no preference yet and will probably start out in a med/surg area.

In regards to new nurses coming in with a sense of "entitlement". I know new nurses on the floor I am on do not get a say as to when they work. We are self-scheduling and the new grads understand that the days they want to work do not necessarily mean they will work those days. It is all based on seniority. And there is nothing wrong with a new grad coming on with the attitude of "no one is going to walk all over me" because hospitals will walk all over you if you do not stand up for yourself.

It bothers me immensely when people generalize about new grads because of their experience at one hospital. It is different everywhere. Also, I know of new grads who have quit nursing altogether because of the horrible work environment because the way the experienced nurses have treated them as if the new grads did not "belong" in their department. Instead of this attitutde, nurses should embrace the new grads and promote a healthy learning environment and help them along. If you have a problem with a new grad on your specialty floor, go to your hospital administration, not to the new grad.

I totally agree!!

[SeychelleRN]

:tinkbll::luvnltr:

[it bothers me immensely when people generalize about new grads because of their experience at one hospital. It is different everywhere. Also, I know of new grads who have quit nursing altogether because of the horrible work environment because the way the experienced nurses have treated them as if the new grads did not "belong" in their department. Instead of this attitude, nurses should embrace the new grads and promote a healthy learning environment and help them along. If you have a problem with a new grad on your specialty floor, go to your hospital administration, not to the new grad.

[NursKris82]

Yes, you are right, new nurses are going into specialty areas w/out proper assessment skills. This is not fair to the patients OR the nurse. Management seems to be desperate for anyone w/a pulse to fill vacancies-

Anyone with a pulse?? New grads are hardly anyone with a pulse. These students have had years of schooling and past the same state board you did! They may not have the experience, but anything with a pulse is insulting and inaccurate!

[NursKris82]

I think the whole process of nursing school admissions has raised the overall cognitive level for nursing students. When I graduted from HS in 1978 if people wanted to become nurses it was pretty much an open door for entry into nursing school. Now with admission criteria so high it is almost easier to enter medical school than become a nurse. At orientation for my accelerated RN class the prerequisite gpa for NS was 3.6. My adviser (with a PhD) commented that she would not be admitted to nursing school today as an undergrad with that gpa screen.

Look at the number of posters here on the site who are on 2 and even 3 year waiting lists to enter nurses training. I think the nursing school admissions process has literally selected for a group of graduates who have the cognitive skills and desire to enter specific nursing specialties. (Adding in BSN, direct entry MSN and accelerated BSN programs serving second career adults it acclerates this trend even more.) Thinking and training plans for new grads need to reflect this new reality.

That is a good point. The programs themselves are also hard and can give a new grad the ability to learn knowledge needed in a specialty area (if the orientation is adequate, of course.).