new RN's in specialty areas

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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......

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.:)

I think that statement may have caused a poster or two to have a stroke!! :eek: Seriously, though- I am an LPN in a LTCF and grad. with my RN in Dec. I was told I must start my career in an ICU, a RN I know said that you really learn how to think in an area like this and I'd be robbing myself otherwise. She started in PICU as a new grad and that was 10 years ago. She just finished training to be a transport nurse also and she loves it!

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I'm a new grad and applied for specialty areas and med-surg floors and only the managers of 2 of the specialty units called me for interviews and both offered me the jobs that I interviewed for. Two of the charge nurses from med surg floors that I did clinicals on wanted me for their floor, but the unit manager did not want to even look at my application until I had taken boards and then they didn't want a new grad if they could help it. Well, I guess that is fine, but I can't wait around hoping they will give me a shot when they get desperate enough.

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Specializes in Cardiac Telemetry, ED.
I'm trying to do this without being personally critical. I do not want to put all new nurses in the same basket, so to speak. You have been blessed to work in a unit where all the seasoned nurses are happy, no one is burned out & all is well. This is a rarity.

Please, do not put words in my mouth. I have not made such a claim. I will say for the record though, that I do work on a unit where teamwork is highly valued, and where mentoring new grads is part of the culture. I think of that as a positive thing, and I have every intention of continuing to contribute to that culture.

Believe me, it's not that we do not want to teach or help new nurses - far from it. Nothing makes us happier than when we see a new nurse "get it". But there have been far too many times when we have seen a pt.'s care compromised because of a new nurse who did not "get it" & did not know enough to ask for help. We have seen critical labs missed & subtle clues that were not picked up. We have seen new nurses who had no critical thinking skills. And while we're precepting, it's OUR licenses on the line. Precepting is not easy - it's not just being there if the new nurse asks for help. It's anticipating, proactively teaching, monitoring, constructively critisizing, teaching more, evaluating, etc.

I am well aware of what is at stake. And I do understand that just because one can make it through nursing school and pass the NCLEX does not mean one is prepared for all that nursing entails. I know I have made a pest of myself on many occasions, simply because I'd rather err on the side of caution for the safety of the patient than be either afraid to ask for help or overly confident in my clinical judgments. I have every intention of making a pest of myself in the future, if it is in the best interest of the patient.

I, too, have seen more than one new grad come and go because they were unsafe, lacked critical thinking ability, or refused to take responsibility for their mistakes. I've also followed many seasoned nurses and can honestly say that just because they have experience does not make them good at what they do.

So please try to understand our point of view. We're tired. And sometimes we just want to take care of our own patients.

I've never asked anyone to take care of my patients. I have, however, asked for assistance with procedures that are outside my scope of practice, and will continue to do so for the safety of my patients and the protection of my license.

Whether new grads "should" work in specialty areas is arguable, but the fact is that new grads ARE working in specialty areas. I agree we shouldn't all be put in the same basket, just as seasoned nurses should not be.

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I went straight to ICU after graduating and I am SO glad I did. I learned much more in that particular setting, and not necessarily just medical issues. Teamwork, listening (particular to the seasoned nurses), and trust, just to name a few. One thing you need more than anything else to survive is common sense.

If you are unsure of something, ASK. Everyone is unsure of something once in a while and it's always good to have someone to ask and verify!!

I was extremely blessed to work w/ the crew I did and I miss them dearly. Had I not got married and moved out of state, I would still be there sludging away :p

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Specializes in peds med surg,.

I worked on inpatient peds and a lot of new GN's were hired for our floor and the PICU. I did med surg for 6yrs and peds the last 8yrs. I feel that my experience on med-surg definitely prepared me for peds.

The other thing I noticed is how many GN's come out and expect dayshift. I did 3-11 for 11yrs and as a new nurse took what was available. There seems to be an expectation for things.

I could not have done peds as a new nurse. It takes timeto build your skills up and med-surg is a good way to learn that. I think everyone should have to work at least one year of med-surg before entering a specialty. Unfortunately, mangagement does not seem to feel this way, and they will easily replace an experienced nurse with a brand new GN.

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Just wanted to add some seasoned nurses who worked specialty would have to occasionally float to medsurge and then would refuse after that b/c they couldn't keep up. In some places (like my old job) floating happens everyday. So while a new grad may go to ICU or wherever, chances are they're getting their fill of med surge as well.

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Specializes in ER/EHR Trainer.

Pediatrics is tricky....I almost have to agree you need to get used to working with adults first...but of course there is always an exception to the rule.

My main issue, at least in the ER is that an adult can be hypoxic for a long time, sob, breathing issues, whatever.....the little ones go pretty quickly! Nothing can be taken for granted when it comes to children. That is something you learn.

Unless having medical problems-children don't have the co-morbidities that adults exhibit, but are sooooo much scarier when they crash or are sick. I still think that nurses need to go where they want to be-as long as the environment is welcoming and they continue learning to provide the best care possible.

As far as, hours and other things---this is how business works----nurses deserve bargaining power too! This is standard in other fields-you negotiate when you are hired---more power to those who state their needs up front, then those who b**** about their lack of benefits to everyone else.

Maisy

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As far as, hours and other things---this is how business works----nurses deserve bargaining power too! This is standard in other fields-you negotiate when you are hired---more power to those who state their needs up front, then those who b**** about their lack of benefits to everyone else.

Maisy

I agree. I can't stand when people complain about everything but don't do a dang thing to help the problem. And that's not directed towards anyone, just a peeve that collaborates w/ daily life in general.

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Specializes in ER/EHR Trainer.

The major problem with floating is that you are like a fish out of water. Different requirements, paperwork, procedures, layout, pyxis, rights, storage, cna names, and whatever else.

just because someone works in the same hospital does not make them oriented to another unit. Even agency and travelers get some orientation-floats do not!

If I were to float, I'd probably lose my license. Things like oxygen, suction, ekg, fluids, ivs and other emergency stuff are initiated as needed by us-doctors will write eventually. The only thing I won't do automatically is give meds(except in triage). I may pull them, but they remain w/me at bedside until the physician has ordered. My fear would be doing this same action on a floor----where a physician must write for every action. It would not be a good fit!

If you think about it, a float may never be able to keep up with those comfortable with your areas, BUT keep you all from having extra patients.

Maisy

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Specializes in LTC, Sub-Acute, Med-Surg.

Can anyone tell me...since when is med/surg NOT a specialty? I might be a little biased, but when the nurses get pulled to our floor from the "specialty units" they can't have more than 3 or 4 patients and wonder how we handle so much on a daily basis. We have to use our critical skills to look at our patients and know that something isn't right and start from head to toe to figure out what is going on. We don't have the luxury of having a monitor going off when our pt starts to desat or become hypotensive. We have to use our skills to know that a pt is becoming septic not only because of lab values but BPs etc. Med surg teaches how to do a thorough assessment and time management. Yeah staffing can be difficult at times..but as long as there is team work..it is totally doable. The wide variety of pts that you see from oncology overflow, womens health overflow, transplant, surgery, ESRD, ESLD etc the learning experience is PRICELESS. The nurses that have left med-surg and have gone on to "specialty units" are stronger nurses. If you think about it we (Med-Surg Nurses ) have to look at the whole person and not just a particular organ..all systems once going bad has a domino effect. So after saying all of this Med-Surg is definetly a specialty just like all of the other departments of nursing.:nurse:

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Specializes in LTC, Sub-Acute, Med-Surg.

Well all have to start somewhere as a new grad..it is unfortunate that you have some nurses who feel as though they were born nurses and never had to start from scratch.

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Specializes in ED.
Well all have to start somewhere as a new grad..it is unfortunate that you have some nurses who feel as though they were born nurses and never had to start from scratch.

Can you define "start from scratch"? i don't really get this comment but what are we are new grad supposed to do? Tell HR/managers that we refuse to accept any job but med/surg straight night shift and if they don't have that then don't offer us anything else? For those that say you should start in med/surg, what if you don't get a med/surg position offered to you? You just stay unemployed until you can find a med/surg position so you can become better at assessment? I do not think ANY person in my class feels like they are "born nurses" and just ready to hit the floor (any floor). We are all nervous and feel like we have SO much to learn. But everyone has to start somewhere and not everyone can get the med/surg positions. Ideally, I would like to get some med/surg experience but the new grad program I applied to at a big hospital did not choose to interview me. I had connections and a preceptorship at another hospital ED and that manager DID want to interview me and offered me a job. Should I say no just because it isn't med/surg?? Will I be a horrible nurse due to not starting in med/surg? I sure am hoping not. It comes down to needing a job and I loved the people on this unit and feel like I would be a good fit there.

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