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......

Specializes in ER/EHR Trainer.

Start where you want, obviously the specialty unit needed and wanted you-new grad or not!

Some people just get their panties in a twist, if things don't go the way they're used to....nurses need to mind their own business and let newbies do what they are hired to do. Become good nurses.

Maisy

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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.

I think she's saying that some more seasoned nurses forget that they weren't born nurses and had to start "from stratch" as a new grad at one time.

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Specializes in Cardiac, Critical Care, LTC.

first i want to say pleeeeaaaasssee do not blast me for asking the questions i am about to ask, i am just asking for clarity, okay now that is out the way

i am graduating on may 9, i accepting a position as a new grad in icu, when the nurse manager call me back the day after the interview and offer me the job, the last thing she said to me was "if i did not think you could do it i would not have hired you" . i think statements like that makes a new grad feel alot better going in the specialty of med/surg or any other specialty. no matter where new grads start they are going to be nervous regardless, and i think it would go a long ways if the seasoned nurses just gave them a little encouragement every now and then. not to say that the seasoned nurses don't already do this (as you can tell i am really trying not to step on any toes, and give everyone on this post respect). i am pretty sure it is stressful for the seasoned nurses also because they mentor and teach the new nurses and some new nurses get it and some don't, some ask all the questions and some just think they know it all, some listen and some don't. as for me i am there to ask questions, learn, and listen to what they have to say, because they know alot more than i do, and the only way to become a good nurse is learn everything you can from everyone you can, then put it a together and then put it all together and the pts the excellent care they deserve.

okay now for the question.

i have heard and read alot of statements saying med/ surg for a year is a good place to begin for assessment and critical thinking skills, but in med/surg you have anywhere from 5-6 pts (sometimes 1 or 2 more) and in icu you have 2 pts (sometimes 1 more), so why wouldn't icu also be a good place to begin to learn assessment and crtitical thinking skills.

once again please do not blast me; it is just a question:wink2:

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Specializes in ER/EHR Trainer.

It's a great question. You will learn more about care at the knee of an ICU nurse while being precepted then you ever will as a med/surg floor nurse with 7-10 patients. Everything you could possibly imagine will happen in an ICU, if that is the path you want to walk. Walk it!

Good luck on your new job!

Maisy

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Specializes in Cardiac, Critical Care, LTC.
It's a great question. You will learn more about care at the knee of an ICU nurse while being precepted then you ever will as a med/surg floor nurse with 7-10 patients. Everything you could possibly imagine will happen in an ICU, if that is the path you want to walk. Walk it!

Good luck on your new job!

Maisy

Thank you so much for responding:yeah:

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

Kristeh said it the way how I meant..maybe I didn't phrase it properly. I mean that when you start on a unit you may have some older nurses that have forgotten that they were once new..and that they didn't have a clue, but someone took the time and effort to teach them and explain to them so that they could become the well rounded nurses that they are today. That's what I mean..they weren't born nurses they BECAME nurses and everyone has to start somewhere..in ICU, PCU, Med/Surg...we all have to start from the beginning.

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Specializes in Mostly: Occup Health; ER; Informatics.
first i want to say pleeeeaaaasssee do not blast me for asking the questions i am about to ask, i am just asking for clarity, okay now that is out the way

i am graduating on may 9, i accepting a position as a new grad in icu, when the nurse manager call me back the day after the interview and offer me the job, the last thing she said to me was "if i did not think you could do it i would not have hired you" . i think statements like that makes a new grad feel alot better going in the specialty of med/surg or any other specialty. no matter where new grads start they are going to be nervous regardless, and i think it would go a long ways if the seasoned nurses just gave them a little encouragement every now and then. not to say that the seasoned nurses don't already do this (as you can tell i am really trying not to step on any toes, and give everyone on this post respect). i am pretty sure it is stressful for the seasoned nurses also because they mentor and teach the new nurses and some new nurses get it and some don't, some ask all the questions and some just think they know it all, some listen and some don't. as for me i am there to ask questions, learn, and listen to what they have to say, because they know alot more than i do, and the only way to become a good nurse is learn everything you can from everyone you can, then put it a together and then put it all together and the pts the excellent care they deserve.

okay now for the question.

i have heard and read alot of statements saying med/ surg for a year is a good place to begin for assessment and critical thinking skills, but in med/surg you have anywhere from 5-6 pts (sometimes 1 or 2 more) and in icu you have 2 pts (sometimes 1 more), so why wouldn't icu also be a good place to begin to learn assessment and crtitical thinking skills.

once again please do not blast me; it is just a question:wink2:

the reason icu might not be the best starting position is that the risk is higher if you do not correctly/fully assess and correctly/quickly intervene. usually, an icu patient can go downhill faster than a med-surg patient, which can be a challenge for a new nurse.

of course, having a consistent preceptor readily available can make either environment much better!

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The reason ICU might not be the best STARTING position is that the risk is higher if you do not correctly/fully assess and correctly/quickly intervene. Usually, an ICU patient can go downhill faster than a med-surg patient, which can be a challenge for a new nurse.

Of course, having a consistent preceptor readily available can make either environment much better!

True but med-surg patients can go down hill fast, too, and to be able to recognize it as a newbie while juggling 4-8 other patients, each in different rooms isn't exactly 'swimming in shallow water' either. Especially when the other nurses you supposedly can lean on are so overloaded with their own patients that when you bother them with "I'm not sure this patient is okay" questions, they get annoyed if it's nothing (why'd you bother me over that?!) and annoyed if it's a problem (why didn't you catch this earlier and take care of it yourself?!)

Experienced nurses may get the same flack for some of their pleas for assistance but they have the confidence to know what they know and don't know, while newbies don't and tend to take feedback very seriously (if someone says they should've known/done something, they're not sure if that's a realistic expectation or not).

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Specializes in ER/EHR Trainer.

Med-surg patients can and do tank quickly----case in point, my FIL is now in hospice directly lated to lack of simple assessment and care on a med-surg floor. Bad care is just that, no matter where it occurs.

A new grad has a much better chance of learning soup to nuts, with a smaller amount of patients and higher acuity than being thrown into a mix of patients that may not belong on a regular med-surg floor and may tax not only your time, but your limited resources to learn.

For the record, some of the nurses that cared for FIL were my peer graduates----and 20+ year nurses-----in less than 5 minutes, I had a full assessment----a call to the doctor---and solutions initiated. While my former peers, had their thumbs up their behinds. My anger with them is not following nursing 101, my anger with the facility----their experienced nurses worked the same way! HORRIBLE! We are all supposed to be patient advocates no matter the area. Basics don't change---bad habits are learned---and we all need to remember that the patient could be a family member. If you have a bad feeling about someone's condition---you probably should check it!

Maisy

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:yeah:know what?i certainly agree w/ you...it's really the attitude...and what we also call "crab mentality"...new nurses should be welcome w/ compassion....a pleasant environment for them to learn effectively...i know later on whenever they will go places...they will always remember the 1st hospital that they had worked w/ and the kind of people they had encountered...why not...teached them the proper way...because before you came to your position you were like them also...sometimes we need to look back....in this field teamwork is important...for we are dealing w/ life...so let's make our life more meaningful by sharing what we know especially to the new ones...:bowingpur:bow:

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.

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Wow great input and passion all ways new and old- i am a new nurse [45 yrs old] my previous experience gives me maturity and confidence that some long time ICU nurses do not have-do I know it all NOOOO - I work at a teaching facility and I pride myself that I have the ability to seek out the answers which is what we should all be doing and to the long time RN's that cant be bothered helping the new grads-shame on you- and a reminder to all its only going to get worst THERE IS A NURSING SHORTAGE and an over abundance of ill elders

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Specializes in PACU, ED.

I just finished my first year in nursing and all that time has been in PACU. I did work as a tech there while going to nursing school so I wasn't totally new to the area. I had two good preceptors and was exposed to as many different patients and as much acuity as possible during the 6 months I was under their wings. In fact, I was glad to finally get cut loose so I wouldn't get EVERY carotid, big bowel, crani, and vented pt that called out from the OR. It was a steep learning curve and I still learn every day. I also help other nurses in my area every week. I am in my comfort zone when I'm at work.

With all that said, it was a huge learning curve and sometimes I noticed gaps in my basic nursing knowledge base. I was comfortable titrating diprovan for sedation or nitro for BP control but had to ask how to give D50 for low BS.

During this time I've seen a nurse with years of experience in areas including tele fail at this job. She just wasn't a good fit with our high acuity patients. Almost all of our patients start off at ICU acuity and then recover to either ICU, tele, medsurg, or outpatient level. I've bagged patients who went home less than two hours later.

Anyway, in short, I think it's most important that the nurse be the right fit with good assessment skills, critical thinking and attention to the patient. Then the department must have a good orientation program in place. Finally, experience in another area will decrease the amount of things that must be learned so the nurse can focus on area specific learning.

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