Truthful advice for new grads "hunting" for their first job

Pangea Reunited, ASN, RN · Jun 22, 2014

There are plenty of new grads with great critical thinking skills, although it's true that they lack experience. New grad programs are helpful, but they don't make up for a lack of experience. Nothing can.

I agree that nursing home skills are valuable, but it can be tough to transition to acute care depending on the job market in your area. I work with a former SNF nurse who tried to get into acute care for seven years before finally succeeding. Her SNF experience was not considered relevant (fair or not) by many employers.

There is some truth to "not getting med surg skills" in other specialties, like psych. In fact, a lot of psych facilities require at least a year or two of med surg for that reason. It's not that you don't develop skills in pysch- it's just a different set. I have plenty of respect for psych nurses and would love to be a psych nurse someday, but it is a different world.

PCnurse88 · Jun 23, 2014

I'm going to respectfully disagree with you, OP.

This is something I’ve encountered a lot on AN, and it irks me every time. Critical thinking is NOT a skill exclusive to nursing, so saying new nurses don’t have critical thinking skills is a tad insulting (to me, anyway). I have excellent critical thinking skills. I have friends who have poor critical thinking skills. Nursing school and my 10-week orientation period did not teach me these skills. Sure, they made have honed them more towards nursing, but to say new nurses lack these skills is plain wrong. We lack knowledge, we lack experience, we lack that “nursing intuition”, sure- but don’t sit there and make generalizations that are unfounded. Same thing with being adaptable- these two traits are not ones that are necessarily taught, but grown. And please don’t say I’m a liability who is probably going to kill somebody because the orientation I got was only 10 weeks. I have seen nurses with 10+ years experience make decisions that could have been harmful to a patient.

Nursing homes (near me, anyhow) are grossly understaffed and can have very unsafe nurse/patient ratios. The home my grandmother was at had one RN, 2 LPNs, and 4 CNAs. A doctor came once a week to do assessments, etc. I would not be better off working at this nursing home. Only one of my friends has ended up in a nursing home; her orientation was 6 shifts versus my 40 shifts. She is also now the ONLY RN on the floor when she works, whereas I am one of 4 or 5. I would rather have my first code occur surrounded by RNs, MDs, anesthesiologist, RTs, and a rapid response team in the hospital than dialing 911 and doing CPR. (actually, my first code was on my very first day as an RN, so I am SUPER grateful that I was surrounded by all of these people plus a whole gaggle of residents and interns!) While I agree that new grads need to be open to any and all settings, your reasoning leaves me a little confused.

Lastly, an RN giving a patient 100 units of insulin instead of 10 units is not a new grad error. This occurred because this RN did not follow the 5 rights of medication administration (dose). New grads make med errors. Seasoned nurses make med errors. Veteran nurses make med errors. This is NOT a new grad problem.

I appreciate that you’re trying to give advice to us new grads, but some of your reasons behind certain tidbits of advice are wayyyy skewed.

HouTx, BSN, MSN, EdD · Jun 24, 2014

It's great that OP is so passionate about nursing -a lot of us are. However, I also disagree with the worst-case scenario that OP presents for new grads :" new grads are LIABILTIES to patients if not placed into a new grad orientation program for at least a year."

Truthfully - NO ONE is providing year long new grad programs in the US any more... it's just too expensive.

There are very few things in life that are absolute either-or dichotomies. This is one of them. New grads who are not in year-long orientation programs are not destined to harm patients.

Patient care is a team activity. No one ever saved a patient's life by him/herself... not even the OP. New Grads can (and are) valuable members of the nursing team... supported by more experienced colleagues who ensure that the newbie is supported appropriately.

krisiepoo · Jun 24, 2014

You make an awful lot of sweeping generalities about new grad nurses... Perhaps you need to look within your self and your own biases before writing a post like this.

Just because you couldn't start in a hospital doesn't mean the entire new grad population can't.

Nonetheless · Jun 26, 2014

Somebody got up on the wrong side of the bed...

orsrt05 · Jun 28, 2014

I love that you all responded to my post so I am going to respond to each and every one of you.

To obesity33, I did not get up on the wrong side of the bed. lol. I was actually suffering from insomnia so I figured I would share some insight in the nursing world. lol.

To krisiepoo, I have looked deep inside of myself and found no biases. I am actually one of the most open minded non biased person you will ever meet. I apologize if my post came across as biased. I was speaking from a stand point of working with and training new grads. I also remember being a new grad myself and how nerve wracking it was. I also have no bitterness at all because I couldnt start in a hospital. I started in a NH as I described in my original post and was shedding some light for new grads. The main point of my original post was that you dont NEED to start in a hospital in order for you to end up in a hospital. Alot of new grads seem to think that you must get a hospital job as your first job or else you will never get into a hospital. Its not true. Im living proof of this point. I was giving this advice to new grads "hunting" for their FIRST JOB. If a job offer is made but it's not in a hospital setting, TAKE IT!!!! It may be the only job offer as a new grad that you get. You can try and move up later or work as a nurse while looking for another job. Everyone else does it so why not you. Theres no rule in the nursing world where it states if you get a hospital job, no matter what, you stay there til you retire.

To HouTx, I never said new grads were destined to kill anyone, let alone patients. But a prospective employer has no clue which new grad will be the one to do it, if ever. This is why employers PREFER experience, rather than demand it. Employers know that they cant just hire nurses w/ experience. But as a new grad sending out 300 resumes and only hearing back from 3 employers, only to be told they hired someone else who had more experience, this is why. Unless you know someone who can vouch for you as a person and state to HR or a hiring manager that they know you personally, they would rather take a chance on an experienced nurse. This is why people who know somebody get jobs much quicker than people who send a resume and it sits in a pool of 500 resumes never to be seen again. You can tell me Im wrong all day long, but think of how many people get jobs because they know someone or they already worked in the institution as a volunteer or a transfer. This also applies to all jobs outside of the nursing world.

To Pangea Reunited, I thank you for your input and point of view.

And finally to rinkskins, I appreciate that you respectfully disagreed with me and than proceeded to try and tear me apart all at the same time. lol. But lets clear up a few points here on what I was trying to say in my original post.

#1 - Lets clear up first the misconception that you may have about me saying all new grads have no critical thinking skills. First off, I never said that!!! I said, "by LIABILTY I mean you do not have the EXPERIENCE to critically think on your own after a maximum 3 month orientation process and adapt to a rapidly changing situation. If you don't develop this ability and sharpen it quickly after a 1, 2 or 3 month orientation , your gonna kill someone." I highlighted the word experience because thats what I was emphasizing in that original sentence. I did not mean to say that ALL NEW GRADS lack critical thiniking skills entirely. If you lacked critical thinking skills you would have never graduated nursing school. I am not brazen enough to make that statement even though I have worked with and trained nurses that make me wonder how the hell they graduated school. lol. New grads lack the experience of taking all of their critical thinking skills and applying them when the pressure is ramped up because a patients acuity level is changing. Why? Because you lack EXPERIENCE. Not because youre a dummy!!! With experience this combination of skills blends together and your experience teaches you what needs to be done before your patient even starts to have issues. This is not an insult to new grads its part of the learning process. Does this mean nurses with 10+ years experience cant have their moment either? Of course they can and do, enough said.

#2 - I never said you were better off working in a NH as opposed to a hospital. What I said was, "Stop limiting yourselves (new grads) to only working in certain facilities. Do you think I liked working in the NH. Hell no!!! But it got me the experience needed to move on to the ER after I perfected my basic nursing skills which are not perfected by any means in school. Where ever you get a job, be proud of it. Become the best nurse in the building." I dont know where you came up with that generality of a statement, but OK. You speak of NHs as being GROSSLY understaffed. This can be very true. But are hospitals known for being GROSSLY overstaffed? I dont think so. The NH I started in had 8 RNs and 20 CNAs divided into 4 units. You do the math. So where was the gross understaffing in my NH? The ER I currently work in has 12 RNs at night to care for upwards of 150 patients at times. Does that sound like adequate staffing to you? I apologize if my suggestion to start in a NH offended you because the one NH by you doesnt have their stuff in order. But what if that NH was the only medical facility offering you a job and you didnt have one at the time? Are you gonna sit home with bills mounting up and no pocket money just simply because the NH is understaffed and your better off somewhere else? No!! Youll take it!!! At that point, please re-read the first sentence of this paragraph. As a new grad do not limit yourself and not work certain places. Every facility should be an option!!!!

#3 - I am glad to hear you had an enlightening experience during your first code on your first day as an RN in a hospital setting. I also hope you pass on your experience to newer nurses and help them learn and be calm during their first code. I know I would be ****ing my pants if my first code was in a hospital setting and all the medical staff came running into the room to help my patient. but that just me lol.

#4 - And last but not least, my most recent endeavor w/ a new grad who gave 100 units of insulin instead of 10 and almost killed a patient. Now, this is partialy my fault because I did not really elaborate in my first post the details surrounding this debacle.

Rinskin, you say this was a problem because the RN did not follow the 5 R's of med admin. Well you're wrong!!! The new grad nurse followed the 5 R's to a T and covered all of her bases. She did beautifully from what I heard. The problem was in the fact that the MD didnt realize as she typed in the order, she put an extra zero at the end of the 10 unit dose of Humulin R, making it 100 units. The new grad nurse, having no EXPERIENCE giving out insulin, never questioned the order and gave the medication anyway. Now I ask you rinskin, as an experienced nurse, would you ever give 100 units of Humulin R to a diabetic patient? I dont think so!! You can also blame this on a lousy orientation perhaps, but orientation in any facility cant cover it all.

To sum it all up, the main point of my post was to drive home the aspect of why new grads are probably finding it difficult to find jobs without EXPERIENCE. Does it apply to every new grad? Absolutly not. Some new grads get jobs right out of school. Some new grads turn down job offer after job offer because they wait for their dream job. My advice, take the first job that gets offered to you so long as you dont wind up paying more to get to work than you make in a day. Start getting your experience as soon as you can and move on. Its a tough market out there for RNs with no experience but unfortunately your diving into a workforce with much more experienced nurses also applying for jobs. New grad programs are extinct and jobs are demanding much more from RNs these days making it even harder for new grads to get jobs.

If you dont know someone and have a hook at a hospital or other facility, your just another face full of promises and ambitions. As a new grad you have a huge ladder of expectation to fulfill when you finally get hired. Having no experience can be very intimidating and employers are demanding you learn everything as fast as humanly possible. Even if your not ready after orientation, you may have no choice, youre on your own!!! But please, please, dont be that new grad that really screws up and almost kills someone. Once again, good luck!!!!

DatMurse · Jun 28, 2014

Rinskin, you say this was a problem because the RN did not follow the 5 R's of med admin. Well you're wrong!!! The new grad nurse followed the 5 R's to a T and covered all of her bases. She did beautifully from what I heard. The problem was in the fact that the MD didnt realize as she typed in the order, she put an extra zero at the end of the 10 unit dose of Humulin R, making it 100 units. The new grad nurse, having no EXPERIENCEgiving out insulin, never questioned the order and gave the medication anyway. Now I ask you rinskin, as an experienced nurse, would you ever give 100 units of Humulin R to a diabetic patient? I dont think so!! You can also blame this on a lousy orientation perhaps, but orientation in any facility cant cover it all.

This isnt because of experience. The first time I gave lantus I was questioning a 50 unit dosage, which is normal for my particular patient.. This is part of the stuff you question from nursing school. This is due to the particular person not thinking it through.

"Have Iever given a dosage this high?? Is this out of the ordinary?"

People will make mistakes on their first year, hopefully it will be just a near miss and nothing will harm the patient.

That med error is also pharmacy's fault and the doctor's fault.

just saying.

applesxoranges, BSN, RN · Jun 29, 2014

I remember 60 of Lantus too. I could barely inject it with the pen.

It's all three's fault. Meds should be verified by pharmacy but the RN should have questioned. If an order said 100 units of any insulin, I would question it unless it happened to be a bag for a drip.

Nonyvole, BSN, RN · Jun 30, 2014

It may also depend on the area where you work. "X years acute-care/specific unit experience required" is very common on job postings for my area, so yes, it is indeed difficult for new grads and people coming from LTC/clinics/home-health/hospice to move into the hospital setting.

Yes, there are many people out there who don't show much in the way of common sense. However, it's not just limited to new grads. Additionally, I have seen experienced nurses make mistakes that the average new grad would not. Does that mean that they're lacking somehow? No, it means that they made a mistake, acknowledged it, and fixed it to the best of their ability.

What does, probably, get new grads in trouble and what I feel that you're focusing on is that new grads, well, don't want to be seen as new grads. They don't want to be seen as weak, or incompetent, or stupid. So they won't ask for help, they won't take the extra two minutes, they'll just let themselves be pushed deeper and deeper into a hole until they're in big trouble. And, unfortunately, extended orientation doesn't automatically fix that. Now, if there were an established peer mentor program where each new nurse to the unit was told "X will help you out, no questions asked," and if there was a culture of helpfulness established and less "did you hear what Y did?" "That student...:no:" then maybe there would be fewer reasons to feel frustrated. And yes, I have witnessed that, in person. I've even been the recipient of comments like that.

It's not just in nursing, too. I could have written something very similar to your post in my previous profession.

(And random aside. 150 patients, 12 nurses, one ED? Please say that was a mass-casualty situation, since I have never heard of a 150-bed ED! And I've been in healthcare in one form or another for over a decade!)

orsrt05 · Jun 30, 2014

I really like the direction this topic is going. I do realize my original post may have been harsh, but I had so much to say I just said it.

In the event of a med error it is true that its all threes fault (MD, pharm and nurse). But the nurse is the last line of defense and the most likely to get fried if a major med error occurred. Sure there's plenty of veteran nurses who make mistakes, but its mostly for lack of awareness rather than trying to be cavalier and proving themselves. New grads are in desperate need of proper mentoring and nurturing.

And Nonyvole, on days when we have upwards of 150 patients in our ED, it looks like a mass casualty scene. Wish I could take picture pictures!!!! I work in a very well known hospital on the outskirts of NYC and people from the neighborhood use it as a primary care facility on top of the critical cases. On the critical side we can have upwards of 40 patients to 4 nurses on nights. On the non critical side we can upwards of 40 patients on either side with 4 nurses each side. And we also have a fast track which handles upwards of 40 patients with 1 nurse.

DatMurse · Jun 30, 2014

I really like the direction this topic is going. I do realize my original post may have been harsh, but I had so much to say I just said it.
In the event of a med error it is true that its all threes fault (MD, pharm and nurse). But the nurse is the last line of defense and the most likely to get fried if a major med error occurred. Sure there's plenty of veteran nurses who make mistakes, but its mostly for lack of awareness rather than trying to be cavalier and proving themselves. New grads are in desperate need of proper mentoring and nurturing.
And Nonyvole, on days when we have upwards of 150 patients in our ED, it looks like a mass casualty scene. Wish I could take picture pictures!!!! I work in a very well known hospital on the outskirts of NYC and people from the neighborhood use it as a primary care facility on top of the critical cases. On the critical side we can have upwards of 40 patients to 4 nurses on nights. On the non critical side we can upwards of 40 patients on either side with 4 nurses each side. And we also have a fast track which handles upwards of 40 patients with 1 nurse.

that sounds extremely unsafe.