Where to start when you don't have experience.

Skips, MSN, RN · Sep 9, 2014

Start where you get a job. (:

Some new grads start in the ICU, but I do like the idea of learning tasks and time management before jumping into a specialty with a huge learning curve. It takes about 6-8 months before a new grad learns effective time management. If you did a rotation in critical care in school, that might serve you well. The "start in med/surg" advice is okay, but if you want to work hard and learn a lot all at once, you can go into the ICU as a new grad. It's been done before.

chio0719 · Sep 9, 2014

Thank you for your answer. I love ICU that is where I did my preceptorship.

**NICU Guy, BSN, RN** · Sep 9, 2014

I asked the same exact question to my Med/Surg instructor. I have no desire to do adult Med/Surg nursing, I want to do Pediatrics (NICU) but have been told many times to start in a Med/Surg floor to get your skills down. His advice is to start where your passion is. He used Patricia Benner's Nursing Theory of Novice to Expert. If you start out in Med/Surg and become "Proficient" in it, then switch to Peds, you will instantly go from "Proficient" in Med/Surg to "Advanced Beginner" in Peds because you now have to learn new set of skills dealing with a different population. By starting out in the area of your passion, you do not back-step in your progression as a nurse and will become an "Expert" in your desired speciality far quicker.

Mr. Murse · Sep 9, 2014

I work on a GI surgical floor (although we have a little bit of everything come through) and I've always said it was probably the best place I could have possibly worked as a new grad. I've seen all kinds of surgeries, drains, pumps, complications, like I said.......a little bit of everything. I feel as though I've established a good sense of time and task management and have developed a good set of core nursing skills. Now I'm probably transferring to surgical ICU in the next month or two and I feel much more prepared for it than I would have been coming out of school, like I have a solid foundation and could really go any direction I want from here. Not that you couldn't do it (many people do), but in my opinion, the best place to start, assuming you have a choice, is somewhere you will be busy and able to see and learn as much as possible. If you're positive ICU is what you want to do and have the opportunity to jump right into it, then go for it. But most of your core nursing skills are still just book knowledge and not applied when you graduate, aside from maybe some brief clinical experiences, and the hands on experience will make you an all around better nurse.

Karou · Sep 9, 2014

Agree with PP who said start where you get hired

It's just that jobs are not easy to come by for new grads so you can't be too picky.

That being said, if you end up in the position of being offered two different areas, I would choose the one you want (follow your heart). If ICU is where you want to end up and you happen to get offered a position then don't blink, just take it! I love med-surg nursing but do not think it's necessary for new grads to start out in that speciality.

amzyRN · Sep 10, 2014

I agree with the idea of starting where you can get hired. I think some people can start in a specialty depending on the length of the training program and support offered, others chose to do a year or so of med/surg or lower acuity specialty. For me personally, I chose to start in tele/step down before going on to the ED which is my goal. I did a residency in the ED and it was pretty overwhelming and unless I were going to be offered a 6 month training program as a new grad, would have never felt comfortable jumping straight into that specialty. I don't think I would have felt comfortable going straight into ICU either. That is just me though. For me it was challenging enough going into tele/step down, developing time management, clinical intuition, interpersonal relationships with patients, families, and fellow coworkers. It was a lot. To add on to that, learning a specialized high acuity area like ICU or ED would have been too much for me. Plus, I feel that in my case would not have enough confidence or trust in my nursing abilities to survive in a more specialized unit. But, some new grads are able to handle starting out in a specialty with enough support from mentors and educators and what not.

I think it is less common for someone to survive in a specialty as a new grad without support and good mentors. In my opinion, I think it is usually more beneficial to start in med/surg or tele, it adds a depth to ones experience as a nurse in general too. The capacity to handle 4, 5, or 6 patients if need be (say an ICU nurse has to float). There have a few ICU nurses that floated to my unit that found that taking care of 4 and 5 patients on my unit was pretty challenging. But you know yourself better than any of us, so listen to you intuition and follow your heart.

chio0719 · Sep 10, 2014

Thanx to all of you for your advice.

JustAdmitToObs · Sep 11, 2014

Where on earth is this place that has hospitals that take new grads in to specialties (if not hired from a tech position)? I remember pondering whether I would go into ICU or ER after graduation. Now, I can't find a med/surg floor that will take new grads!

scaredsilly, BSN, RN · Sep 13, 2014

In my area, new grads are hired in ICU or med surg almost exclusively. I got lucky and was hired in L&D, but only because I had connections there. ICU seems to be realtively easy for new grads to get a job (if you can call anything about getting a job easy!)

JustAdmitToObs · Sep 13, 2014

Scaredsilly! What the heck! ICU and ER is hardest/impossible to get into around me. I'm dying to know where you are. I'd relocate if it weren't for the house and hubby.

DatMurse · Sep 13, 2014

Where on earth is this place that has hospitals that take new grads in to specialties (if not hired from a tech position)? I remember pondering whether I would go into ICU or ER after graduation. Now, I can't find a med/surg floor that will take new grads!

Do a year of M/S and then move into ER.

1 year of floor nursing wont kill anyone.