Who feels new grads should definately start on med/surg unit?

Long Term Care Columnist / Guide · Aug 12, 2006

I used to feel very strongly about new grads doing a year or so of Med/Surg right out of the starting gate, to learn how to prioritize and gain a working knowledge of the many different disease processes, psychosocial aspects of illness, etc., etc.

Now I'm not so sure that a one-size-fits-all approach is the right one, especially if you know from the get-go that acute care is not where your interest lies. Med/Surg nursing is hard even if you love it, and if you don't, it's impossible.

I don't regret a minute of my five years in acute care, as it prepared me to face almost any situation with at least some degree of competence. However, knowing what I know now of the physical and mental demands, the politics, the workloads, and the ever-present fear of making even minor mistakes lest they result in legal action, I wouldn't recommend it to a new grad just for the sake of getting experience, if they really wanted to be someplace else.

suzy253, RN · Aug 12, 2006

Certainly it's not written in stone that you should start with med surg but I hear the same thing as well. I just graduated in May and enjoyed doing my clinical rotations on the floor that I'm assigned to now which is a med surg floor + step-down telemetry unit. One of the busiest and difficult floors in the hospital besides ICU. The main reason I chose this floor is a wonderful nurse i met there when doing clinicals and wanting him to be my mentor/preceptor which is how it has worked out. I'm 53 (!) and presently still orientating at 40/hrs week 7 am - 3 p.m. It's exhausting me. I'll be starting my assigned shift which is 3 pm-11 p.m. with 24 hrs/week in two weeks time and I think that will work better for me.

I have to say that I am learning a whole lot on this floor. Kinda like being thrown into the fire. My assessment skills are getting better and better which is really important. So I feel like I'm getting a very well rounded continuing education and am enjoying it. so far so good with the exception of too many hours for me.

Good luck to you.

gentle02 · Aug 12, 2006

Who feels that new grads should definately start their nursing career in on a hospital med/surg unit?
I'm about to start my last semester of nursing school and already realize the hospital med/surg route is going to be very tough for me. I'm in my late thirties, have a toddler and another child on the way. I'm feeling that community nursing (i.e. clinic, county health department, women's health, instacare, doctors office, etc.) with nice regular hours (or better yet, part-time hours), may be more my speed. What sort of opportunites do new grads have for such jobs?
Any and all advise/insight will be greatly appreciated!
jenalv

I just graduate(took the summer off) and I got two children and for me, like you, I do not see myself on a med/sur floor. I whish I could work in the Public health or some kind of floor less crazy and fast. I'm in the thirties also and I feel this would be too much. My plan is to work only part-time.

gentle02

PANurseRN1 · Aug 12, 2006

Who feels that new grads should definately start their nursing career in on a hospital med/surg unit?
I'm about to start my last semester of nursing school and already realize the hospital med/surg route is going to be very tough for me. I'm in my late thirties, have a toddler and another child on the way. I'm feeling that community nursing (i.e. clinic, county health department, women's health, instacare, doctors office, etc.) with nice regular hours (or better yet, part-time hours), may be more my speed. What sort of opportunites do new grads have for such jobs?
Any and all advise/insight will be greatly appreciated!
jenalv

I don't think home health nursing/community health is a good place for a new grad. You need to have solid assessment and technical skills and be able to make decisions independently. You will need to be able to handle numerous disease processes. You might be seeing a heart pt., a diabetic pt., a cancer pt., a wound case and an ortho case all in the same day. You will not have the luxury of having someone else to just grab for a second opinion. Patients and doctors depend on nurses in this specialty to be able to make assessments and act accordingly. A new grad simply does not have that level of skill.

What you should do is at least get a year of experience in an area that will give you the opportunity to solidify your skills. Home health is not just all about easy hours, either. There is often on-call, and while you may be theoretically scheduled 0700-1530, pt. needs come first, and it is not uncommon to work later than you planned.

While I can appreciate your wanting to have a normal schedule, there are other things to keep in mind.

Corvette Guy · Aug 13, 2006

I used to feel very strongly about new grads doing a year or so of Med/Surg right out of the starting gate, to learn how to prioritize and gain a working knowledge of the many different disease processes, psychosocial aspects of illness, etc., etc.
Now I'm not so sure that a one-size-fits-all approach is the right one, especially if you know from the get-go that acute care is not where your interest lies. Med/Surg nursing is hard even if you love it, and if you don't, it's impossible.
I don't regret a minute of my five years in acute care, as it prepared me to face almost any situation with at least some degree of competence. However, knowing what I know now of the physical and mental demands, the politics, the workloads, and the ever-present fear of making even minor mistakes lest they result in legal action, I wouldn't recommend it to a new grad just for the sake of getting experience, if they really wanted to be someplace else.

Great words of wisdom! :bowingpur

A lot depends on the specific area of nursing one chooses. Besides, the nursing profession has so many different opportunities for career choices.

NJNursing, ASN, RN · Aug 13, 2006

My first 2 semesters of nursing school they pushed into our heads over and over again that we should do 6-12 months of med-surg under our belt. However in our last year of nursing we found that many hospitals are willing to hire new grads into specialities including ICU and ER. I got into Maternity. They're finding that it's easy to really 'program' a fresh new-grad into their specialty rather than have them do something else for a year, get into a routine and then have to retrain them all over again. Sort of the 'do it right the first time' theory. I've got a daughter who is starting kindergarten and is doing cheerleading. We've got the option of 8 hour days or 12 hour days, so I'll probably opt into 8 hour days - even if it does mean working 2 more days a week.

Corvette Guy · Aug 13, 2006

My first 2 semesters of nursing school they pushed into our heads over and over again that we should do 6-12 months of med-surg under our belt. However in our last year of nursing we found that many hospitals are willing to hire new grads into specialities including ICU and ER. I got into Maternity. They're finding that it's easy to really 'program' a fresh new-grad into their specialty rather than have them do something else for a year, get into a routine and then have to retrain them all over again. Sort of the 'do it right the first time' theory. I've got a daughter who is starting kindergarten and is doing cheerleading. We've got the option of 8 hour days or 12 hour days, so I'll probably opt into 8 hour days - even if it does mean working 2 more days a week.

Your post is an excellent example as to why Med/Surg nursing experience does not need to be a requirement for all nurses.

prmenrs, RN · Aug 13, 2006

I really think that, @ least in NICU, that med-surg year is a handicap. MOST of what they study in school relates to adults. A year in med-surg cements the adult "frame of reference" into their brains.

Newborns and premies are almost another species! When they come down from med-surg, it takes a lot longer to get the newbie on his/her feet and going if you have to jack-hammer all that med-surg stuff out of their heads 1st. So, so much easier to orient a new grad!

I did do 2+ yrs of med-surg, including ICU. It took me 6 long months to really know what I was looking @. I was used to being a competent adult nurse, I could look @ a pt and get a "Gestalt" of how they were doing. I was miserable not being able to spot when a baby was going to do something bad.

Tweety, BSN, RN · Aug 13, 2006

I feel people should go to areas that interest them.

I'd rather work with someone who wants to be a med-surg nurse, rather than someone forced to do something they don't want to do merely as a stepping stone to what they are really interested in.

Prioritizing, critical thinking, etc. etc. comes with time in any setting. People in speciality settings can come up with many examples of "mistakes new grads made in critical care" and I can come up with an equal number of "mistakes new grads made in med-surg". A new grad is a new grad. Let them be new grads.

jb2u, ASN, RN · Aug 14, 2006

Do you think somewhere on the internet a medical student is leaving a post asking..."should I go into general medicine first or straight to cardiology?"

:lol2:

prmenrs, RN · Aug 14, 2006

S/He will have to do Gen'l Med before Cardio!

But, if s/he wants to a Neonatal Fellowship, s/he'll have to do gen'l pediatrics 1st.

Nurses have done the "gen'l nursing" in school. When they graduate, they should go into a specialty if they want to.

JMHO.