Why do instructors feel it is necessary to push new grads into a Med/Surg position?

[redmykal1524]

I have not yet graduated nursing school but I will be pinning on in August. I currently work as a nurse technician and have floated to many floors. I love the ICU and ED because critical care is a passion that I have. I have worked in these settings quite frequently and have already received hints as to when and how to approach a position in these areas. Managers are already waiting to pull me into several desired spots. I share this information with my instructors at my college and they snub their noses at me and tell me that I should really be thinking about a Med/Surg position to practice and hone my skills for the first year or two, and that they will not allow me a preceptorship in such a setting for that reason.

I do not dare to question them but I feel like this will slow down my learning for such a critical care position. How could such a higher level of care effect my assessment skills in a negative way? One would think that my skills would be even better "honed" in a critical setting than any other. I am curious to find out why instructors are so adamant to place new grad RN's into step-down units or med/surg floors. Do they not feel like they have done a well enough job in educating me? Is there secret assessment enhancement tricks on these floors that are not like any other? Do ICU nurses not possess sharp enough skills, that would hinder my learning and performance as a new nurse?

I surely am utterly confused and even more frustrated. Please enlighten me for I am writing my thesis on this subject for a final grade! Any journals, studies, or literature on this subject would be much appreciated because I, for the life of me, cannot find anything that supports their theory.

[llg, PhD, RN]

Some specialized units (such as ED, and ICU) do not offer good orientation programs for new grads. If you take one of those jobs as a new grad, you could end up "in over your head" and get your career off to a very bad start. That has happened to many people over the years. Note though, that some specialized units offer excellent orientations for new grads. So, it is not always a mistake to take a job in such a unit as a new grad.

Over the years, people who have seen new grads struggle trying to succeed in the more intensive units have come to believe that new grads are better off working with a more predictable patient population (general med/surg) for the first year or two of their careers -- further developing their skills before taking responsible for the care of more critically ill patients.

Some people feel that way. Other people disagree. You will find wide disagreement on the topic. I think a lot depends on the particular new grad and how much orientation support is available on the job as well as the culture of the unit.

[Fiona59]

Well, time spent in the trenches is never wasted. Time management skills are quickly honed. You learn the differences in your patient. Many a mere floor nurse has spotted the patient tanking before the doctor.

You'll also learn that many managers say things they can't follow through with. There are often experienced staff with developed skills looking to move to those units. My hospital put a mixed group of new grads and experienced floor nurses through an OR education programme. The new grads felt they were the perfect fit because they were used to the classroom setting. But they had a harder time on the course than the experienced med/surg nurses. The "old dogs" new what they were looking at with the patient.

[mina7]

I appreciate if anyone can help here; I'd like to know the answer to the followings:

1- Can some of the nurses who chose the med path after graduation share their experience?

2- To enter med school after practicing nursing for a year, is there a pre-med program at UBC Vancouver or should one enroll in chem, ochem, physics, etc., as an unclassified student. Can these prerequisits be taken while studying in an accelerated nursing program?

Thanks everyone for your comments.

[RN34TX]

The mentality of new RN's needing X amount of time working on med/surg floors is as old school/white hat nursing as it gets. Just another example of older outdated educators passing on outdated information to new nurses/students.

Yes llg is correct in that a good orientation/preceptorship is key to success but that goes for any specialty.

The fact that your instructors are refusing to let you precept in the area where you desire to be tells me enough. Don't let them steer your career upon graduation. You have to play their game for now but go where your heart and gut tells you after graduation. They are not experts in career management.

I work in a large university teaching hospital and my unit sees LPN/LVN, ADN, and BSN students from different schools on a regular basis for their critical care rotations. It makes no sense to me that a school does not have students rotating to a critical care area whether they choose to be ICU nurses or not.

We all had to do L&D rotations even though the vast majority of us will never be L&D nurses.

I've heard many med/surg nurses gripe that they don't want to train new grads to med/surg if they are only using their med/surg experience to springboard into another specialty after a year or two. It's a waste of their time and resources if you already know that you do not want to be a med/surg nurse.

[Fiona59]

I appreciate if anyone can help here; I'd like to know the answer to the followings:

1- Can some of the nurses who chose the med path after graduation share their experience?

2- To enter med school after practicing nursing for a year, is there a pre-med program at UBC Vancouver or should one enroll in chem, ochem, physics, etc., as an unclassified student. Can these prerequisits be taken while studying in an accelerated nursing program?

Thanks everyone for your comments.

These questions have nothing to do with the topic posted. Med/Surg nursing refers to medicine and surgical ward work by nurses.

Medical school is totally different. You need to talk to the advisors at UBC for this kind of advise.

[Music in My Heart]

I've heard many med/surg nurses gripe that they don't want to train new grads to med/surg if they are only using their med/surg experience to springboard into another specialty after a year or two. It's a waste of their time and resources if you already know that you do not want to be a med/surg nurse.

No it's not.

They, too, may one day find themselves as an ICU customer and be very grateful for the excellent foundation that their nurses might have received on a med/surg floor.

Or they might consider the value of having nurses who understand what it's like for the folks on the sending/receiving floors.

Or they may realize that we all owe something back to the system that has trained us up to the point that we are.

I despise the sort of attitude that you describe.

[RN34TX]

No it's not.

They, too, may one day find themselves as an ICU customer and be very grateful for the excellent foundation that their nurses might have received on a med/surg floor.

Or they might consider the value of having nurses who understand what it's like for the folks on the sending/receiving floors.

Or they may realize that we all owe something back to the system that has trained us up to the point that we are.

I despise the sort of attitude that you describe.

OK I think that to "despise" the attitude I've described is a little harsh for purposes of a healthy discussion.

My colleagues and I debate this issue from time to time but no one really gets that bent out of shape over it.

You are preaching to the choir in a sense that I am one of those nurses who went from med/surg to ICU. My colleagues who share your view on the subject say that this very fact works against me in that since I myself did not go straight to ICU upon graduation, I am my own invalidation of the theory that one can and should go straight to ICU if that is where they wanted to be in the first place. They also say to me "How can you tell new nurses and students that going to med/surg first isn't necessary when that's exactly what you did in your own career path?"

Those are excellent points but for me, I've seen enough examples of other nurses going straight to ICU and being successful that I don't think that new grads should all be sent to med/surg and discouraged from pursuing what they really want.

Yes I do see the value of prior med/surg experience as I was the only new ICU RN in my group to finish orientation early. They were still struggling with what I considered to be very basic nursing skills but they eventually caught up. They just needed more time because everything in nursing was new to them.