What did you do when you graduated? Did you get the experience you needed?

[TheCruiseAcademy]

I got out of school way back in 1996... back when there was no nursing shortage. Actually, there was a glut of nurses and you had a hard time finding a job, especially if you were a new grad.

I worked as a nursing assistant on a surgical floor in a hospital with hopes that I would be hired on after passing the boards... no such luck. They didn't hire 'new nurses' and there were about 4 of us who worked there who were in the same class.

So, I went off to the nearest nursing home that would hire me, I think I made a whopping $13 / hr as a GN before I took my boards. I learned some, mostly gave meds and did treatments so I got some good knowledge of that and wound care.

As luck would have it, my hospital called me after a month or so and said they were hiring us all, and I had a job on my floor, 5 north, the post-op unit. I was elated.

We did an classroom orientation for a week and did IV certification, and then it was off to the floors. I had a few really great preceptors and learned so much during that period; much more than I ever could have learned in nursing school. Eventually, after about 6-8wks I went to my position on nightshift. The unit was a 32bed unit, and generally there were 3 nurses on nights, 4 if the census was at capacity.

I worked on that floor for 2 years, and I will tell you that it set me up to be the great, knowledgeable nurse I am today. I definitely advocate everyone gets at least 1 - 2 years of good med-surg experience. You will be the well-rounded nurse who knows his/her stuff.

Once you get the experience, then go to your specialty. OB, Critical Care, ER, ETC.

I don't think new nurses should be working in ERs or ICUs, I think those units are specialty units where highly trained nurses ought to be. You can't be highly trained nurse if you just passed the boards. I think a new nurse would learn a great deal, but it's just too much at once.

Learning the basics and getting comfortable with your assessment skills on not so critical patients needs to come first, before you can assess critically ill patients. Just my opinion, so please feel free to disagree; it's ok, but keep it nice.

I'm a nurse, A critical Thinker and Jack of all Trades. These are skills I have learned from being a nurse.

Common Sense + Good Knowledge Base + Adaptability = A great nurse who will succeed.

BSN NOT REQUIRED!!!

I guess you know my stance on that subject!

[AmandaWIRN]

I disagree that a good nurse needs to have 1-2 years of med/surg experience.... If given a proper orientation program, I have seen many nurses succeed as new grads in the ER or ICU. I have never worked med/surg, and I'm a damn good ER nurse. I started off as a new grad in a very specialized area- peds oncology/chemotherapy, and did fine. I switched to ER after doing that for a year and a half.

[TheCruiseAcademy]

Amanda -
I was merely expressing an opinion as a nurse who considers herself 'well rounded', it was certainly not an attack on anyone who jumped right into their specialty.
If you'll notice, I even stated: "I think a new nurse would learn a great deal, but it's just too much at once."

I stand by my opinion, as I am entitled to. I'm sure you are a great ER nurse, but when you specialize, your knowledge base may not be as broad as a generalist's might be. There are some things you will never see in an ER, that you would on a floor.
I personally never had a desire to work in an ER; however 12 years later, I sure know that I certainly could.

New nurses make mistakes; seasoned nurses make mistakes. We're all human. However, when a family member or I go to a hospital in an emergent situation, I want a nurse who's got some experience under her belt, not someone who is still green and can't get an IV or doesn't know her ACLS backwards and forwards.
Same in an ICU / Critical Care unit.

Again, just my opinion. I feel the same way about med students and residents.

[AmandaWIRN]

I disagree again, that there are things seen on the floor that aren't seen in the ER. Where do you think the majority of med/surg patients come from??? The ER.

On the contrary, I know for a fact that there are a lot of things seen in the ER that aren't seen on the floor. In addition to med/surg patients, we also take care of ICU patients, trauma patients, surgical patients, psych patients, pediatrics, obstetrics.....

I know that most ER nurses could go to the floor and do the job of a med/surg nurse (we do that all the time when we have to hold patients in the ER, after all), but most med/surg nurses would not be able to come to the ER and take a full patient load without a period of orientation.

[TheCruiseAcademy]

Again 'Amanda', we can agree to disagree, however I don't understand why it is necessary to to be so hostile and negative towards my post.

I started the thread to gain the opinions of nurses as to what they got, and what they thought about it. It specifically said it was an opinion. Of course, someone has to turn something innocent into a negative 'sparring' contest.

And you are a moderator? I guess your job is to shoot flames into a thread to keep folks coming back.

There are in fact things in BOTH departments that are proprietary to the individual department.

I've received MANY a patient from an ER nurse who I thought to myself... you know what, I'm not stooping to that level.

:23: This is a conversational thread, not an attacking one so I won't do that.

[AmandaWIRN]

I was in no way being hostile, just stating my opinion. You state that you posted your original thread to hear other's opinions, but were you prepared for the fact that some people's opinions might be different from yours?

Yes, I am a moderator, and no my job is not to "shoot flames" at others- which I did not in any way do. My job is to facilitate discussion amongst board members, and we encourage others to share differences of opinion, which is all I was doing. If you are going to post threads asking other's opinions, then you need to be able to accept that not everyone is going to agree with you, and you cannot accuse others of being "hostile" or "shooting flames" when all they are doing is expressing a difference of opinion....

[cassioo]

I worked as a nurses aid at 2 hospitals during nursing school one was an oncology/resp floor with 40 beds with lots of total care patients. The other was a ortho/neuro/uro floor with 20 beds and a 4 bed neuro stepdown unit. When I graduated I went to another hospital part-time peds 1 RN and 1 LPN at night 2-3 RN's during the day(that also go adult overflow when slow) and part time surgical 2 RN's, 2 LPN's 2 NA's at night with 40 pts. I also continued perdiem on the ortho/neuro at the other hospital and picked up per diem peds/PICU at that hospital....after a while the "home hospital" I went to full time peds and dropped the surgical. After 5 years went to home health through the hospital and took care of all of the peds pts in a rural 3 county area and if not enough peds patients saw adults drawing labs and I had a few adults that were my primary that had weekly IV infusions. If somebody couldn't draw a lab I'd get sent "she does babies she can do anybody" which isn't always really true. I've been L&D for the last 7 years. At my hospital besides L&D I take care of anybody pregnant and do all kinds of testing NSTs, Amnio, etc, post partum and GYN surgeries, csections and tubals and PACU. I'm certified in inpatient obstetrics, ACLS and a NRP instructor and on too many committees to count including P&P. I've also taught OB/Peds clinicals at the community college level

In general I think it's not a good idea to go to a speciality unit to start BUT that also depends on the individual nurse, training and drive. I think taking care of lots of patients helps with learning to prioritize care but then in a specialized unit you still prioritize what type of care an what treatments you do first for you lesser number of patients.

I've worked with new grads that have come right to L&D that do great and those that don't do so well. I've seen the same for general units. It's an individual thing and it goes from one extreme to the other and everywhere in between...some swim no matter what unit you put them in and some sink no matter where they are. That's what's good about nursing there are many avenues for all different tastes and talents.

[TheCruiseAcademy]

Wow, it's interesting where you started and where you've come. I worked as an aide for 2 yrs on the floor I ended up working on, it was really good experience. I loved it until I hurt my back, then I sought our different jobs that were less physically strenuous.

I worked in a prison for many years; did lots of teaching to inmates, became a certified HIV counselor, handled lots of varied emergencies. You see it all, anything from the oh so common sprained ankle, to status asthmaticus, flesh eating MRSA, head injuries to knife wounds. You do a combination of ambulatory, inpatient, ER, and teaching. I really loved it.

Some folks are afraid of working in a prison / jail environment, but I felt much safer working there than I did in a psychiatric hospital where there is no one arm's length away from you to protect you from harm. It's nice to hear how other nurses got their start. I wonder how many of us actually have worked as aides prior to becoming a nurse; a lot I think.

A lot were LPNs first too. I'm sorry that LPNs have fallen from popularity in the job force. I think LPNs have their place in nursing. I think alot of the delegation going on these days should not be happening to unlicensed personnel as it does, but to LPNs. I've worked with some Super LPNs who were more skilled than some RNs I've worked with. It all goes back to your training I guess.

[Aaron C.]

In my opinion IDEALLY you would like to have nurses working in the ER/ICU to have had some prior nursing experience.

I don't think it is by any means necessary, however it would seem logical to require that if you could.

[JennyP]

I'm an old 3 year (mainly hospital-based) diploma RN, and back when I went to school 40 years ago we were pretty much told that: A.) you HAVE to work as an aide and practical nurse during the 3 years to understand nursing; and B.) you were assigned to be charge nurse on a floor before you graduated.

I've spent my last 34 years in critical care; and I've seen many young grads right out of school start out in ICU. I used to say that all new grads had to spend a year or 2 in Med/Surg; but I've come to view Med/Surg as a specialty of its' own. I have a very deep respect for nurses in every area of medicine; IMHO, it's becoming less and less possible for a nurse to learn all of the skills needed to stay current in every area of a hospital these days.

I remember my last time being floated to a step-down unit; the reality of caring for 4 or 5 patients was terrifying to me! Even scarier for me, was the fact that *those* patients got up on their own and left their rooms!

We have to break the old saying that "a nurse is a nurse is a nurse" because it just isn't true any more. We are all specialists; and we should be darn proud of that fact.