The experience one gains after entering the work force determines the workers' value. The new RNs will realize this soon enough, or they'll remain specialists and limit their value.
Your Associated Press article Feb. 19 regarding residency programs for new registered nurse graduates ("Job-support system") discussed the issues facing an inexperienced RN in a Miami emergency room. Hospitals, including our local facilities, do newly licensed RNs and licensed practical nurses a disservice by allowing them to be placed in speciality areas.
When I was in nursing school in the 1970s, it was unheard of to start your career in an intensive care unit, ER or other speciality without first getting a year or two of basic medical-surgical nursing -- and the nursing shortage was critical then, too. I worked in an ICU at Medical College of Georgia Hospital, and the best RNs in the unit were those with the most floor experience.
I would really like to hear from a hospital administrator why this practice continues. I know new grads want excitement and/or prestige when they start working, but going to a speciality right out of nursing school is not in their best interest.
Martha Brown, RN
Hephzibah
Comments
The experience one gains after entering the work force determines the workers' value. The new RNs will realize this soon enough, or they'll remain specialists and limit their value.
PT: Leave this discussion for those who know what they're talking about, although it's never stopped you before. I can't speak for for the 1970's but I do know that nurses had even less autonomy than they do now.They were often seen as the Dr's handmaidens. Things have changed, Somewhat for the better. During nursing school you go through a series of clinicals, from, med-surg, OB, Psych, Community Nursing, etc. Also electives such as perioperative nursing, cardiac, nutrition, etc, were offered. Your final qurter was senior practicum in the field you chose.Those in my class used their experiences to see what type of nursing was the best fit for them. Most also worked as externs in hospitals after their junior year to gain more experience. I joined with the VA and their VALOR program between my junior and senior year. We had one day of class per week where experts in various fields lectured, the other 4 days were spent under an RN preceptor in each nurses specialty of interest. After the summer we continued to work with the preceptor during our senior year. My interest happened to be Open Heart, ICU and this is where I stayed. When I started full time employment with the VA (cont)
we had an extensive critical care course. I won't mention her name but the instructor was one of the best I ever had This was 1993 so if she reads this, she'll know. I then had an extensive orientation period, again under a preceptor. I say all this so readers won't get the impression that their ICU nurse jumps right into the job with no training or experience. As far as whether or not an ex floor nurse makes a better ICU nurse, I've seen it both ways. Some new nurses as well as some with years of floor experience just couldn't cut it in an ICU setting. Some new nurses as well as some with floor experiece turned into very good ICU nurses.It depends on the individual. As far as limiting their value, my years of ICU training and ACLS instructor training, have opened more doors annd furthered my career(and pay) more than any number of years as a floor nurse would have. In the end it boils down to what you have a passion for. If a nurse is stuck for years in an area he or she doesn't like just to satisfy some arbitrary number, you run the risk of that nurse seeking some other profession.
TechLover-good comments! I too have seen (and precepted) RN's, both straight from school and others from the floor...and TechLover is correct..a lot does depend on the individual and their willingness to learn, etc...the extensive orientation and preceptorships that are given are done so for a reason...the question to ask might be why the RN:patient ratio is not better...
TechLover, well said! This should just about end any further discussion on this article. GGpap
julie:Some times the ratio is insane, especially on the floors. Even in CCU where I work, for some crazy reason, staffing is done at 1700 and then again at 2100. We started the night with 3 patients which called for 2 nurses. We then proceeded to get 7 admissions over the night (only a 10 bed unit thank God). Luckily we had a charge nurse covering CCU and ICU who assigned someone in ICU charge there, then took patients on our side. Ended up with 2 nurses with 3 patients apiece and I had 4. Scary, scary night.
I have been in the nursing field for 27 years and i have worked floor nursing, ICU's and doctors offices. I have to disagree with Martha. You will see things and experience things in an ICU that nurses that have been on a floor for 30 years will never even hear of and would run the other way if you asked them to do. There is something to be said for on the job training, not just in Nursing but in all fields. You can read as many books as you like and work as much floor nursing as you want, but until you have been in a situation (with peers that have been in that same situation many times before) no amount of floor nursing will prepare you for it!
May I give an example?? During a recent disaster when some stable ICU patients had to be moved to another area to make room for the disaster patients, an RN was pulled from the floor to supervise because there were only a couple lowly LPN's with the patients. The RN ran away crying saying she "just didn't think she could handle it" !!!! So then they brought another RN down and she had to ask about everything she did and refused to give a patient a sedative because she had never used it on the floor!
As always PT thinks that he is the final word on everything. Doctors are expected to specialize right out of Internship and residency, nurses can do the same. Some choose long term care and others choose CCUs while others still choose to remain in flaot pools and gain knowledge and understanding of all areas of hospital nursing. Nurses are the unsung heros of health care and always will be. A nurse practitioner friend of mine once said to me "Doctors diagnose while nurses heal" this is the truth at all levels of nursing.
As a soon to be nursing graduate, I would like to say that I have heard that you need at least one year of med-surg before going into a specialty area. That is the old way. The reason..to become organized, not learned. A year of my clinicals was spent on the med-surg floor. Yes, nurses are needed in specialty areas NOW. So, the hospitals hire them as a senior student nurse, train them and precept them, even after graduation before licensure. This, in addition to the clinical experiences, prepares new nurses for the specialty areas. Based on my clinical experience, I do not think I would ever want to work a med-surg floor. That's just me, though. 5 or 6 patients to one RN is not my idea of quality patient care. I am now precepting in the ER. If for some reason, I am not comfortable with my responsibilities, I can look elsewhere. My expereince in the ER will be a plus not a minus. However, I am in the 'honeymoon' phase and can't wait to get out there!!! The young lady in the last article was in a different phase at 9 months and should've hung in there if nursing was truly her 'calling'.
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