Wednesday, April 17, 2013

General or Specialty RN Jobs After Nursing School?

In nursing school we are exposed to the many different specialty fields afforded to RNs. We learn about critical care nursing, obstetrics, cardiology, pediatrics/neonatal nursing, and psychiatric nursing, to name a few. Some of us have a passion for one specialty over the other and can’t imagine doing anything else with our nursing career. However, I’m sure that all of us with an intent for specialty nursing have heard from either instructors or experienced nurses that we must have at least a year of general nursing first.

The thought is that working as a general nurse on a medical/surgical floor, for instance, will teach us how to become a nurse. For some new graduate RNs, working on a medical/surgical floor is desired and even sought out. For others, however, working as an RN on a floor that is not their ideal job sounds difficult and disheartening.

If we start off in the specialty we want, will we not also become nurses? Will working in the field we want from the beginning help to decrease new graduate RN burnout?

According to an article in the International Journal of Nursing Studies (Rudman and Gustavsson, 2011), nearly 1 out of every 2 new graduate nurses has experienced burnout and has considered leaving the nursing profession altogether. Is this related to an increased perceived pressure in doing a job they don’t want to do?

Many new graduate programs assist new RNs in finding and staying at specialty jobs they are interested in. A new graduate RN interested in working in a neonatal ICU right out of nursing school may get this opportunity through a new graduate program. This new nurse may then be more likely to continue in the nursing profession because they are satisfied at their job and not dissatisfied working on a floor they are not passionate about.
Many nurses also report that it is harder to transfer into a specialty unit after they have already been a nurse for a while than it is to start on that unit as a new graduate.

Have you had to work on a floor you had no interest in? Do you feel it made you a better nurse? Or did you get a job in the specialty you wanted right away? Are you a nursing student that is desperate to work in a specific area right away? Please share your experiences.


keyara brown said...

is it hard to be a nurse in like the baby part of the nurse

keyara brown said...

what do you have to do to be a nurse

keyara brown said...
This comment has been removed by the author.
Anonymous said...

I'm currently in the hiring "holding pattern". Our monopoly of a hospital only accepts so many new grad/interns every year. I have applied for 3 consecutive months with only two interviews (which I thought went really well). I did my preceptorship on the Oncology floor at my local hospital ( I had to jump through hoops to get it). Now they decide they aren't taking new grads in Medical Oncology. I'd love to specialize, but some specialties seem to think their patients are too fragile for newbies. I guess my point is.... in this market we can't always choose between General or Specialty, we have to take what is available just to get our foot in the door. Thank you for your Blog!

Anonymous said...

I think it all depends on the person, their level of motivation/work ethic, if they can pick things up fast, how they handle stress, and quite frankly for areas like the ICU where you apply a lot of technology to a lot of physiology, their level of intelligence.

I started as a new grad in a high-risk/high-volume cardiovascular intensive care unit (largest ICU in the state, transplant center etc etc.) I came in with a 10 week internship under my belt in an intensive care unit at the Mayo Clinic (general Med/Surg ICU not CVICU) so I thought I was somewhat prepared and had an idea of what to expect.

My first day seeing a postop heart with a swan, chest tubes, all these monitors etc (and he was considered stable!) I was overwhelmed I didn't know where to start! With that said I had a LOT of support from the people around me, many experienced nurses worked there on all shifts. My orientation was 5 1/2 months, I bought an ICU textbook and studied it as routinely for the different drugs I was learning about, reading up on ECGs, procedures (I also bought at CV Surgery textbook). My 5 1/2 months were some of the toughest months of my career BUT... I'm SO glad I did it. Was I an expert when I was off orientation? No, but could I practice safely and know when to ask for help or if I had a question about something, absolutely.

We had a lot of new grads start in our unit. One nurse who has been there a LONG time said he prefers that because we come in fresh, without bad habits developed and they start teaching us with a fresh slate. Don't get me wrong, we had some nurses from the floor who came up to us and were phenomenal and definitely had the basics and time management down. We had others who came with an attitude and they didn't last long. The same can be said for some new grads with attitudes or those who just couldn't handle the stress or frankly were smart on paper but couldn't apply it to the real world.
For the new grads who started who were good, within about a year or two they were taking care of some of the sickest patients in the unit and I would trust my life to them.

To summarize, I think it really depends on the person as well as the unit culture. Some people are meant to specialize right away, and some need to work on a general med/surg floor. WIth all of this said In many cases now days, new grads don't have a choice and the market will dictate where they work...

Anonymous said...

A great discussion here! For the new graduate RNs, you are our inspiration! At Barco’s Nightingales Foundation, we are dedicated to honoring the spirit of those women and men who choose nursing by focusing our philanthropic efforts on helping to mend the lives of children and their families.

The Foundation is always looking for stories to share from nurses from around the globe and across the country. We hope that by bringing their stories to life, more will join us in saluting their work and the work of all nurses, and that some may be inspired to embrace nursing as a profession.

Check out our information on Facebook or message me for more information at:

We invite you to join us as we continue to celebrate nurses and the profession of nursing! – Phyllis Grabot

Jim said...

My mother and sister are both nurses. My Mom retired after 40 years in a big university hospital (SUNY at Stony Brook). Sister is with Hospice and other part-time private duty cases, etc.

We've had multiple health problems in the family, so we are no strangers with the hospital. A relative of mine is one of those people who always has some kind of crisis everyday, and almost always way over embellished (basically, factitious disorder, etc.). Not only that but he soils himself all the time (number 2) but never makes an effort to go before he does, knwo why? Because the Nurses, he knows all too well, will come in, wipe his ass, and clean everything, etc. I am not mean, I swear this stuff is obvious.

Anyway, my point is that there wouldn't be ANY health care in this world if not for Nurses. Sure, they get to come in and be a hot shot, write a few things and leave. The Nurses, in my opinion are the ones keeping medicine from withering away.

My point is that these women (mostly, but there are some male) do all of this stuff without hesitation, preserve someone's dignity even though the patient often seems to not care about dignity.

I can't tell you how much respect I have for them, cause so many would suffer should they cease to exist.

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