Med/surg and new grads: A 21st century conundrum

By | 2015-10-26T16:18:26-04:00 October 27th, 2015|3 Comments

In 2015, the employment landscape for new nurses is challenging, to say the least. New graduates face tough competition for limited positions. For those who feel compelled to get a year of med/surg experience under their belts, the going may be even tougher.

Dying med/surg tradition

When nurses leave school and enter the workforce, most are advised to land their first job in med/surg, a setting where they can sharpen previously acquired skills while amassing new skills and knowledge. Med/surg is a fantastic place to cut your teeth, but the simple reality is that there are more new grads than coveted med/surg positions.

Frustrated by their inability to find employment in med/surg, many new nurses may feel their nascent career is already ruined, especially because of the persistent myth that any other position won’t prepare them for a long and satisfying career the way the golden years of med/surg could have.

Perhaps the era of every nurse experiencing even one year of med/surg is dead, and a new method of welcoming novice nurses to the fray must be born.

Alternatives to med/surg crucible

We nurses must acknowledge that new graduates may just not have the opportunity to undergo the crucible of med/surg training that many of us feel they should experience. While it’s a lovely thought that every new nurse would be so welcomed into the profession, the times have changed, and new nurses need novel avenues through which to begin their careers.

Nurse leaders in practice areas where new nurses can safely function must be open to welcoming novice nurses among them, while providing mentoring and oversight that will help the new nurse practice safely and successfully. In this regard, staff nurses need to be educated and guided to be skillful mentors and preceptors. Openness to novice nurses begins at the top, and rank-and-file nurses can follow their leaders’ examples of grooming new nurses for success.

Profession must innovate

New nurses face a difficult healthcare ecosystem. They are encouraged to enter the profession, indoctrinated that they can only begin a viable career via med/surg, then have door after door slammed in their faces when they lack the coveted year of med/surg experience to gain entry into our exclusive nursing club.

It’s time to create innovative programs for the training and orientation of new nurses, programs where the novice nurse is expertly guided toward the attainment of relative nursing mastery.

If we want new nurses to succeed as our valued peers, we must allow them to find meaningful work, even without experience. Our blindness to this very real nursing conundrum is unfortunate; we must remove our rose-colored glasses and see what’s in front of our collective nose.

It’s time for the nursing profession to create more entry-level opportunities for the new nurses who are, of course, the very future of our profession.


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About the Author:

Keith Carlson, BSN, RN, NC-BC
Keith Carlson, BSN, RN, NC-BC, is the Board Certified Nurse Coach behind and the award-winning blog, Digital Doorway. A widely published writer, Keith is the author of “Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century.”


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    Beth, ARNP November 1, 2015 at 1:21 am - Reply

    I believe there HAS been recognition in the nursing profession that new grads need a pathway to specialization. Maybe it has not gone mainstream, but those of us in the specialty of oncology realized years ago that new grads who wanted to make oncology nursing their career choice needed to develop a way to welcome and embrace these enthusiastic young professionals. At St. Vincent’s Medical Center in Jacksonville, FL, where I was the nursing manager of the oncology unit in the mid-90’s, we developed a 9 month internship for new grads. It was a tremendous success. Are there no pathways or programs like this in the major systems. My career turned away from management to advanced practice so I’ve not been closely following the trends.

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    Linda Lawrence November 2, 2015 at 1:16 pm - Reply

    Perhaps it’s not the staff who need to change. When I came out of school 37 years ago,I had completed my training by taking a course called team nursing. The difficult thing is that now new nurses have such skimpy clinicals because they have little hands on experience with real people. It’s frightening to see what my daughter who graduated 3 years ago went through. This just means that whatever unit you get a job on has to train you. It frustrates both the new person and their mentors.

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    Kate Walker December 14, 2015 at 1:09 am - Reply

    I have been a RN for nearly 35 and it shocks me how unprepared the new nurses are now. Before we could graduate, we had to demonstrate back basic nursing skills ( on a real patient) like urinary catheter insertion, IV insertion, wound and drain care, and so on. I am seeing new nurses that haven’t ever accessed a vein in 4 years of school. How do they expect us to take them on if we have to train them for a year or more to work as a RN? Most of us were prepared to be in a charge position shortly after graduation! I think these BSNs (of which I am one) are getting too much theory and too little practice.

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