Nurses Are Talking About: Jobs for New Grads

Laura A. Stokowski, RN, MS

Disclosures

December 12, 2011

In This Article

Get Out of the Hospital

The premium placed on hospital med-surg experience puzzles some nurses who work in ambulatory care and community settings, and it prompts questions about what we are doing wrong in nursing education to continually produce new graduates who almost singe-mindedly aspire to jobs in acute care hospital nursing.

"I'm surprised at the disparaging comments about practice in long-term care and other community-based care settings, where clinical judgment, multidisciplinary collaboration, autonomy, creativity, and excellent organizational and management skills are needed. With an aging population and declines in hospital beds/stays, these areas need our brightest, most energetic nurses. While new grads perceive hospital nursing as the ultimate in practice, this simply isn't true. What are we as a profession doing to bury this simplistic and stereotypical thinking -- that practice in settings outside the hospital doesn't really count or may be OK as a temporary job solution at best?"

Well said. In a similar vein, another nurse suggests that new nurses' perceptions about nonhospital jobs are mistaken:

"Nurses need to wake up and see the changing world of healthcare. All the stereotypes I believed while in nursing school are not true. Long-term care and community health positions have traditionally been staffed primarily with LPNs, and we RNs have decided that these jobs are 'not challenging' or require a lower skill level. You practice the same skills in community settings as you do in the hospital, but you have more time to really interact with your patient and their families. Another difference? Instead of spending most of your time in the hospital documenting that you have done 'education' (which primarily consists of handing out brochures at discharge), in the community you actually do real education. Outpatient care is the future and we need to get away from this idea that 'real' nurses work in hospitals, or that outpatient nurses won't develop skills."

If ambulatory care is the future, we do need to prepare our nurses for these roles, a recommendation made in the recent Future of Nursing report.[2] Unfortunately, even these doors may be closing to nurses who are newly licensed but still without experience. A reader reports that even long-term care and home health employers are asking for a year of experience. Orientation and training are expensive, and rarely offered, as this new graduate relates:

"As a new grad I had a chance to take a home care position. But there was absolutely no training involved with this position. Basically I would have been thrown directly to the wolves. I really felt that this would have been an unsafe situation and just couldn't bring myself to take this job."

One solution might be to offer internships and residences in ambulatory care nursing, but such programs are still uncommon.[3] With adequate, well-planned residency programs, new grads could certainly perform just as well in ambulatory roles as they do in traditional hospital roles.

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