Why Choose a Large Teaching Hospital?
If at all possible, one of the best places to train is a hospital associated with a medical school. By the same token, your first job as a nurse in one of these facilities can be one of the best experiences you may have in your career. Patients in a teaching hospital are primed for students and these patients have a good understanding of the culture in a learning environment. These facilities often have more funds available to afford the most state-of-the-art equipment. The doctors are usually well versed on the latest in procedures and treatments. You will be exposed to patients with far more complex diseases and those having experimental treatments.Start General — Then Specialize
Once you have a strong foundation of experience in basic nursing care for adults, you can branch out into more specialized care and you have options to go anywhere in your career. You will always have the confidence that you have developed skills and seen and done a wide variety of procedures successfully. If you don't have this opportunity, opt for the most general experience you can get in your area. No matter how much experience you may have gained in school, a good solid foundation as a generalist will give you the tools to build your career in any area of nursing.
Not all new nurses will find jobs in general med-surg nursing, but if you have an opportunity to do it first, grab it and if not, try to float through as a per diem nurse. You won't regret it. Some nurses feel that it is not necessary to have a year's experience in med-surg nursing. However, if you want to eventually move into something like home health or another field in which you will have a lot of autonomy, you really do need a general background. You will always be glad you made this choice.
This general background will give you both the experience and the credibility to be able to move laterally and to move upward. The additional advantage is that even after a long career in a highly specialized area, most nurses with a strong generalist foundation will find the courage to move into a whole new realm much more often than those who headed straight to their specialty area after graduation and stayed there for ten years. These nurses tend to feel trapped because they have been pigeonholed and don't have a general background to fall back on.
One of the reasons most nurses leave nursing is because of burnout and feeling trapped with nowhere to go because they are too specialized and making a change would take too much re-education. This seems to be especially true for those wishing to move from something like pediatrics into adult care.
The nurse with the general med-surg background has many opportunities to move directly out of the hospital into areas such as clinics, home health, and case management. With some additional training or internship in a specialized area, they can move into a multitude of areas such as ICU, pediatrics, rehab, oncology, and women's health and clinical trials.Broaden Your Horizons
The one advantage of the nursing shortage is that you can find a job almost anywhere. Take advantage of it and get the best experience you can in your first year. Then the whole world of nursing will be wide open to you. Look for an opportunity in a supportive environment. With the nursing shortage worsening, you might find yourself working in an area staffed primarily by new grads and nurses who have only one or two years experience.
This won't afford you the best scenario for finding help and guidance as a new nurse. Think about some of the hospitals where you have done your clinical rotations. Which one might offer you the best opportunity to spend at least your first year gathering all the experience you can get? If you took the opportunity for an externship program as a student, you may have gleaned some valuable insight into finding an employer who is going to offer you the best place to spend your first year as a nurse.
Some career counselors feel that nurses can move into any field with ease and succeed, because of the nurses' training and their strong critical thinking skills. Nurses have a well-rounded education and are trained to think on their feet.
Externship programs are usually offered to student nurses during the summer months. You work in a clinical environment under the supervision of a preceptor. This is an opportunity for private tutoring to learn procedures and to see firsthand the day-to-day functioning of the hospital. Unlike an assignment in school where you may only care for one or two patients on a very limited basis, in an externship program you will work with your preceptor as he performs his daily duties.