CNO Roundtable

New Grads at the Bedside

Q: Do you think new grad RNs should earn their stripes in bedside med/surg before moving on to other specialties?

Katie Hughes, RN, MSN, CRRN

(pictured above, left)
Chief Nursing Officer
Casa Colina Hospital and Centers for Healthcare

I am often impressed by the level of critical thinking and knowledge new graduates possess and have no doubt that a new grad can be successful moving straight into specialty practice. However, I still believe that med/surg is a great place for nurses to start out. A nurse who starts in a specialty area of nursing may be limited later if they want to pursue a different career course.

Med/surg provides exposure to a wide variety of illnesses and interventions and is great for honing time-management and patient assessment skills. It provides a solid foundation on which to build a career in nursing. I think this is particularly important for nurses who plan to pursue a career as an advanced practice nurse. I certainly believe my experience working in med/surg — first as a CNA and later as a nurse — has helped me to be a better leader.

Jennifer R. Castaldo, RN, BSN, MSHA, NEA-BC

Vice President / Chief Nursing Officer
Henry Mayo Newhall Hospital

My message to new registered nurses drawn to a specific specialty is quite simple: A nurse’s intuition is a powerful force. It will help you to make better decisions, regardless of where and in what specialty you choose to practice.  I hope that all new graduates entering the profession will have encountered professors and mentors who understand the importance of imagination and intuition. Whether you are entering the workforce for the first time or a seasoned RN involved in training others, your intuition is your most valuable asset. My role is to ensure that all our registered nurses, including our new graduates, are supported and receive the training they need to provide the best care possible for the patient population they wish to serve, whatever their individual specialties.

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Derek Drake, RN, DNP, NE-BC, CNML, CNL

Chief Nursing Officer
St. Francis Medical Center

I absolutely, 100 percent disagree that nurses must “earn their stripes” before transitioning to specialty practice. We don’t require physician specialists to “earn their stripes” in general practice medicine, so why should we do the same for nurses? I firmly believe that with the training, precepting and mentorship, any new graduate can be successful in just about any area of specialty practice. I myself was hired as a new graduate in a very busy and complex surgical/trauma ICU. I was successful because of my previous healthcare experience, training, education, leadership team, educators, preceptors and mentors (whom I still rely on to this day). I believe in, encourage and practice hiring new graduates into specialty practice areas. As CNO, I try to replicate as closely as I can the strong foundations my new graduate program provided me.

Robyn M. Nelson, RN, Ph.D., MSN

Dean, College of Nursing
West Coast University

A new graduate should have the opportunity to pursue his/her passion without two years of med/surg! Service and academia should partner to offer accredited residency programs that provide a foundational transition into practice experience. Giving a new graduate a solid direct care, multiple-patient experience with the promise of specialty practice after six months to a year is a win-win. My opinion is that requiring new graduates to work in med/surg can lead to some new RNs feeling unfulfilled in their day-to-day work and disenchanted with their career choice. Some new graduate nurses may quit the nursing profession altogether before even moving into the specialty of their choice. With rising turnover rates for RNs and an average turnover cost (based on 2016 data) of $37,700 to $58,400 per position, why take that chance?

Lauren Spilsbury, RN, MSN

Vice President, Patient Care Services
Redlands Community Hospital

The common belief that new grads should receive their foundational orientation in a medical/surgical unit prior to moving to a specialty is based on two fallacies: first, that med/surg is not a specialty in its own right, and second, that people are not self-aware. People know what they seek in their lives. New grads don’t want to delay launching into their chosen new careers. My own nursing journey has been blessed with many different roles in multiple specialties. I want to share that same professional joy with all our nurses. We offer a robust transition-to-practice new grad program to provide a solid professional practice foundation for our staff in their chosen specialty areas. When it is time to explore other opportunities, we also offer shadow opportunities to provide a taste of another specialty and transitional orientation for “new to specialty” staff.



Irena Zuanic, RN, MSN, NEA-BC

(picture above, right)
Vice President / Chief Nursing Officer
PIH Health Good Samaritan Hospital

We do not require our new graduate nurses to start in medical/surgical units. I believe that a new graduate nurse can go into any specialty. I think that you can learn in every specialty of nursing and that you can transfer that knowledge to another field of nursing so long as you have a passion for the specialty. When you have an interest and a desire to learn, you are more likely to succeed in the specialty of your own choice.

For more from the CNO Roundtable:

2020: The Year of the Nurse and the Midwife

Your Path to Leadership

Lifelong Learning

Nurses in the Media

Staffing Challenges and the Silver Wave

CNO Reading List

Exciting Innovations

The COVID-19 Pandemic

Chief Nursing Officer Roundtable 2020 (homepage)


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