New Nursing Graduates in Specialty Areas?

New Nursing Graduates

This month I have the honor of hosting the Nurse Blog Carnival and the age-old question, “New nursing graduates in specialty areas?”

As a nursing instructor, I get to hear a lot of dreams and goals from my students. I actually encourage it. It helps give them direction and really start thinking about their careers. As with most dreams, they are lofty. Although I encourage dream building, I also try to encourage them to be realistic. I like to remind them that dreams and goals are often obtained after a journey and usually some sacrifice and hard work.

Most nursing student goals are about working in specialty areas. The place they always dreamed of working and often the reason they became a nurse. However, sometimes, in their educational journey, they run into dream crushers. You know them – the ones who paint the dismal picture of how “you MUST get a LEAST a year of med-surg under your belt”. Well, although not a popular opinion, I don’t necessarily agree. I think there is place for new grads in specialty areas – they just have to be the right candidate. Just like you need the right candidate for a med-surg position.

The Bossy Nurse also agrees with this not-so-popular opinion. In their article The Myth of Medical-Surgical Nursing: Why New Grads Should Pursue their Specialty of Choice, she gives some great advice on why seeking a position in your ideal specialty is a good idea. I particularly like how she sums it up with, “Any specialty in nursing can give you a foundation in your desired nursing practice.” I couldn’t agree more!

I almost fell prey to those dream crushers. However, I took some advice from a wise, old nurse who gave me some wonderful career advice – “If you want to work anywhere, get some ICU experience! You just might have to make some sacrifices, but I know you can do it.” (That wise, old nurse was my mom & it was good advice!) I graduated from nursing school in Brooklyn, NY in 1998. You could hardly find a job after graduation at the time and forget about a job in a specialty area. So, after a job hunt and some work put to an ATS-friendly resume, we made some sacrifices and moved to…. Memphis, TN for an ICU internship.

Yes, it was hard. Yes, we made the sacrifice to move from our families. But, we had a dream and a goal and that sacrifice paid off. I can attest, it was one of the hardest things I did. I thought I studied a lot in school – learning ICU care was even more challenging! And the learning curve was steep. But, I was more invested and loved all of it!

If you are interested in what it might be like to start off your career in the ICU, you have to read An Intensive Start to Your Career at This is an artful and articulate description of what it is like to start your nursing career in the ICU. They even have a link to ICU internships listed by state. Although typically very competitive, you never know unless you apply!

Like I mentioned before, working in a specialty area right out of school is not for everyone. I precepted quite a few new grads in the ICU and they are not successful as they did not really investigate all that would go into starting off in a specialty area. Brittney Wilson, BSN, RN at The Nerdy Nurse gives some great career advice in Best Nursing Specialty for a New Grad. She gives frank advice on the reality of career choices and some tangible advice on how to land a job in a specialty area.

Although “old thinking” is sometimes hard to change, it does change and is changing. However, don’t get locked into the idea that you HAVE to have your dream job as your first job. Again, dreams are things we aspire to and move towards. I often tell my students, your first job might not be your dream job, but all experiences are invaluable and will lead you to your dream job.

So, should we have new graduates in specialty areas? Sure, why not! But, more importantly, we need to make sure we have the right person for the job. It is human lives we care for, and for that, our choices need to be made carefully and wisely.

What are your thoughts? We would love to hear what you have to say? What are your opinions and experiences? Leave a comment below and lets start a conversation.

This post was written as part of the Nurse Blog Carnival. More posts on this topic can be found at If you are interested in participating find out more details and sign up.


Nurse Blog Carnival


18 thoughts on “New Nursing Graduates in Specialty Areas?

  1. Hi Joan!

    Thanks for dispelling the myth that new graduate nurses should only begin their careers in Med-Surg. Specialty placements right out of school are challenging because of the competition, but not impossible. And, the learning curve may be steep, but it’s doable if you handle stress well, have a great support system, are a fast learner and have great critical thinking skills. Great post!

    • Thanks! I am proof it is possible, maybe not easy, but possible. Therefore, we shouldn’t limit people’s potential! Thanks for participating!

  2. I think the nursing industry as a whole is still very much split on this topic. I think that the nurses who have been practicing longer think nurses need to work in med-surg first, but “fresher” nurses look at things differently.

    Great topic! It was a fun topic to contribute to.

  3. Great post! While most nursing positions prefer newer nurses to have med-surg experience….. it is definitely not for everyone. I went straight into Neonatal Intensive Care out of nursing school. However, after the recession in 2008, healthcare and nursing changed. In many areas of the country , new grads are lucky to be hired into any job.

  4. I currently work in a CVICU and it’s very rare for us to hire new grads. We have on occasion, depending on their experience and what kind of preceptorship they had, but we have a 12-week orientation and when they’re done with it, they’re expected to be able to take fresh open heart surgery patients. Like you said, if they’re the right person, it can totally work out. But I’ve noticed having some kind of background really helps, especially if it’s cardiac related. Going to critical care requires a lot of extra special training and it can be overwhelming, especially if the new hire is still trying to figure out time management and other basic skills you can only figure out once you start nursing. Just my thoughts on the matter. 🙂

    • Thanks so much for stopping by! I totally agree – definitely not for everyone, especially if you don’t want to put in the extra effort to learn on your days off. Thanks for being part of the conversation!

  5. Thank you for writing this! I graduate I’m May, and my dream is to be an ICU nurse. I have heard over and over that I have to start on a med-surg unit. I realize that yes I may have to, but thank you for re-encouraging me to shoot for the stars! 🙂

    • Never give up on dreams!! They might not come true immediately, but with work, dreams come true! So glad to be an encouragement!

  6. I will be graduating in a very short 23 days and have recently accepted a new graduate position on the Pediatric, PICU and NICU floors at one of the local hospitals here! I had been told time and time again that my dream to work as a Women’s and Children’s nurse would have to wait after I gained some experience. I was totally okay with this idea, but kept pushing for what I knew I wanted! I am excited and nervous all at the same time to begin this amazing adventure! Thanks for a wonderful read!

    • Congrats!! Such an exciting time! Enjoy every crazy moment of your graduation time! And super congrats on getting an awesome, well coveted position! Get ready for a wonderful new adventure. Considering your diligence, you will be fine – continue that motivation as you continue to learn and grow! And don’t hesitate if I can ever be of support!! We gotta stick together!! Glad you found the encouragement in my humble little blog! Thanks for the kind words! Take care!!

  7. I totally agree that a new grad can flourish in a specialty. Mostly because if they have plans to stay in that unit and they are invested then the staff in that unit can shape them into an amazing nurse before they pick up other habits. I myself did the med surg route first before moving into ER but I’m thankful for that because prior to that job I wanted peds and labor and delivery, if I had started there I would’ve been well versed in things I’m not using now. So I value my med surg experience in the ER, but if I had specialized early I might not have gone this route. Also I encourage new grads not to be too set just so they don’t limit their opportunities, but I totally think shoot for the moon!

  8. I just recently graduated and although I had my heart set on ICU (that’s where I did my preceptorship in school), I ended up landing a night shift position in Intermediate (critical care step down unit). I also knew med/surg nursing wasn’t for me and I knew I wanted a more specialized critical care area. Ill do my time in Intermediate and then try to transfer to the ICU.

    • Don’t sweat it young grasshopper- EVERY experience you have will be valuable – I promise!! I started out in a step down unit – that was super hard work, but it definitely prepared me for my next step in the ICU! Show them your awesomeness and they will come begging for you! Good luck & never hesitate if I can help!!

  9. I, personally, think that the policy makers at the hospitals also play big roles in deciding whether or not new grads can start in any units but med-surg. I say this based on what I see going on in one of the local hospital group in Jakarta, Indonesia. The hospitals policy says All new grads must start off with med-surg for one year before they can request to work in ICU/E.R/O.R. By the time they complete their one-year “probationary period” at the med-surg units, the position(s) in the ICU/E.R/O.R may not be available anymore as it is given to new nurses who have previous experience in those specialty units. Then the new grads will be stuck for another year working in the med-surg units or they resign.
    I tried to change this in three out of ten hospitals here. It is not easy to convince each hospital’s management to change the policy but those three hospitals have seen the differences in the staff and patient satisfaction scores after they let new grads start off in their preferred units. Still have seven more to convince 🙂

    • Very interesting to see this is truly an international problem. Thanks you so much for taking the time to share your experience and for being a change agent! Good luck with the other hospitals!!

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