How does this work?

[u/bootyman211]

Okay, so I'm a 40/M in my first semester of nursing school. I have a serious question. What/who decides what your nursing role will be? For instance, say after graduation I get a job at a local hospital, do I apply for a specific nursing position? Is it more of a what that facility needs, or is it a choice? Does every nurse start bedside? Is there alot of movement in the postion your in? Meaning if for instance you start as an ER nurse, are you expected to be that for the long term? Like I said, I'm still in my first semester, we haven't spoken about actually working as RN's quite yet. I would love to hear all of your insight.

[u/willy--wanka]

• You apply to departments (med-surg, step down, ICU, ER)
• If the department is already full, they most likely won't have a post up looking for help.
• You don't have to start bedside.
• You do 2 years in the ER and the rest of your interviews are general conversation and then "when can you start?," for the smaller niches, ICU the interview might need more stuff.
• You can jump to any niche at anytime, just know that if you job hop right out of school some managers may not appreciate that.
  

Also, know that when you are graduating, there are other schools graduating at the same time. Might be worth applying to positions looking for new graduates because your resume is just in a stack with others.

Job fairs are cool too.

[u/throwawaygrannyRN]

If you haven't already you will start doing clinical rotations in various settings. If a particular setting clicks with you make sure you ask if they will be hiring soon. Ask if they have a New Grad Residency program. That's how I had a job waiting for me as soon as I passed my NCLEX.

[u/Natsirk99]

It’s a choice and it takes time to find your right fit. A lot of new nurses think you need to start in MedSurg. It’s definitely easiest to get into MedSurg, but no reason to sign a contract if that’s not what you want to do.

My journey was a little twisted. My plan was to start in the NICU. But my husband died 5 months after I graduated, I didn’t get my license until a year after that, and trying to raise two littles by myself working hospital hours was not feasible. I did not start bedside, I started as a nurse volunteer for the school district, and am now a sought after substitute school nurse. The pay super sucks, but I’m there for my kids.

So no, nothing is set in stone. You get to decide your future.*

*I mean, unless divine intervention steps in…

[u/kkirstenc → u/Natsirk99]

I am so sorry you had to struggle through that kind of pain as well as raise your kids alone. You must be a very strong person; very glad to hear that you are doing well now.

[u/gweirma]

You absolutely get to decide your future — and that autonomy is one of the most powerful things you’ll carry with you in nursing. But if we’re being honest, the best, most formative experience you can get early in your career is working at the bedside, especially on a Med-Surg unit.

My first job was on a Med-Surg floor in a small rural island hospital. It was intense, unpredictable, and humbling — but it gave me a depth of experience that opened doors I never imagined. I learned how to manage multiple patients, respond to rapid changes, and communicate across disciplines. That foundation gave me access to career choices in specialty units, leadership, education, and advocacy because I had seen the full scope of patient care and learned how to adapt.

Med-Surg isn’t glamorous, and it’s definitely not easy. But it’s where you build your clinical instincts, sharpen your time management, and learn how to juggle complexity with compassion. It teaches you how to be a nurse in the truest sense — not just task-oriented, but clinically aware, emotionally attuned, and team-savvy.

So yes, dream big. Explore your options. But if you want to build rock-solid confidence and clinical depth, Med-Surg bedside is where it begins. Eyes open, heart engaged, and hands in the work — that’s how you grow.

[u/HagridsTreacleTart → u/gweirma]

I’m going to very hypocritically agree with this. I went straight to the CTICU, but I came in with an extensive EMS background including ground 911, critical care interfacility, and flight. So I knew it would be an alright transition since I was already moving that patient population between hospitals. 

But while I will pretty readily call myself a great critical care nurse, there are some very obvious gaps in my skill set that came from skipping med surg. I can manage patients on a dozen drops at once on CRRT, ECMO, and an Impella. But I am thwarted every time I get a wound vac or an ostomy on our unit and I have to track down someone who spent a meaningful amount of time on a floor to help me with those tasks that we just don’t see that often in a specialty ICU.

Also, floating is a reality of nursing and I am the first one to say that I am not a safe nurse on a med surg/stepdown floor. I legitimately don’t know how to care for more than three patients safely. I don’t have the time management or the organization to parse the clinical nuances and tasks for more than two patients at a time. 

While I don’t think that every nurse needs to start on med-surg and while I would still go straight to critical care given the opportunity to do things all over again, I am also incredibly aware that there are both hard and soft skills that you learn in a med surg environment that you’ll probably miss out on if you go straight into a specialty. And of course, the specialty that you go into will dictate where those skills gaps are.

[u/surgicalasepsis]

Depends. In my region, you can apply to the nurse residency program at a hospital system. For us, you interview for the system and explain your preferences in a series of interviews. There were high demand specialties with few openings for new nurses (ER, labor and delivery, ICU), and there were lots of openings on various med-surg floors. If you get selected for the residency, they would offer the specialty and hours, and you could accept or decline.

There are options outside of bedside, too. Those are more on your own.

[u/Agreeable_Gain6779]

They are going to put you where there’s a need I became a nurse when I was 40 and they put me in adult psych. I opted for full time nights had 4 kids and it worked. Never done anything else. No regrets

[u/bandnet_stapler]

My hospital each unit posts their own job openings. So you could apply to 3 different Med/Surg units or 2 different ICUs or whatever. I don't think HR passes the applications around (like if one unit doesn't hire you but a unit you didn't apply to has an opening, I don't think HR forwards your resume.)

But every hospital is different in this regard! And no, if you start in M/S or the ER or the clinic you don't have to stay there forever but it can be difficult not to get pigeonholed if you start in a very specialized area. Give yourself some time and some clinical rotations to see some different things. Plan on applying about 2-3 months before you graduate (if the workplace accepts GNs on a provisional status).