med/surg

APRN., DNP, RN, APRN, NP · Jan 11, 2011

You can receive a great deal of time management skills by working in Med/Surg. Imagine for a moment, coming to clinicals and finding out that you, the nursing student, have 8 patients that you are responsible for, - for the entire shift from beginning to end - AND having to know what's important to include in the medical record - and know what the next shift RN needs to know in order to not crash and burn on their shift , and have to make the Dr. calls (and what's important and not important to call about), discharges (and what's important to chart and not chart), admits, family interventions (and what's important and not important to chart), out-of-whack lab notifications to the MD, as well of having a patient circling the drain and no-one believing you that they need to go to a higher level of care - so you spend most of your time keeping them alive while you go round and round with the doc trying to get them moved up to ICU.

Yeah....it's a little overwhelming.

As the RN - YOU are the patient's advocate. This literally means that you have a good enough working knowledge about what the Doc SHOULD be doing in order to act in the patient's best interest. If our patient's were educated enough about medicine, they wouldn't need a nurse, they could get by with CNA's to help with physical tasks.

The doc ordered a med that the patient is allergic to? You better be aware of that! The Dr. ordered for the patient to start on 40 Meq's of K Dur QID when the patient is getting dialysis for end stage renal failure? You had better be calling that doc on his/her mistake. Med/Surg will open your eyes to many "laws of the land" where medicine is concerned.

Soooo.....how do you know what to automatically as a Midwife when your L&D patient is circling the drain? What are the protocols that are universal to any hospital, anywhere? You gain experience working in your area of expertise first.

Med/Surg gives you a good jumping off point to gain general skills in this area. If a patient is complaining of SOB, how do you know what the Doc is going to order, and then what comes next after that order is carried out? Med/Surg will give you a really good grounding regarding what to expect.

It will also help you figure out what NOT to call about. In nursing school, you learn that a Hgb & Hct of 9.2 and 26.7 is really not good......However, in real practice, you learn that the Doc really isn't interested in transfusing until the H&H is lower. These things become instinctual, and become ingrained and second nature after working Med/Surg for awhile. .......Kinda like knowing when you need to leave for work/school early in your area because you know when the traffic is going to be bad or not. It just becomes second nature, like breathing.

THIS is why you are informed by so many different nurses that you need to get your feet wet in Med/Surg before going elsewhere. It is to help you.

carolmaccas66, BSN, RN · Jan 11, 2011

It's basically just busy, busy, busy. Insanely so when you have 7-10 patients, and half of them might be post op, you're trying to check observations (obs), cath bags, wounds, do neuorological obs as well as IVABs and other meds - then someone says 'Your patient is ready to be picked up/taken to theatre', so you have to schedule time for THAT and get handover from the theatre staff, who you may have to wait to see (cos THEY are busy too). And orthopaedics can be worse, because people who've had hip/knee surgery are suddenly immobile, so the buzzers start going and your pager goes so crazy, you think it's going to explode! Then u have to factor in emergencies, like your asthmatics, reactions to blood transfusions/medications, panic attacks after surgery and relatives interfering at times. Also people wanting to pee/poo so you need to consider how you are going to work that out after they have had surgery, ie: bottle, bedpan, can they hobble to the loo with their epidural in place, can they stand, will they get dizzy (always follow hospital/facility protocol re fentanyl/narc pumps etc - some patients aren't allowed to get up).

But I do enjoy the pace, and doing the IVABs and pumps etc. I like talking to the patients and hearing their stories. You can make any job as miserable or interesting as you want, I suppose. I also LOVE doing bladder scans - maybe I should be an US tecnician!

My advice is get fit, get very good shoes with cushion/support socks, (and keep another pair of shoes at work to change into if necessary), develop a great sense of humour, and get used to working 10-12 hours with no break sometimes. But do try to keep yourself hydrated as much as possible. But it's great clinical experience for sure, that will stand you in good stead for any job (just gruelling!)

oliviajolie · Jan 11, 2011

thank you so very much for all the replies. you guys have been extremely kind to me! from the threads that i have read, it's possible to conclude that i may be a good fit for med/surg as it keeps you on your toes- and i get bored easily (what can i say i'm a gemini lol)so i think in this respect it's good because it will keep my mind very active-which will make the 10-12 hour shift fly by quick. but......yes there's a but, being that i am a new student grad and as you know the school really doesnt teach all you need to know in the field, what if i screw up, meaning i forgot a pt's med or i didnt correct the MD on a med cause it's contradicts my pt's care will i be sent to the frying pan and i'm sure there has to be some kind of on the job training for the specific department that one will work but how long as those trainings? and even if i have finished training still being new am i allowed to ask for help if i become nervous or unsure of myself?

carolmaccas66, BSN, RN · Jan 12, 2011

You probably will forget meds and screw up. Hey it's part of the busy job.

There are other nurses to help you, and I don't do any narc meds fast - in Aust we need to double (and triple check these if necessary). If unsure, ALWAYS ask re meds and hunt someone down to help you. Sure they may be cranky cos they have got their own work to do, but most nurses are good. Remind people you are new, keep reminding them but don't keep saying sorry (I find that annoying personally and crawly too).

Just make sure you do yourself a plan for the night, like with a cheat sheet (most wards have these printed out, or on their compter, or you can make one up at home), with patients down the side and times at the top, so you can document for each hour what you need to do. It is hard to keep up some days. I know nurses who have worked med/surg for 18 years, and still screw up and forget stuff.

And if you forget a medication, tell someone and try to rectify the matter. Don't ever hide any slip up to do with meds, cos it will come back and bit you in the bum. Also it's better to do meds slow and correctly, than rush and have something disastrous happen.

You have to have confidence in yourself and a plan of attack. I think you will be OK, everyone has doubts.

You screw up, you live and learn and have to deal with it. That's life isn't it?

(hee hee)

Music in My Heart · Jan 12, 2011

After just over a year on M/S, I've just moved to the ER (and I still pick up M/S shifts). M/S was a good experience and there were times that were great. Certain patients were a joy to care for; many others, though, not so much.

I really prefer the short-term relationship of the ER. I've had several patients in the ER that evoke the thought, "and people like you are why I don't want to work M/S" as I send them up to the floor.

I'll also echo the frustration of dealing with people's chronic, unmanaged health problems, geriatric patients who really belong in a SNF, or psych patients whose medical problem bars them from getting into the psych facility where they belong.