The Case Against Med-Surg!

[jb2u]

"I believe that everyone should spend their first year in Med-Surg." These are the words as spoken by the Director of my nursing school. As one that has always liked a challenge, I made my case as to why one shouldn't go to Med-Surg. I am not against Med-Surg nursing as a profession. My belief is that you should only go there if that is where your heart leads you. Going into Med-Surg, if that is not where you want to go, leads to lost time, wasted money, and lost sanity.

If you follow the crowd to Med-Surg post-graduation, you will find yourself with a lost year. The year will not be wasted. Med-Surg offers the new graduate plenty of learning experience.

Besides solidifying your nursing skills, you will also learn invaluable organizational skills that will serve you no matter where you end up spending your career. So, why not just go to Med-Surg then? Well, it depends on where you want to work.

You can learn invaluable nursing and organizational skills in telemetry, renal, ICU, or just about any floor that you go to. This proves that going to Med-Surg for your first year is not needed in order to learn nursing or organizational skills. So, why would the year be lost?

Let's say you really wanted to go into ICU nursing. If you go straight into ICU, you now have one year of ICU experience. In your second year, you will be an experienced ICU nurse. If you had listened to those that say, "spend a year in Med-Surg," you would be an experienced nurse without any ICU experience. Also, you do not even know if someone has an ICU position for you after your first year. You may be spending another miserable year in a position that you did not want in the first place.

In addition to losing time, you will also be wasting money. I am not talking about your money. I am talking about the hospital's money. It cost the hospital good money to recruit and train a new graduate. What do they get for their money?

They get to train a nurse for a whole year. It will take you a good full year to really get comfortable in nursing. After your first year, you should be able to take on any assignment. You should be able to organize and plan your nursing care without having questions for the experienced nurses. At the time when you are really ready to function, you are now telling your manager, "I'm sorry; I did my year in Med-Surg. I am off to the ICU." Now, the manager has to spend more money to recruit and train another nurse.

Time and money may be lost, but you can always find misery. This one does not apply to everybody! I do know some Med-Surg nurses that love it; however, I have seen many new graduates, as well as experienced nurses, in Med-Surg in misery. I have witnessed several new graduates on Med-Surg crying. Nursing school prepares you for the NCLEX. Nothing prepares you to have 6-10 patients with 20 medications a piece, complex wound care, total cares, angry doctors, and short staffing. I would not want to put myself through all this just to get some nursing skills and learn how to organize my day!

To truly enjoy your first year, I say go into the field that interests you most.

You will spend that first year learning the medications that you need to know. You will learn how to care for the types of patients that you are interested in caring for. You will learn how to organize your day for the type of unit that you are on.

I went straight into ICU. While my peers from school were running up and down the halls of Med-Surg, I was studying my two ICU patients. The first year I learned about vasopressors and advance life support. I learned the skills that helped me succeed and better contribute to my unit as I went into my second year. Learning is easier when you are interested in the subject. I really wanted to learn ICU; so, I got more from my first year. But most of all, I spent my first year happy!!

[Guttercat, ASN, RN]

I'm inclined to agree more than disagree with the OP.

There are however, valid arguments on either side of the fence.

I've long been rankled at the nursing school model of focusing on their NCLEX pass-rates, more than assisting the candidates to discover their working and learning style, talents and interests in a given area, and developing a plan/pathway to get them there after graduation.

Can we not apply the APIE model to ourselves, as well as the patients? :)

This is apples and oranges of course, but how many physicians are told, "you must spend a year working as a family practitioner before you go for that surgical residency?"

I think a mighty paradigm shift is in order in terms of how nursing students are prepared for the real world.

[jb2u, ASN, RN]

@

karamarie91

med-surg is fine to go into for those that are not sure what they want. i just don't like people being discouraged from going into the area they "know" they want to work before they spend that first year in med-surg.

being a tech in med-surg will help you with your nursing career. you will find some nurses that will really "take you under their wing" and teach you things, even though they do not have to.

good luck to you.

[jb2u, ASN, RN]

"

so, why would the year be lost? let's say you really wanted to go into icu nursing. if you go straight into icu, you now have one year of icu experience"

"

i went straight into icu."

lol.

students we have the answer!! just pick your specialty and start there. you don't need no med surg experience, just graduate, pick your specialty and show up.

it worked for me. as an individual, you need to know your limitations. a good orientation program can mold a new grad to become a great nurse in that area. it beats trying to beat the bad habits developed somewhere else. one of the hardest things for me when i went from icu to er is trying not to do a complete head to toe assessment. had i went straight to the er, i would have learned a focus assessment.

plus i never said "just show up." i worked my butt off in icu. i joined the aacn. i bought and studied icu books on my own time. my point is i would not have done all of that had i went to an area that did not interest me.

it makes sense to me, but i accept that some people will disagree with me!!

[jb2u, ASN, RN]

I plan to go straight into Psych when I graduate in May. Although, I am currently on an Oncology floor & my preceptor told me she would put in a good word for me. So who knows where I may end up. These days a job is a job, but my intention is to be a psych nurse and if I can get a psych position right out of school, then that is what I plan to do.

This is my point. If you are on a medical psych floor, then med/surg would help you out. Although, you can learn those skills while working on the psych floor. But, if you plan to work for a psych facility that deals with addiction or suicidal ideation, then med/surg would not be as much benefit. You would be better served starting off in psych.

Best of luck to you.

[jb2u, ASN, RN]

Understand three things...

1) There are jobs out there. You may have to move. You may have to work at a different hospital than your first choice. What means more to you? Working in the specialty that you want or living in the area that you want/grew up? That choice only you can make. Yes if you limit yourself to one hospital or one 20 mile radius, then well your choice is limited; however, if you are willing to move for what you want, you can find it. Get the experience that you need and then move back to your hometown, if it means that much to you. This is your professional career we are talking about!

2) I never said you should not go to med/surg. I am only saying if you love ER, then go to the ER. If you want to go to med/surg, go to med/surg.

3) Yes, a year in med/surg will make you marketable in the beginning, BUT what happens when you finish your year in med/surg and spend the next 10 years in dialysis? If you lose your dialysis job, do you think anyone will care that 10 years ago you did a year in med/surg? I am an assistant nurse manager. I can tell you that I only care about recent experience.

I hope that clears things up a bit. I know that the economy is tough now, but there are jobs. And, with this tough economy, nursing schools are cutting back as well. What does that mean? That means less nurses are being produced every year. Fewer nurses equal higher demand.

[NightOwl0624]

I think the point of "Just show up..." was that it just doesn't work that way for many new grads. If you can find a hospital that takes new grads into ICU or ER with no nursing experience, sure, go for it. None of the hospitals around here will do it right now. These jobs are very competitive, so it may be unrealistic to think it will happen to you.

But if you can get right in, I say go for it, too. Just don't be too disappointed when it doesn't work out quite that way.

[jad623]

I am a new graduate who just started an OR residency; and I couldn't be happier. But I took the time to really think about who I am and what my strengths and weaknesses are and where my interests lie. Am I a little nervous that I could be limiting myself? Sure. But given all the consideration I've given my decision I truly believe I will be happy and made the right decision.

I started nursing school convinced I wanted to enter peds; well that ended after my first day in peds clinical. I spent my senior semester in a Level I trauma. By then knew what I wanted-- to a certain extent. I knew I wanted a challenge, critical patients, and knowing that I needed to "know my sh*t" so to speak. And I did love it, but there were things that didn't suit my personality. I dare say that the pitfalls of the healthcare system are never more apparent than when you're in the ER. I know myself, I'm bubbly and happy, but I'm prone to sarcasm and cynicism. And knowing who I am and what I want, I had a suspicion that I would burnout and become, bitter and jaded fairly quickly. This is not the nurse I am, the nurse I want to be, nor the nurse my patients deserve. This is in no way a reflection of all ER nurses (a part of me will always miss trauma), but it I knew wasn't a good fit for me.

I wish more schools had a co-hort program like the one I was accepted into. It was one floor nurse, paired with two students; 12 hour shifts and 4 patients. It was as though the nurse shadowed us, we did assessment, admission, discharge etc. I never had to wait for a professor who had 8 students to perform a procedure; I really felt like a "real nurse," and that provided me with the opportunity for self-reflection.

I would encourage everyone to try to attain a job as a PCT, CCP etc. during nursing school, and if you can in the specialty you want all the better. You learn so much about yourself, how hospitals work and the nurse you want to be, and whether the specialty is all it's cracked up to be. I did ICU and while I was interested in it, I learned it wasn't a good "fit."

It's so hard with budgets etc. to offer residencies due to the financial obligations and the amount of nurses willing to accept that responsiblity. But I wis more hospitals offered them to new grads. I think it would really revolutionize the way nurses are trained and retentions rates. New graduates who feel more prepared and confident in their skills stay longer, and are happier. We all have the ability to implement change and pick up where seasoned nurses left off; it's an uphill battle, but we're new and can do it. And God knows that if the staffing ratios in Med Surg weren't so horrendous the retention rate would be higher... but that's another forum. If you 're positive about the specialty you want then go for it... try your best to get into a hospital with a strong residency... But realistically you may to take what you can get, just approach it as a learning experience and do your best to keep netowrking. No hospital want to lose a new grad (especially after the financial investment), but there are also ways to quit/transfer without burning bridges.

I hope all nursing students/ new graduates take the time for some serious self reflection beforehand. And good luck in your nursing careers!

[symphie]

I always thought I would follow the "do a year in med-surg and then get the hell out of there" advice I was given by my first nursing professor when I graduated, but now that I'm less than a year from graduating, I know I won't be.

I will be entering peds or women's health simply because I hate working with adults. I'm a very small person and I look very young for my age. I'm almost 22 and most people guess 14-15. This made my peds clinicals much more fun because the kids tended to trust me easier and I could build up rapport with them faster. I also completely fell in love with my women's health clinical. I loved L&D, postpartum, nursery, NICU, GYN, all of it. I realize this goes against my "working with adults" thing, but to me, a laboring woman is NOT a typical adult. At least not at that time. Much more similar to a monster. But I loved working with them.

Now, I don't have false expectations about getting a job. Because I'm being picky about specialties, I know I can't be picky about anything else. I'm willing to work for any hospital, any shift, commute as far as I have to, etc. I think everyone has to decide when they're looking for a job which things are the priority and which ones aren't as important. For me, the patient population is most important. Everything else, I can be flexible with.

[karamarie91]

@karamarie91

Med-Surg is fine to go into for those that are not sure what they want. I just don't like people being discouraged from going into the area they "know" they want to work before they spend that first year in Med-Surg.

Being a tech in Med-Surg will help you with your nursing career. You will find some nurses that will really "take you under their wing" and teach you things, even though they do not have to.

Good luck to you.

Thank you!

[chansen]

"

lol.

students we have the answer!! just pick your specialty and start there. you don't need no med surg experience, just graduate, pick your specialty and show up.

i'm sorry you live in an area where healthcare organizations don't have programs in place for new grads to transition into critical care areas and succeed. however, some of us do, and are quite happy to skip over the year on the floor and go right to a unit where we want to work.

[subee, MSN, CRNA]

No one would debate that a year of ICU experience, rather than a year of med-surg experience, somehow doesn't prepare you for a future in another specialty. Just my 40 years of observation, but a year of OB does not prepare you to care for the patient that happens to bleed out or code on the OB floor (yes, death does happen in OB:(). That year of dealing with all of human's common medical conditions prepares you for any other specialty- especially how to handle a crisis in a specialty where crisis rarely happens. You learn the common meds, lab values, how to separate the zebras from the horses. You can take that experience with you forever because you'll always use those skills. However, I do understand that in this economy, people with debts need a job. While that's not a justification to avoid that med-surg experience, I understand that it is a reality...but it is the nurse's loss.

[Despareux]

Good article and I agree. I wish all new grads had a choice and I hope that's the case for me. I used to want to practice in peds or PICU. But I've changed my tune. ICU or Neuro Trauma for me...I felt 100% comfortable caring for those types of patients. I've done most of my rotations on various med-surg units and I don't get excited about it like I do NT or ICU. But I will take whatever I can get and be happy with it.