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!!

[Gregmercer601]

I had been practicing in the Psychiatric field for a few years as a Residential Counselor when I entered Nursing School. I learned in all rotations, but I had never had a doubt I would not follow anyone else's 'rules' when it came to my career. Med-Surg Nursing in important and challenging, and the experience is valuable and opens doors. Still, its a year of your life, and unless you enjoy such work, its not likely much will come of those opportunities. How strong will your references be if you lack enthusiasm? How many of the opportunities you reveal will be just as unsuited to you as your starting point? I've had my moments of doubt over the years when times are tough, but on the whole, I have thrived. My practice has been Psych from day one to present, now transitioning into teaching. There is no one path we all 'must' take - Nursing is a very large, very diverse tent. I could handle Med-Surg if I so chose - I chose not. No specialty is 'better' or more valuable or important than any other, and I know many talented Med Surg & other folks who wouldn't dream of taking on the challenges I face every day with a big smile. Nursing is not for everyone, and Med Surg Nursing too. We each must find our place in the world, our contribution, our dream.

[jb2u, ASN, RN]

I enjoyed reading this post.

I graduate this May. Yay!!!! and want to go into the ICU. I work as a ED technician in the crash area and deal with critically ill patients and code situations frequently and this is where I developed my passion.

I have taken some critical care classes through my hospital and have loved it. I do believe that tech experience can make a big difference in making that transition from new grad to ICU nurse. I have developed more confidence, knowledge and strengthen my basic nursing skills as a tech whereas on the first day when I had back to back codes in 5 minutes I was stunned and through experience/hands on I do not even have to think about what I need to do now. It comes naturally.

I am not cut out for med surg. I like ICU patients, monitoring devices and critically thinking. I can see both people's side about med surg and at the end of the day follow your heart.

I'm glad you enjoyed the article.

I promise that you will enjoy that first year so much more by doing what you love. And, guess what, that second year is even better because the first year "jitters" are gone and you are a confident nurse by then!!!

[hgrimmett]

I completely agree. and my teachers are telling me the same thing. When I graduate (RN, March 2014 or so) I want to work in/for hospice. I can see where ICU and ER experience would be good to have.. med/surg, maybe. I am going to do my best to get into hospice ASAP. Considering getting my CNA and working for them as soon as I can too.. if nothing else, it would be relevant job experience. Maybe not RN but I'd still learn a lot from it, I'm sure.

and I don't see many people who are hot to work in hospice care, so YAY that means less competition for me to get those jobs..

[ChesterMcE89]

Does anyone know what Mayo's (Rochester MN) policy is on hiring new grads for ED/ICU??

I don't know if it's my nursing professor or the floor itself that is currently making me despise

med-surg, or the fact that my sister is only 28 years old and is already burning out from her

overnights in med-surg.

I want to avoid this at all costs! HALP!

[KSGMaine, ASN]

This is a great article and great insights from everyone! My question is, never mind, just med surg, what about starting at a hospital at all as a new grad??? I landed a job at a hospital (lucky I guess) on a neruo/trauma floor, I am 3 months into it and on my 4th week of being on my own, so to speak - really having second thoughts about working in a hospital. Just so everyone knows this is a second career and I am 47 years old. I have been offered a Mon-Fri 9-5 job at a speciality physician's practice, no nights, weekends, holidays,etc. This would fit better with my lifestyle and that of my spouse's, however, I feel like I need to or should stick this out, for the experience. I have an insurance background and would eventually like to work, I think, as a nurse consultant at an insurance company - does the hospital experience really matter???

Thanks

[hgrimmett]

With your insurance background you'd be crazy not to take the office job.

(and I'm 49 and just started nursing school in December. :)

[OCNRN63, RN]

@subee

I understand what you are saying, but I would think that a bleed postpartum would be something taught to a new grad in OB(s/s of bleed, what to do, etc). As far as codes, they really are not that big of a deal. I'm not sure about OB, but most floors do not even require ACLS for their nurses; so, that nurse's job would be to call a code and follow ABCs until the code team gets there. Right? Any nurse should be able to do that.

Again, I'm not saying that there is zero value in med/surg experience. I just don't think a new grad needs to be miserable their first year just to get these "skills." I agree some new grads would never make it going straight to the ICU; however, there are nurses that could not do ICU even if they spent 15 years in med/surg. There are some nurses that can't do med/surg.

People do not say, "spend a year in med/surg" because it is easy, do they? No! They say spend a year in med/surg because of the broad spectrum of what you will see and do, and the organizational skills that you will learn. What if I have great organizational skills and I do not need to learn a broad spectrum of nursing skills?

Any new grad who would say that is a new grad I wouldn't want as a co-worker. No new grad comes out of the chute with "great" organizational skills, and as for someone to be foolish enough to think he/she don't need a broad base of clinical skills? Well,...

[jb2u, ASN, RN]

@OCNRN63

I see where you are coming from, but...nurses are not the only people with great organizational skills and there are jobs in nursing that you do not need a broad spectrum of nursing skills, nothing foolish about that.

Yes, you will need to learn how to organize your day as far as nursing goes, but how a floor nurse organizes his day is different from how an ER nurse organizes her day which is different from how the nurse informatic organizes her day. Do you really think that nurses are the only people with organizational skills? I know some very organized people in other professions that would absolutely come into nursing with organizational skills. They would certainly translate those skills to their new profession. You would NOT need to teach them HOW to be organized. You would need to give them their tasks, and they would be able to organize themselves. I watch nurses fumble around with reports all the time. I came into nursing and right away designed a card with the different body systems, lines, diet, etc. and had a very organized report ready to give to the next shift. This was NOT taught to me by spending a year in med/surg. I, in fact, came to nursing with that skill.

As far as the broad spectrum, yes it is always nice to have, but it is NOT a necessity in all specialties. Do I need to know how to manage a chest tube if I am going to work in an addiction treatment center? Do I care how to insert an NG tube or start an IV if I work in nursing informatics? Do I care about working with intense dressing changes if I want to work in the OR or PACU? How about working in research, endo, or radiology? Yes, of course you could make the case that if your research involved dressing changes then, yes, you would need to know about dressing changes, but at that point I'd say you were just being argumentative.

On any given day a broad spectrum of nursing skills can be an asset, no matter where you work; however, there are still nursing positions that do not require a broad spectrum. Now, if a nurse comes to me and wants to work the floor and they think that they do not need to know a broad spectrum of nursing skills, then yes, that nurse is foolish. But, if a nurse comes to me and has never managed a chest tube, inserted an NG tube, or inserted a foley and wants to work for my company that does pancreatic research...well....I'm fine with that!!

I would never call someone that knows exactly what they want and knows that it does not require a broad set of skills a "foolish" person. I'd say they are smart enough to know what they want and to know what skills they need and which ones they don't; however, it could be foolish to spend a year learning skills that you never use again for the rest of your career just to satisfy some dogma.

[Catch22Personified]

Some of us didn't have a choice. It was either long term care or long term unemployment.

And LTC experience doesn't mean anything to hiring managers it seems. I've been flat out told "it doesn't" count in an interview for an "entry level" med-surg position.

[wannabecnl]

This is a discussion I have had with people for more than 2 years now, ever since I started (and continuing since I ended) nursing school. What I find interesting is that nurses seem split on the issue--there is no clear consensus. I was in the PACU for my clinical immersion and capstone semester, and that is where I want to spend my career. I found that about half the nurses I worked with (in phase I and II recovery, some of whom also do pre-op, plus a handful of OR nurses) said I needed the year of med-surg first and the other half said to just go straight into the PACU. It was somewhat associated with the paths that the nurses had taken themselves, though some in the second group had started in the ICU right out of school.

Going straight to a specialty is more easily said than done; several of my classmates managed to land jobs in specialties such as the ED, psych, or OB, but not everyone has. The PACU where I did my clinical has a policy of not hiring new grads, but other hospitals in the area seem more flexible on that point. I think (as many posting to this thread have said) that if a hospital has a strong mentorship program, a new grad could do well in almost any specialty, including med-surg. Without a strong mentorship program, I don't see how any new nurse could survive with what we've learned in school, especially in med-surg!

Yes, I called med-surg a specialty. I think it is, and we devalue it when we dump all new grads there for this purgatory year before, as others have said, they get the heck out of there. Why devalue med-surg nursing? Most patients in the hospital are on med-surg floors! Their care is challenging and important. There are med-surg nurses who are so gifted there, who would be bored to tears in the PACU or OR or OB, who thrive on the atmosphere, and who ultimately stay there for many years, not because they can't get out but because they don't want to! (I know there are others who stay because they have to, but hear me out) My desire to work elsewhere is not knocking med-surg as a specialty but rather an acknowledgment that the day-in-day-out aspects of the job don't fit at all with how I think about patients, illness, and problem-solving.

Someone made the point that doctors don't have to do this, and I want to comment on that. Although the internship year is pretty much the analogous experience, A) that is the way it is done for all new docs, B) it is specifically designed to be the basis for future education in the residency, C) it is actually related to the specialty the physician is pursuing, and D) it is not a specialty in and of itself that the person is going to leave in a year to go learn something else.

We could debate this all year long, but until hospitals start getting serious about placing people where they can get the best training for what they want to do, it's going to stay the same: fuzzy, unclear, and divisive. Nurses will continue to flee med-surg, specialty units will continue to cherry-pick, and new grads will continue to hear conflicting views on the best way to get experience.

[KalipsoRed21, BSN, RN]

I don't agree with this article. The idea that a nurse should go into a specialty he/she is interested is a good one, but not entirely reality.

The current market for nurses isn't exactly a great one for new grads to be so narrow minded as to only go into a specality they enjoy. A nurse that hasn't found a job in 6months or a year after passing the NCLEX because he/she is being picky about what type of nursing they start in will likely end up not getting any nursing job ever. So in the interest of reality I think it best that new grads keep an open mind and look for the opportunity that will get them closest to their nursing goals.

I graduated in 2008. I knew before I graduated that I wanted to be an ER nurse. I had worked as a tech in a large level 1 trauma department and had an offer to start out my nursing career in this ER. After taking a long and honest look at my abilities and how I learn, I felt the steep learning curve for the new grads in that ER would set me up to be a failure. It's not that I couldn't learn what was needed to be a good ER RN, but I didn't believe that I could pick up all that I needed in the 6 month preceptorship offered by the facility.

Thus I started my nursing career in a cardiac step down/telemetry unit. It was a very nerve racking year and I HATED my life. Mostly because I felt very overwhelmed with my 5-6 post CABG patients. However I stuck it out for 2 years then tried to move to the ER. None of the ER positions I applied for (in and out of my hospital) came through...even the few I got the opportunity to interview for. So I decided to try travel nursing.

Travel nursing was a good and miserable experience. I got to see some of the USA and got paid GOBBS more money than I had gotten paid as a cardiac nurse. That was good. I got stuck in hospitals that were woefully understaffed with just one day of training before I was out on the floor. I worked mostly med-surg, ortho, and tele. I would have anywhere between 7-10 patients. That was miserable.

I applied for several ER positions again and was fortunate to get hired at a community hospital that does both pediatrics and adult emergency care. (I've never worked with kids.) Yay!

While I'm estatic to be a ER nurse now, I'm SOOOOO grateful for the experience I had before I became an ER nurse. First because I actually understand and have practiced the basics of nursing and thus my new training builds on concepts I haven't just learnt about in a book, but have seen and done. Second, because I know what people on the floor are responsible for and how their day flows because I've worked it.

There is NOTHING I hate more than a catty nurse that has never worked in any other specialty but their own and yet feels the need to critizie those in different units because those in the other unit aren't practicing nursing how it is practiced in their specailty. (This happens frequently.)

Working in several different floor enviornments prior to getting in the nursing specialty that I desired gave me the opportunity to see the bigger picture of how a hospital environment flows thus making me a well rounded, tolerant nurse that practices better team work than the majority of those I've met who have only worked critical care. I feel this is because those who did not have to earn their place kind of get a bit of 'I'm better than you because I work in the ICU attitude'.

Not all are like this, but I would say the majority are and it is not a good attitude to have as a nurse. If you are a new grad that gets a job in the specailty that you desire, then be grateful and I celebrate for you. For those who have to take a longer path, well don't feel bad about it because I promise you will gain so much as a nurse from the experience. That well rounded abilites will give you a great advantage over any nurse who has only had one specialty experience in the hospital.

[MPKH, BSN, RN]

I am a new grad myself, and while I do see the OP's point of view of not going in to med surg if you know with absolute certainty which specialty you want to go into, I do agree with several posters saying that the ability to do that may not be realisitic for many new grads.

I have my eyes set on ICU right now, and all the ICU positions in the province that I'm living in requires minimally 1-2 years of recent acute nursing experience. Where do I get that 1-2 years of experience for me to be able to go straight into ICU if not for med surg? It is similar in other specialties--the magical 1-2 years of recent acute nursing experience is a not merely an asset but a requirement. To get to a specialty, one has to start somewhere, even if that somewhere is the "dreaded" mes-surg.

I am enjoying my job in a rural hospital working as a staff nurse in the inpatient unit. I see all sorts of medical-surgical diagnosis, and it gives me practice to perfecting the skills I learned at school...not to mention, as I'm at a rural area, sometimes we do get critically ill patients and I am exposed to the critical care aspect of nursing. I am able to hone my time management skills, learn to talk to doctors more efficiently, and to assert my role as a Registered Nurse in the bigger healthcare picture. I believe all this will help me land an ICU job in the future. While this is one lost year of ICU, it is not a lost year. A lost year would be me holding out for an ICU job and refusing any and all other job offers.

And you know, attitude is everything--if a new grad spends all of his/her free time moping and whining that they're not working in their dream speciality unit, then of course, they're going to be miserable working med-surg. But if they embrace med-surg as a learning opportunity, then maybe it wouldn't be so bad. Of course, some units are notoriously bad to work at and I'm aware of that. I am not against people going into a speciality right out of school, but I am a believer in that med-surg is a good place to consolidate your nursing skills and knowledge as a new grad.