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!!

[simonemyheart]

I agree. I am a new grad working in telemetry and I know I am gaining crazy experience, skills, time management, the whole lot.

[simonemyheart]

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.

When I applied for my position in telemetry it said 1 year experience.......I applied anyways, got a call back a few hours later and I got the job. Now granted this is after months of searching, applying, calling, etc. I was like whatever....they probably won't call me back anyways so why not.

[subee, MSN, CRNA]

Temetry IS med-surg

[neelieyelik]

This is all well and great if it were possible to get a job in whatever area you preferred. As a July 2011 grad with a BSN, I've applied to over 200 jobs in about ten different states and not one has called me back. Med Surg is not my top priority but I will absolutely take it if I can get it. I don't give a damn if they have to train someone else later!

[adreamdeferred, MSN, RN, APRN, NP]

Oh, I absolutely love this reply! You hit every point smack dab on the head. I really think there needs to be some education or dialogue on how far the nursing profession has come. During my rotations I would ask the nurses about their overall knowledge and they consistently said they knew nothing about things outside their specialty and you are not going to know everything. You learn what you need to do your job. You don't have to start your career the way your instructor did. How many places did they have to go besides the hospital or LTC? It is good to have clinical experience, don't get me wrong but no one should have to be miserable or validated because of tradition. If it was such a problem no one would hire nurses straight out of school into a specialty, but they do all the time.

@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.

[adreamdeferred, MSN, RN, APRN, NP]

Oh, I absolutely love this reply! You hit every point smack dab on the head. I really think there needs to be some education or dialogue on how far the nursing profession has come. During my rotations I would ask the nurses about their overall knowledge and they consistently said they knew nothing about things outside their specialty and you are not going to know everything. You learn what you need to do your job. You don't have to start your career the way your instructor did. How many places did they have to go besides the hospital or LTC? It is good to have clinical experience, don't get me wrong but no one should have to be miserable or validated because of tradition. If it was such a problem no one would hire nurses straight out of school into a specialty, but they do all the time.

@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.

[mjs488]

I have not read through all the posts so I'm sorry if I'm repeating a question, I'm late to the party. I'd love nothing better than to go straight into ICU. But how do you do it, especially in an in-demand area like Northern Ca? Not sure where you were.

Thanks!

[cjcsoon2bnp, MSN, RN, NP]

I have mixed feelings about the original post. As a nurse educator, I do not blindly subscribe to the "every nurse must have a year in med/surg" philosophy but I do think that there is some merit to it for certain specialties and many newly minted nurses. Let me use myself as an example...

I began my career in a pediatric psych/mental health facility, I believed myself to be a good nurse because I received positive feedback from my patients, peers, and management team. On my own time, I would often research different diagnoses, treatment options, and nursing care interventions to use in this specialty and so I felt that I was confident in my knowledge base and skills as a nurse. After my first year I went part-time in this position and I took a part-time adult med/surg position because I feared that without any med/surg experience I would be unmarketable to managers if I should attempt to try another specialty in the future.

Did I personally love every single aspect of adult med/surg nursing? Absolutely not.

Did I learn things about various medical diagnoses/conditions, nursing assessment and treatments/procedures that I find made me a more well-rounded nurse? Without a doubt!

I was surprised after about 6 months in adult med/surg that when I would go to work in my pediatric psych. position, that I was much more comfortable with completing physical assessments, managing chronic medical conditions, and performing certain nursing procedures. I also have noticed that some of my peers who do not have any med/surg experience are more easily alarmed by slight variations in vital signs and are uncomfortable managing chronic medical conditions that (e.g. giving insulin to diabetics, administering respiratory treatments to COPD patients). Could I have continued to be a competent and professional pediatric psych. nurse without the med/surg experience? I believe so, but speaking only for myself I am glad that I got some med/surg experience. Additionally, my med/surg experience has allowed me to transition into a community ED and having both psych and med/surg experience allows me to also work per-diem in a psychiatric ED (very different than my community ED position). For the flip side of this argument, I believe that there are certain specialties where having adult med/surg experience provides minimal benefit or is simply not necessary. The strongest case for this is NICU, the NICU is such a highly specialized area and my understanding is that many NICU nurse managers will usually only hire nurses with the following experience:

• Experienced NICU nurses
  
• Nurses from the same facility who want to transfer from post-partum, newborn nursery, labor and delivery, or PICU units.
  
• New grads who have no other prior experience (so they will only know the NICU way of doing things).
  

In these situations, I think that having worked for a year as an adult med/surg nurse will not help your chances at employment and I don't think that the skill sets are as easily transferable. I think that some of the other specialties do not necessarily require experience in med/surg but new nurses would require an extensive orientation.

Another consideration is that when you don't have med/surg experience it can be difficult if you are moved outside of your unit or normal working environment for any reason. I say that because when I did med/surg we occasionally had ICU nurses floated to our unit and the newer ICU nurses without any med/surg experience struggled to handle more than 2 patients. The ICU nurses often spent more time completing tasks for patients who were less sick and more independent than they were used working with. While they possessed a great deal of knowledge of critical care and had awesome assessment skills, they sometimes lacked the ability to multitask beyond one patient and manage their time to handle higher volume/lower acuity. I think that this can also be applied to nurses who work in community settings (VNS, primary care offices etc.). Although seeing someone who is acutely ill and requiring hospital level of care isn't a daily occurrence, if you don't have that acute care experience you may not notice the beginning signs that a patient is deteriorating.

Long story short, I think that it is a complicated issue and the "one year of med/surg experience required" should not be an absolute rule. It depends on the practice setting, available education and training for new nurses, and of course, the new nurse applicant themselves.

!Chris

[viprn21, BSN, RN]

Unless you want to do med surg working a year after graduation is little more than torture. I don't regret my first year in telemetry but I didn't know what career satisfaction was until I moved to the ICU.