Bad Rep for Med Surg

  1. Any med surg nurses out there have any ideas or input about why med surg has such a bad reputation and what could possibly be done about it? We see so many new nurses and experienced come and go (before completing orientation). We see new nurses doing everything possible to avoid that "year of med surg." I know there's short staffing woes, but that can only be fixed if we get some good nurses to stay. I know there's the eat your young thing - but isn't the buffet open on all units in some way? Why are we so bad? I love it. I try to show why and what I love about it, but nobody works with me hardly unless they are eagerly watching for the chance to jump ship to another dept! We hear on our floor that we need to learn to work as a team better - I said, that would be easier if the players didn't change so fast.
    How do we make med surg less of a nightmare and help nurses choose this field?
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  2. 74 Comments

  3. by   jjjoy
    Personally - decreased workload... if a good day is just barely getting by, I'm not going to want to stick around. To get folks to stay, you've go to get them into a comfortable (I don't mean boring, just not overwhelming) position with decent pay, so that the idea of moving on and all the work and hassle that that involves is less appealing than staying there. Let nurses have more time to spend with patients. As it is, many med-surg units are chaotic and harried on the best of days. As long as one is working their tail off like that, might as well move on to an area where you might feel like you're doing more than just barely keeping one's head above water day to day.
  4. by   RNsRWe
    Kelly, I'm looking for the answer to that myself! like jjjoy said, the workload is what kills everyone, not the work itself (from what I've seen). My co-workers all seem to enjoy the TYPE of patient care we do, we're just fried from the sheer number of patients and/or acuity of patients compared with the staffing at any given time.

    Obviously, in order to decrease workload, we need more nurses. And when more nurses hire on, we need them to STAY long enough (beyond orientation, beyond a few months more after that) to become really valuable to the unit. And so often, they don't. They get eaten up because of the high ratios, and don't stick it out until some more get hired, easing the load. They bail, leaving us short again. Thing is, our unit isn't much different from other units that are short of staff, but for some reason there's this weird idea out there in schools that to be successful, you have to work in either a warm-fuzzy atmosphere (think mother-baby) or TV-Movie-heroics (ER or ICU). They don't know what they're missing on a (medical) surgical unit like mine! They see it as something they "have to" do, rather than something rewarding and challenging in itself. And for those that DO come aboard, how many manage to survive the chaos minimal staffing causes?

    I'd really like to improve retention for our unit, but not sure what to do beyond the cliche'd "get us more staff".
  5. by   meownsmile
    Ill 3rd that, the workload and the pace at which you have to do that work is sometimes beyond rediculous. I love med surg, love the change in patient care pace, it keeps me on my toes. But i know a lot of people just get so burned out so fast because they dont cope well with the intensity and pace. Med/surg sees some of the fastest patient turn over rates. You have to be on your game EVERY day.
    Being able to slow the daily pace at which you have to recieve your patients could help. People also have to understand we get admissions from several different places, recovery room, direct admits from offices. So not only do we have surgicals coming, but we may get several admits at one time from different places. I sometimes think maybe ER and admitting forgets they arent the only ones sending us patients.
  6. by   Jessy_RN
    I have an upcoming interview for GN position-I am debating whether going into med-surg. Reason? I have done 12 months (3 rotations) in various floors and they are chaos. No time with patient, more time charting and running up and down the halls. At the end of the day, no job satisfaction because one feels that a mediocre job has been performend. The pt. load is too high and the turn-around of nurses is very high.

    It does make me nervous as a new nurse to jump "head-first" into this type of environment. I love med-surg-but not under those circumstances. Nurses move on all the time other areas and new nurses and very few seasoned nurses remain.......it's scary.
  7. by   Lorie P.
    i love med'surg, but agree that the work load and pt acutity play a big part in why new nurses leave. the experience one gains in med/surg is incredible, you can have one pt with chf, one with copd, one with dka and then one with all the above.
    i have seen new nurses come with the attitude that " i can't take more than 4 pt's, and wow i had no idea you have to do this" also on a very busy med/surg floor the nurse is also the tech, the nurse, the unit secretary and a whole lot of other jobs.
    i have to admit that there are days when i ask myself why? but when i actually save a pt's life, it is well worth it too me.
    guess that some people just can not tolerate this field, while others can.
  8. by   tencat
    Hmmm......I think there are many reasons why people leave Med/Surge. I left because scheduling was not flexible enough for me, and the nurse manager couldn't get a schedule out for more than 2 weeks ahead at any given time. I also left because I felt like a glorified waitress who handed out pills. Maybe I missed the boat on this, but I felt like I rarely ever had the opportunity to really use my critical thinking skills and trouble-shoot issues. I don't think it's necessarily like this everywhere, but that was just my experience with it.
  9. by   jjjoy
    I think the assembly-line mentality of some management needs to be tossed. They do studies on how to streamline this and that, save a minute here and there... but in service jobs, no matter what kind, you need a big margin for unexpected turns. You can't just say, well, the average time needed to do X is 5 minutes, so 5 minutes is all you get.

    Unfortunately, the bottom line numbers don't differentiate between satisfied workers and a harried and stressed workers. And it seems whatever formulas are used indicate that it's "cheaper" to maintain slim staffing (and a harried workers) than to pay for the "excess" staffing that could lead to a better working environment (and less turnover). It's not always just because they can't find nurses. Isn't it true that on low census days, staff are sent home, and the staff at work still have a hectic day?
  10. by   southernatheart
    I think patient ratios are highest on our med/surg floors. Personally, I love med/surg and can't imagine doing anything else. I'm so glad to see your signature include 'yes, med/surg is a specialty'!
  11. by   jlv1971precious
    MedSurg simply isn't the MedSurg of ten years ago. The patients my unit receives are much sicker and more acute than they used to be. We are functioning almost at the same level as an intermediate unit, but still with the large nurse/patient ratio. It does get frustrating for the new nurses on our unit since they (like me) want to actually know their patients and provide quality bedside nursing care. Unfortunately, that isn't usually possible, so the charge nurse (yes, me) ends up trying to fill those gaps, which again moves something else off the priority list. And nowadays, with malpractice lawsuits on the rise, we're again having to spend even more time charting to protect our livelihood and licenses, thus leaving less time to give that quality care we swore we would all give to every patient we came into contact with. No wonder nurses don't want to stay on a MedSurg floor! And the sad thing is, until hospitals figure out that employee satisfaction is just as important as patient satisfaction, and until they figure out that unlicensed assistive personnel is just as critical in functioning properly, there will always be staffing issues on these units.
  12. by   RNperdiem
    Morale becomes low when after all the rushing around and multitasking and missing lunch a nurse does not feel that she provided good care. If there is too much work to be done, it will not all get done.
    My med surg unit could have used one or two more nursing assistants. When several patients are incontinent, need feeding(takes a looong time), and help to the bathroom, a couple of good CNA's are worth their weight in gold.
    My hospital has a great IV team. This relieved the nurses of some of the IV starts.
  13. by   NurseShelly
    I've recently relocated and made the switch from an infectious disease unit to Med Surg, and I absolutely love it. I sing med surg praises to anyone who will listen. My mother, who is also a nurse at another facility, loves med surg as well, and doesn't hesitate to say "I told you so." So far, I love the variety of pts. I do have love/ hate for the pace. Sometimes, in order to keep up with orders, charting, new admits, and discharges etc... I feel like I'm failing my pts because I can't be more attentive. On the hand, I start my shift at 0700, and before I know it, its almost time to leave. I can't believe how much I'm learning either. I know I'll never know it all, and have a loooooooooooooooong way to go before I know nearly as much as my coworkers, but when I'm going through my assignment, assessing pts, checking labs etc... I'm finding that I know a little more each day. Unfortunately, at least I gather from my former classmates, the perception is that Med Surg isn't a specialty, and it just doesn't sound as good as going to the ER or an ICU. I know I lack experience, but I think in order to clear Med Surg units of the bad rep is to start by word of mouth from nurse to nurse to potential nurse. Hospitals/ employees also need give med surg the respect of being a specialty, just like the ICU's, ER, L&D etc.
  14. by   veronica butterfly
    I've been on med/surg as a RN for a year next month. WOW! I made it a year, unbelievable. I was a LPN for 3 years before, 1 in subacute and 2 in a failry busy Urgent Care. I can't imagine how I would have done it without the excellent LPN experience.

    Med/Surg is H-E-double-toothpick and I love it. Well, I loved it after 7 months, it finally fell altogether, until then I was ready to quit.

    I think it's a combination of many things. 4-5 patients on eve's and 6-7 at night, all with completely different diseases/illnesses, and all we're supposed to be experts on all of them??? Some are new admissions, some are discharges, some don't speak English, some have major family issues, some are mentally ill, or developmentally delayed in addition. You walk into a patient's room and they look at you and have complete trust in you and think you know their entire history and outcomes for their disease process, and uhhh..... we just read 5 minutes of their history before we hit the floor. Most days I can barely keep straight if Terry in room 2200 is a male or female, or wait, is that Pat is 2201???

    There's just not enough time to do everything. We ALWAYS leave feeling we forgot to do something, check a coccyx, reinforce that dressing on a wound, give emotional support, all that little stuff we thought we'd do when we were in nursing school. There's always a crisis, a fire to put out. Charting sometimes is minimal at best. And helllo???? we're actually supposed to update the careplan? yikes... We wake up in the middle of the night remembering we forgot to pass onto next shift an important detail. OR if we work nights, we wake up at noon remembering this important detail and then, well, forget it, our sleep is wrecked for the rest of the day.

    But... when we do a good job... and we actually get a chance to make a difference.... doesn't it feel incredible???!!!

    Rock on med/surg nurses, we rule!!!

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