I can provide some input into surgical nursing. The majority of my patients fall into four categories: Surgical/Oncology (ie: masectomies, ostomies, thoracotomies, etc. related to cancer diagnosis), vascular surgery, bariatrics, and every other surgery is lumped into General Surgery. I also see a lot of potential problems that could escalate into surgeries (ie: partial bowel obstruction). My wound care skills are pretty awesome at this point. Med passes aren't terrible unless a patient also has high blood pressure/blood sugar issues (usually just lovenox/heparin, protonix, colace, and pain meds). You manage a lot of chest tubes, NG tubes, and drains of various types. I occasionally get people with DVTs who need a heparin drip. I don't see a lot of trachs. But for the most part, you help get your patients recovered and ready to go home, while monitoring for any potential post-op complications (Is there an infection? If they had their gall bladder taken out, is there a bile leak?).
"Ideal" day goes:
- Get there a little early and check 6am vital signs and patient summary.
- Get report
- Quickly go into each room and introduce yourself, check pain levels, and make sure your patient is breathing
Let them know you'll be in soon to see them. Do blood sugar coverage as needed for breakfast.
- Check labs and orders while pharmacy restocks the omnicell between 7:30 & 8:00.
- Assess your patients and do your morning med pass. Make sure lines are patent by flushing, check your dressings, wounds, and drains.
- Discharge rounds with the MDs/NPs, home care, PT, pharmacy, and social work, where you update them on patient progress, figure out who needs consults where, and approximate discharge date.
- Lunch insulin coverage. Review labs, orders.
- Afternoon med pass
- Dinner insulin coverage
- ALWAYS check your patients pain levels, but be sure to do it around 6:00 pm so they're okay during change of shift. Hang new bags of fluids for night shift so they don't hate you.
In addition to this, you'll be juggling patients on the call bell needing everything from pain medications (after surgery, patients HURT!) to assistance getting up to the chair/to the bathroom/etc. A lot of patients will be very anxious and need more education/reassurance. You'll have admissions and discharges throughout the day because surgical patients usually don't stay long unless it's a major surgery or there are complications. You become a master of multitasking as a surgical nurse.
The downside? Dealing with gods--I mean, surgeons.
(actually tbh, they're pretty good at my hospital--especially the residents). Hopefully someone else can come on here and give you a medical nursing perspective -- I'll get the occasional stage IV bedsore overflow onto my floor, but it's rare.