New grad ICU nurse looking to medsurg for skills

[CFrancine, BSN, RN]

Hi all!!

I'm a new grad ICU RN and have been working for 7 months. Things are going well enough although I don't feel strong by any means. I was hoping to pick up a second job for the extra money as well as variety in my knowledge base. I don't know where I want my career to go but I want to give myself as many options as possible.

So recently changed the policy at my hospital where ICU nurses can float or pick up in med-surg or tele. So I was thinking maybe picking up hours would be easier than finding a PRN job (which would likely be a SNF). I currently work 36 hours a week on nights so I was thinking 8-12 hours a week maybe.

So I have a couple questions.

1) Is this a good idea? Do you think I would actually get some valuable experience from this or will I be giving my self stress for nothing? I'm only used to 2-3 patients so the thought of going to med-surg being a new grad and not used to the workload is a big scary. Makes me wonder if my coworkers will see me more as a nuisance with my questions....

2) Would days or nights be better? I LOVE nights but is there enough going on to help develop skills? Or even if nights doesn't have the hands on tasks, should I start there just to get used to the pace?

3) What books or pocket guides would you recommend for med-surg as the few things I bought are ICU focused. Since ICU is my only experience, I only know the handful of diagnoses we get all the time.

[JJsMama79]

I think it's a good idea to pick up extra shifts if you're looking for extra money, instead of getting hired on at a new place. On my floor, we were short-staffed a lot, and ICU and tele nurses were often pulled to our floor. A lot of them, I will be honest, didn't really like working on our floor, because instead of having 2-6 pts max, they had 6-8. That can be overwhelming. Some of the med-surg pts are really, truly sick...and you have to be able to pick up on the "subtle" signs that things are starting to get bad. This is where your ICU experience comes in though...being used to taking care of the really sick pts, you'll be able to pick up those signs relatively easily. I used to work on med-surg on nights for years...and don't let the time of day trick you lol. Nights can be just as busy, if not more, than days...just a "different" kind of busy. The night is where those cute little sundowners go absolutley crazy...and being nights, you often have less staff than days to help out. Med surg is definitely the "melting pot" of the hospital....you get a lot of different diagnoses...pneumonia, copd, abdominal pain, acute renal failure, to name just a few. On my floor we also had a ton of post-ops...knee/hip replacements, fractures that were fixed, appys, cholys, colectomies, hysterectomies....basically any surgeries that required an over night stay. We had a lot of CBIs and even some chest tubes! While the pt herself may not have had every line and drip imaginable, we also had ports, piccs, central lines, and vas caths. So yes, they can be medically complicated as well.

The big thing about med surg I hated were the drug seekers. TRUE drug seekers...the moment when you walked in the room, they'd ask when they could have their next pain medicine, or they'd say "Just give me all my prns I can have." They'd ask that, while at the same time, be talking on the phone, or on facebook on their laptops, and asking for bedtime snacks...while rating their pain 10/10 and asking for phenergan. That drove me nuts. And sometimes all the pts in your group would be like that. You knew their pain couldn't possibily be a 10/10....but, being as pain is "subjective" and is what the pt says it is....you basically have to kiss their a** and give them what they want and what the dr has ordered.

So, if you can handle the bullsh** patients like that, then yes, pick up extra hours. You will still learn a lot since med-surg is a diverse population. But don't expect your assessments (or getting bedside report) to be as thorough..there just aren't many hours in your shift where you can be as thorough as you can in ICU...and there will be days when all you feel like is a glorified waitress and drug dealer.

PS..those little med-surg pocket books are nice to have.

[generalRN2008]

It would be a different skill set. Try nights since you are still new. Go for more surgical than medical floors for learning

[Lennonninja, MSN, APRN, NP]

I think it'd be a good idea to do this and work on your time management. Also, if you have to float out of the ICU and to M/S sometime, it won't be nearly as scary. I went from M/S to the ICU, and the time management skills I brought with me are so helpful. Plus, on the rare occasion that I hear another ICU nurse say something disparaging about a M/S nurse, I call them out on it. Don't knock those nurses until you've been in their shoes and dealing with 5+ patients!

[boogalina, ADN, ASN, BSN, MSN, LPN]

I think there's plenty of action to be had on night shift. Nights are still incredibly busy in med-surg where I work. . .and usually night RNs have 1 more patient than day shift. Good time management is crucial in med-surg. . .move fast, chart even faster! You can't beat med-surg for diversity of patient condition - and there is no guarantee of patients arriving from the ED hemodynamically stable or staying that way, so your critical care assessment skills are still relevant.

Here are my top 10 things that work for me considering I am always a float (like you will be in med-surg):

1. Avoid talking about how things are done in your home unit to workers who "live" in the unit where you're floating. Some ICU nurses are less than complimentary of med-surg staff and fail to recognize it as a specialty unto itself (and this can make people grumpy). However, by the same token, if asked about your unit, share information. People are curious about the unknown and like to learn, too.

2. Listen to your CNAs (should you be lucky enough to have one!), especially the experienced ones on the unit. If they think your patient looks "funny," time to stop what you're doing and come look at them, because chances are, they're trying to decompensate and it can take some time to call the doc (no on-unit intensivist, especially at night you are dealing with a potpourri of hospitalists, surgeons and/or PCPs depending on who is "it" for your patient).

3. Get a quick tour of the unit. . .don't even get me started on the variation in supplies by unit (because different units need/emphasize different things) and it can be hard to find what you need in a hurry.

4. Chart in real time as much as possible. . .because if it's easy to get behind with 2-3 patients, imagine 5-6! Also, just when you're almost with your head above water, that's the time fate will pick for you to get a new admit or to have one of your peeps decompensate.

5. Look at whether you have your meds for future med passes early in your shift. Sometimes it takes a while for missing medications to arrive from pharmacy, so plan ahead. Look at your drips first thing, because it's no fun running out of a special-order drip and having to wait for a replacement. Same thing except even more important for PCA bags!

6. Round on your people hourly. In addition to the 4 P's (pain, position, potty, personal belongings in reach) this is a good time to check LOC, respiratory status, for any other changes. Guess what? No monitoring (except maybe tele). . .you are the monitor!!

7. Have a good brain. Some EMR's allow you to print a "rounding sheet" that has your patients' info pre-printed on it. If you don't have a good med-surg brain, there are shift organizer sheets available here on AN that can help. I've attached the one I got from my busy, busy preceptor during my med-surg preceptorship in nursing school It is a gem. However, use what works for you!

8. If everything feels OK, get worried. Something is gaining on you, or it soon will! (Murphy's Law, I swear!)

9. Know where to find the applesauce, pudding and juices. These are invaluable for giving meds (I know oral meds are given in critical care, too, but the catch in med-surg is knowing your options early because Mrs. Jones will ONLY take meds crushed in chocolate pudding and not vanilla and of course guess what flavor is out on your floor on night shift? Yup!)

10. Have fun and make new friends. One of the best things about floating is getting to see people from other areas of the hospital. It is the best!! And enjoy your extra income!

med-surg brain.doc