New Grad To Med-Surg, What To Expect

veronica butterfly, ADN, RN · May 3, 2008

A medical floor is not a "dumping ground"... It is a place where sick people come to get medical attention and hopefully leave better than they came. But for the grace of God go us nurses. None of us leaves the earth alive and on the way to wherever we're going, we're probably going to make some stops in ED's, nursing homes, liquor stores, etc.

When you work med/surg, most of your admits will come through the ED. It is rarer where I work to get a direct admit from clinic or a surgical pt that hasn't already been admitted to the hospital. Exceptions are knee or hip replacements. But even a "simple" knee pt may have alcohol withdrawal, be elderly and frail, may hallucinate from pain meds, may have mental health problems, etc. You have to be ready for anything.

Correctly listening to lung sounds is something that is difficult for new grads to grasp it seems, yet so very important. Lungs are often the first things to go downhill in the hospital. Read up on fluid overload, nosocomial pneumonias, importance of doing coughing, deep breathing, incentive spirometer.

Also watching for skin breakdown in the elderly or bed-ridden is critical. Do a good initial assessment of the patient so you know what their skin is like when they come to you. Then, make sure the bad stuff heals and the good stuff doesn't get worse.

You will get great experience doing your transition class there. Just enjoy the ride and listen to all the stories and experiences of the other nurses there.

ChristineN, BSN, RN · May 3, 2008

Thanks for your advice. I'll be sure to review those things you mentioned.

I just spent my first day on the floor, yesterday. Ugh. I know I'll learn alot, and I know I can do the job, but what I hate most about adult nursing is that almost all of the adult floors I've done clinical on or worked on don't have good teamwork. Right now I'm a PEDS PCT, and the teamwork you see on PEDS floors is out of this world. Nurses help other nurses, no body lets the call light ring and ring, and if you have to turn/reposition somebody, they fully expect you to ask for help. Yesterday on the adult med-surg unit I was in my pt's room (isolation, so all gowned and gloved), had done all I could do by myself, and put the call light on so I could get some hellp turning her. I probably waited 10 min at least for someone. You may flame me for saying this, but it seems to me that a lot of adult nurses (not all) seem to like the "everyman for himself" policy. (In case you can't tell I have no intention on a long career in med-surg :no: )

My only comfort is that I have a great boss and an excellent preceptor.

veronica butterfly, ADN, RN · May 7, 2008

It's true med/surg can be grueling at times. A lot of places don't have good teamwork, but maybe being a student doesn't help... you don't know people as well and often times students sort of get left out from the staff nurses. I felt that way on my clinicals.

As far as waiting for help in the iso room for so long, I would suggest getting a team or helper ready before you go in. Hunt down a nursing assistant or your assigned nurse and tell them you're going in and will need some help in 10 minutes. Even at my job where we have GREAT teamwork, we always need to plan ahead if we know we're going to need help. Everyone is just really busy with their own patients and stretched pretty thin, so you have to make a plan...

Hope you're learning lots and not too miserable! It will go fast!

WDWpixieRN, RN · May 25, 2008

Ugh. I know I'll learn alot, and I know I can do the job, but what I hate most about adult nursing is that almost all of the adult floors I've done clinical on or worked on don't have good teamwork. Right now I'm a PEDS PCT, and the teamwork you see on PEDS floors is out of this world.
You may flame me for saying this, but it seems to me that a lot of adult nurses (not all) seem to like the "everyman for himself" policy. (In case you can't tell I have no intention on a long career in med-surg )

I'm just a newly graduated nurse, but I seriously hate to see generalizations after having done clinical rotations, an internship, and work as a tech in several different facilities.

We did a rotation through a local children's hospital (one of the "ranked" hospitals) and I went back and did a shadow on another floor as I was very interested in peds/NICU. You couldn't pay me or many of my fellow students, enough money to go back there on their floors.

On the other hand, the hospital where I am a tech and did my preceptorship has a pretty good working team. Sometimes it's personality-dependent (as many jobs are) where if you've ticked off a co-worked the cooperation might not be as great, but bottom line, I think what you point out as an absolute is related to the facilities you've been in rather than nursing as a whole.

I personally don't think that's wise to do in any situation. Reminds me of my kids telling that everyone is doing ________ (fill in the blank). Rarely is it everyone, everywhere, always, etc.

ChristineN, BSN, RN · May 28, 2008

I'm just a newly graduated nurse, but I seriously hate to see generalizations after having done clinical rotations, an internship, and work as a tech in several different facilities.
We did a rotation through a local children's hospital (one of the "ranked" hospitals) and I went back and did a shadow on another floor as I was very interested in peds/NICU. You couldn't pay me or many of my fellow students, enough money to go back there on their floors.
On the other hand, the hospital where I am a tech and did my preceptorship has a pretty good working team. Sometimes it's personality-dependent (as many jobs are) where if you've ticked off a co-worked the cooperation might not be as great, but bottom line, I think what you point out as an absolute is related to the facilities you've been in rather than nursing as a whole.
I personally don't think that's wise to do in any situation. Reminds me of my kids telling that everyone is doing ________ (fill in the blank). Rarely is it everyone, everywhere, always, etc.

I agree generalizations are bad, and it's partially do the the fact I worked at this med-surg hospital for 1 1/2 years while in school. I saw how the nurses were treated, 6-8 pts a piece-high accuity. I see nurses who work under these conditions getting burnt out very quickly. Whereas the local peds hospital has the highest rate of retaining staff in the area. Their nurses have fewer pts, and they treat their staff with respect.

BTW Pixie, I've reached a realization. I love adults, and IMO I provide good care for them, but I've come to realize that I have no interest in being a med-surg nurse. My heart is in Peds, and I am fortunate enough so close to graduation to have been able to land a peds job. Yes, I had to kind of break a contract to get it, but IMO it's worth it.

amybud, BSN, RN · Jun 3, 2008

Thanks for the awesome link, rosemadder. I just got hired as a new grad in Med-Surg/Oncology and that will help me when I'm trying to plan my day. :nuke:

LittleWing21, RN · Jun 26, 2008

I'm a new grad w/no experience so you can def. choose to completely ignore my post BUT....all I hafta say is: Don't go into the experience already jaded towards the group of pts. Some of the best clinical experiences I had were w/so-called "difficult" or unwanted pts. As a new grad, you'll have so much enthusiam that you're likely to make a big difference in some of these "dumped" pts. I plan on trying to make up for my lack of experience in clinical skills with a great deal of empathy, concern, and compassion for all my pts ESPECIALLY the shafted ones.

ChristineN, BSN, RN · Jun 26, 2008

I'm a new grad w/no experience so you can def. choose to completely ignore my post BUT....all I hafta say is: Don't go into the experience already jaded towards the group of pts. Some of the best clinical experiences I had were w/so-called "difficult" or unwanted pts. As a new grad, you'll have so much enthusiam that you're likely to make a big difference in some of these "dumped" pts. I plan on trying to make up for my lack of experience in clinical skills with a great deal of empathy, concern, and compassion for all my pts ESPECIALLY the shafted ones.

Hey LittleWing, thanks for your post. However, as I stated in my thread, my atitude was so "jaded" because I was trying to do something that deep down I did not want to do. I LOVE adults, I always assumed all through out nursing school I'd work med-surg, at least for a while. Once I did my pediatric rotation though, I couldn't think about anything else by kids, I had found my niche. I am able to provide excellent care and compassion for my adult pts, but my heart is not in to the same was it is when I'm dealing with kids. I am truly passionate about kids, and this is where I belong. :)

LittleWing21, RN · Jun 29, 2008

Totally got ya Christine...I love kids as well (dunno if I love pedi cuz I've only had like 3 pedi pts in clinical!!). I'm doin the med-surg thing first too and trying to really figure out what I'm meant to do.

I think it was just a wording thing ("dealing w/this group of pts"). That's one thing that stinks about the internet, alot of things get lost in the translation!!! Good luck w/everything :)

silentRN · Jun 29, 2008

I'm not a big fan of med-surg nursing....so where did I land a job? ON a med-surg unit haha. BUT, there are several factors that makes the unit I'm on enjoyable and a great experience for me since I too am a new nurse. For one, I work in a Magnet hospital and it's a teaching hospital so it's a great learning enviroment and the max patients I can have is 4. Second, everyone on the unit seems to be very cohesive with each other. Outside of work we will all go hang out and have a good time or call each other up. Everyone on the unit seems to have less than 2 years experience so everyone still appears to be stoked about there job :) . The only problem I have with the place I work is that the PCTs will sometimes have 10 patients a piece and I don't really like that. I worked as a PCT for 5 years before I got my RN and PCT work can be very back breaking and hard; and it also means your PCTs will seem non-existant because they are busy with 10 patients and probably tired and burned out.

The unit is actually an intermediate care unit but still under med-surg. I noticed that we don't receive the nursing home patients (once in awhile we do), and I know that I still have a lot to learn and am looking forward to learning this new stuff. We deal with transplants, trauma, and some gen surg. It's not the typical med-surg unit that I have experienced from past work and clinical rotations, and I like it haha. But, I think that I want to get more into ICU or ER. I did my preceptorship (or capstone some call it) in the ER, but I"m still undecided which direction to take.

-David

ChristineN, BSN, RN · Jun 29, 2008

I'm not a big fan of med-surg nursing....so where did I land a job? ON a med-surg unit haha. BUT, there are several factors that makes the unit I'm on enjoyable and a great experience for me since I too am a new nurse. For one, I work in a Magnet hospital and it's a teaching hospital so it's a great learning enviroment and the max patients I can have is 4. Second, everyone on the unit seems to be very cohesive with each other. Outside of work we will all go hang out and have a good time or call each other up. Everyone on the unit seems to have less than 2 years experience so everyone still appears to be stoked about there job :) . The only problem I have with the place I work is that the PCTs will sometimes have 10 patients a piece and I don't really like that. I worked as a PCT for 5 years before I got my RN and PCT work can be very back breaking and hard; and it also means your PCTs will seem non-existant because they are busy with 10 patients and probably tired and burned out.
The unit is actually an intermediate care unit but still under med-surg. I noticed that we don't receive the nursing home patients (once in awhile we do), and I know that I still have a lot to learn and am looking forward to learning this new stuff. We deal with transplants, trauma, and some gen surg. It's not the typical med-surg unit that I have experienced from past work and clinical rotations, and I like it haha. But, I think that I want to get more into ICU or ER. I did my preceptorship (or capstone some call it) in the ER, but I"m still undecided which direction to take.
-David

Hey David, that sounds like a great floor you're on for getting ICU or ER experience. I have thought about going to the ER in a year or two myself (pediatric ER). You made a good point, employee to employee relations can make or break a unit. The med-surg unit I almost ending up working on had absolutely no teamwork whatsoever. It was every nurse for themselves. Nurses had anywhere from 5-8 pts (on daylight!!!) and it was not uncommon for the PCT to have all 24 beds (and yet still be expected to do all the vitals, blood sugars, accurate I&O, etc). I found their RN as well as PCT pt loads to be, IMO, unsafe. I know it "works" for them, but they also had a very impressive number of pts falling every month. Nurses and PCT's were getting burnt out, but for many of them this was all they knew.