The top 10 things I have found are:
1. Patients are sicker now than 10 years ago, requiring more intense care.
2. Patients and families are paying more, therefore, demand more.
3. Nurse turnover is very high in the med/surg units, therefore, new nurses are frequently hired to this are. When this occurs, expertise is not there - they must learn to expand their clinical skills.
4. Younger nurses have different work ethics than the older nurses. I know this will get everyone's attention -
Trust me, I have been a nurse for 29 years, and many of us have seen this first-hand.
5. Med/Surg units are often speciality areas. Ours in: general surgery, othopedic/ urology, oncology and respiratory disorders. Sometimes the patients are "mixed" due to bed shortage, resulting in physicians being angry.
6. Electronic documentation - the thing of this era. Some of the older nurses resist this.
7. Demanding physicians. They want to be waited on hand and foot. Lack of respect.
8. You must be organized. In school the student cares for 2-3 patients, graduated, expect to care for 5-10 patients right out of orientation.
10. Varied wages from one institution to another one.
Good luck - nursing is great, all you have to have is one patient say a kind word about what you have done for them and sometimes that is enough.