What is med surg like these days???

Tweety, BSN, RN · Oct 23, 2005

Things haven't changed much. Realize this if you decide to go back into it.

SFCardiacRN · Oct 23, 2005

My med-surg friends are still over-worked and under-appreciated but if you read some of the threads, you'll find many RN's that love this specialty. However, If you did not like it in the past, you probably won't like now.

Long Term Care Columnist / Guide · Oct 24, 2005

Patients on med/surg floors now are much sicker than those we cared for even a year ago. We're doing insulin drips, dealing with all sorts of high-alert medications and taking care of people with multiple IVs, tubes, drains etc. who were considered critical care pts. only a short time back. Staffing, of course, has not kept up with the higher acuity, although I certainly can't complain about our ratios as compared with much of the rest of the country (we usually have no more than 5 pts. on day shift, 7 on nights). The problem is when you have two (or more) going bad on you at the same time, or when you get a critical-care move-out, a fresh post-op, and a new admission all at once, or when you have several total-care pts. and no aide.......unfortunately, these occurrences are becoming more the norm than the exception.

Don't get me wrong---I love my work; it's the job I hate sometimes. My advice to anyone re-entering this field after an absence of more than a year or two is to take a refresher course, or make sure to get a decent orientation period (at least three months) in order to get back up to speed.......believe me, you'll need it.

Good luck to you. I don't want to scare you away from Med/Surg---Lord knows we need everyone we can get!---but I do want you to be prepared.:)

Rickymom · Oct 26, 2005

I am leaving Med Surg. I tried it for 7 months and I'm headed back to pedi. I have never been so abused and tired. Give me my little patients.

bjm · Oct 27, 2005

I worked in on a medical floor at one facility and loved it...had a great TEAMwork of nurses and resources. Then I went to another small facility to the surgical floor. Overworked, underappreciated, understaffed, RAN RAN RAN my feet off until I had to have surgery on my feet. If you didn't like it before, you are NOT, I repeat NOT going to like it any better now. If you are happy where you are STAY there. If you are not happy there, seek something else in nursing. There are a lot of options...but I admit it takes a good while to get a break into some areas, but be persistant and keep applying until you get your break into something new if that's what you need.

RNinSoCal · Oct 27, 2005

I love med/surg. I have been doing it for 2 1/2 years and I am never bored. I work in California and I never have more than 5 patients. I work on a true general med/surg unit with everything from fresh post-ops to detox, psych overflow to gestational diabetes out of control. My feet hurt at the end of the day and my brain is fried but I always come back for more. I have no desire to leave med/surg for now. I might want to become a med/surg educator some day if teaching job salaries ever catch up to acute care levels. I also love precepting and mentoring. I wouldn't have liked med/surg as much as I do without the excellent mentoring I received my first year. Maybe I'm just crazy enough to thrive in the midst of insanity.

bjm · Oct 27, 2005

You are very fortunate to have only 5 pts. I thought CA was going to lower their ratios to 1:4. Is this not the case. I liked med/surg when I was at one facility but moved and when I worked for another, I got burned out in just a year.

Hellllllo Nurse, BSN, RN · Oct 27, 2005

I love med/surg. I have been doing it for 2 1/2 years and I am never bored. I work in California and I never have more than 5 patients. I work on a true general med/surg unit with everything from fresh post-ops to detox, psych overflow to gestational diabetes out of control. My feet hurt at the end of the day and my brain is fried but I always come back for more. I have no desire to leave med/surg for now. I might want to become a med/surg educator some day if teaching job salaries ever catch up to acute care levels. I also love precepting and mentoring. I wouldn't have liked med/surg as much as I do without the excellent mentoring I received my first year. Maybe I'm just crazy enough to thrive in the midst of insanity.

Sounds heavenly!

I had 10-13 pts by myself, no CNA, no unit clerk when I worked med surg. I stuck it out for only 3 mos, but it felt like 30 years. I almost left nursing because of my med surg experience.

Supportive mgmt, teamwork and good ratios seem to make all the difference in the world.

RNinSoCal · Oct 27, 2005

:wink2: The hospital where I work is 5:1 med/surg, 4:1 telemetry, 2:1 ICU/CCU. I haven't heard of any plans to lower these ratios at this time. We are doing just fine with these ratios because we still have our CNAs. 4:1 total care on a med/surg unit would be back breaking. You know the CNAs would be gone if they lowered the ratio to 4:1. I love my CNAs and try to always respond for a pull up or turn assist!! To all nurse managers and hospital administrators that may be reading this : PLEASE KEEP OUR CNAs TO PRESERVE MY BACK!!!! I only have the one and I like it the way it is.

irishnurse67 · Jan 4, 2006

Let me tell you about my evening shift I did yesterday. I offerred to work an extra 4 hrs on my day off (3p-7p). Wound up staying until 11:00 to help out.

Anyway, I was psyched when I saw I had only 4 pts instead of the usual 6! Then I met my 1st pt. Dx neuroleptic syndrome, new CVA, only responsive to painful stimuli. He's literally drowning on his own secretions and here I am suctioning the hell out of him all the time so he doesn't drown (of course traumatizing the hell out of his esophagus and casing more secretions in the process).

This guy's a DNR, but there I am w/ blood in one port of his IJ, fats/TPN in the other and numerous IV meds in the other (you're right, the doc is offended when I suggest that given his respiratory status and code status, should we be doing all this ****?) BTW, this guy is swollen like a ballon all over w/fluid. Just slow the stuff down and give him Lasix, is the answer.

Then I call the doc (who told me to hang the blood even though his T-max is 102) to tell her that the CXR says his NGT is in his esophagus and no one, not even another doc, can advance it. I also mentioned that the thing looks scabbed all to hell and I don't want to pull it b/c of possible esophageal varisces and I don't wan't a bloodbath on my hands (not in those words of course). The doc couldn't convince anyone to pull it and put the NGT meds on hold until the am. She was mad as hell, esp. when I pointed out that his H&H of 8 and 25 had to be from somewhere, and he had no hematuria and his stool was neg for OB.

I coudn't get this guy transferred to the unit. The doc said she wasn't going to do ABGs or tube him. I told her that wasn't what I wanted, I just wanted him somewhere where a nurse could care for him and NOT ignore her other pts, which is what I had to do (thank God they were all alright).

What I'd like to ask my fellow nurses is this, I've only been a nurse for 6 yrs, so a lot of you could give me some advice, I bet. What do you do when you have a pt like this and you have another one that goes bad and all of the other nurses also have a heavy assignment? And why the hell do we give DNRs on their death bed all this stuff when all it does is torture them.. One of these times I'm going to tell a doc, "You go torture that old lady w/a NGT, foley and IV, I'm not-I have morals."

I have 29 yrs until retirement, I don't know if I can keep doing this and if I do, am I going to hell?

Help!

P.S. You can be sure my lengthly nurse's note said, "MD made aware" many, many times.

Long Term Care Columnist / Guide · Jan 4, 2006

Let me tell you about my evening shift I did yesterday. I offerred to work an extra 4 hrs on my day off (3p-7p). Wound up staying until 11:00 to help out.
Anyway, I was psyched when I saw I had only 4 pts instead of the usual 6! Then I met my 1st pt. Dx neuroleptic syndrome, new CVA, only responsive to painful stimuli. He's literally drowning on his own secretions and here I am suctioning the hell out of him all the time so he doesn't drown (of course traumatizing the hell out of his esophagus and casing more secretions in the process).
This guy's a DNR, but there I am w/ blood in one port of his IJ, fats/TPN in the other and numerous IV meds in the other (you're right, the doc is offended when I suggest that given his respiratory status and code status, should we be doing all this ****?) BTW, this guy is swollen like a ballon all over w/fluid. Just slow the stuff down and give him Lasix, is the answer.
Then I call the doc (who told me to hang the blood even though his T-max is 102) to tell her that the CXR says his NGT is in his esophagus and no one, not even another doc, can advance it. I also mentioned that the thing looks scabbed all to hell and I don't want to pull it b/c of possible esophageal varisces and I don't wan't a bloodbath on my hands (not in those words of course). The doc couldn't convince anyone to pull it and put the NGT meds on hold until the am. She was mad as hell, esp. when I pointed out that his H&H of 8 and 25 had to be from somewhere, and he had no hematuria and his stool was neg for OB.
I coudn't get this guy transferred to the unit. The doc said she wasn't going to do ABGs or tube him. I told her that wasn't what I wanted, I just wanted him somewhere where a nurse could care for him and NOT ignore her other pts, which is what I had to do (thank God they were all alright).
What I'd like to ask my fellow nurses is this, I've only been a nurse for 6 yrs, so a lot of you could give me some advice, I bet. What do you do when you have a pt like this and you have another one that goes bad and all of the other nurses also have a heavy assignment? And why the hell do we give DNRs on their death bed all this stuff when all it does is torture them.. One of these times I'm going to tell a doc, "You go torture that old lady w/a NGT, foley and IV, I'm not-I have morals."
I have 29 yrs until retirement, I don't know if I can keep doing this and if I do, am I going to hell?
Help!
P.S. You can be sure my lengthly nurse's note said, "MD made aware" many, many times.

Experiences like this were what finally drove me out of Med/Surg. After three years of working hurt, working sick, working too many days in a row, I suddenly lost it one day and quit. The catalyst was being threatened with a lawsuit and treated like dirt by this one very angry, ungrateful family after doing everything humanly possible to save their loved one, and then reamed out by management for not moving her to the intensive care unit myself without a doctor's order.:angryfire Like I knew this was even an option??!! Whoever heard of an RN going over the MD's head and transferring a patient herself---I'd probably have been fired outright.:stone

It broke my heart, and worse, it broke my spirit......I had five patients that day, all of whom were post-ops or new admits plus this gravely ill woman whose husband lied like a dog, saying that I never came in to check on her when I spent at least 3 out of the last 4 hours of my shift in that room. Then I got hung out to dry by management, who not only failed to back me up when the emergency was hot but left me to twist in the wind when the husband complained "that nurse didn't do anything about the vomiting or check on her or get her moved to ICU".

This was, however, merely the last in a loooooooong line of crappy shifts, which had been a regular occurrence over the past 6 months or so. When the bad days outnumber the good ones by 4 to 1 or more, it's time to move on.........Lord help me, I never want to go back to that.:stone