Soon-to-be New Grad : I Don't Want to Settle for Med-Surg

[Nurse Beth]

Hi Nurse Beth,

I am a nursing student getting ready to graduate soon with my BSN. I have been an LPN for 6 years. I am starting to apply for GN residency/job opportunities. I know that I like the ICU and hope in 5 years to graduate to an ICU trauma unit eventually. However, I have a lot of nurses tell me to get a medical surgical background. The only thing is I know I do not like having a large patient load of 6-8 patients. The small patient to nurse ratio is of the reasons ICU appeals to me, I feel like I can give better patient centered care.

My question is - I do not want to pass up opportunities, but I also do not want to accept a position as a med surg nurse when I already know I do not like the patient to nurse ratio. In an interview I am afraid this will make me sound like I can't handle it, or am unorganized or have time management issues. How do I make this sound like a positive attribute?

Basically I do not want to settle.

---

Dear Don't Want to Settle,

Don't worry about what the other nurses are telling you. You will find strong opinions either way on the "start in Med-Surg or not" debate. Just nod and thank them for their input.

Hiring managers will not judge you for applying to and preferring ICU over Med-Surg. It's very common and everyone has a preference.

The question is, what will you do if you are not offered an ICU position? I would take a hospital position in Med-Surg over no job. You always want a backup strategy, and you can transfer later.

Best wishes,

Nurse Beth

[moldyoldyrn]

Good old med-surg is hard and tough. After you have worked med-surg I think you get more organized and it teaches you about coordinating care, setting priorities, the sort of thing that everyone needs. Nothing negative about wanting ICU and yet why pass up what might be a good experience? Where I worked they brought new nurses in usually to a rehab unit where they learned the computer systems and the routines, after 6 months to a year it was expected that they would move to a med-surg unit, telemtry, neurology, for 1-2 years and then they could go to any ICU they wanted, neuro, cardiac, medical or surgical. Most of the RNs I ever worked with appreciated the broad experience they got this way. I started out on Pediatrics, and PICU, neonatal. Where I worked then they had 4 Pediatric units, Medical under age 3, Surgical under age 3, Medical age 3-16 and Surgical age 3-16 in addition to PICU. I worked them all and was so glad I did. If you concentrate only on one area you miss out on some tremendous opportunities and experiences. Besides if you work on a unit where you transfer patients in and out it helps to know what some of the other units experience when a transfer comes in. I worked on one med-surg unit that took primarily Renal and Aids patients in the late 1980's. We got so many transfers from the ICU that hit our floor and died. They had been made a DNR prior to transfer but when you get someone like that who passes as you are pushing their bed into place it hurts the relationship with the family. At least in my experience it sort of pushes the patient out the door without a care for their situation. If someone who is from the transfering unit knows how things like this impact staff and families then you have a little more empathy for the people involved and can apply that to decisions you make and the kind of care you give. I know that ICUs now retain more people who are close to death but there are still places that push them push them out of the door. You got to think about the whole, big picture and maybe a little experience helps that.

[betsykenrick]

Dear "Not Settle" Even with your LPN years, (since there are alot of procedures that LPNs still are not allowed to do) I think at least 6 months to a year of Med/Surg would be very beneficial as a new grad. I've been a nurse for 48 years.....(20+ of those were as an LPN) and I found that working in Med/Surg after I graduated as an RN to be very valuable. You learn alot more on your own. You develop more confidence performing without classmates and an instructor watching your every move, etc. Try to find a position in a facility where you won't get too heavy an assignment. Good Luck!

[ndl20]

I was actually that nurse that absolutely did not want med/surg, I was also an LPN home care peds for 9 years prior to completing my RN, So bad I didn't even interview for it. I wanted L&D or NICU, well I didn't get either of those positions and was asked to interview for Med-Surg. I thought well if I didn't get the position that I'm so passionate about I won't get this one and the interview experience wouldn't hurt. Well guess what?! I got the position I didn't want. I was devastated, but it has taught me so much time management and how to deal with the entire interdisciplinary team. Many experienced nurses told me the experience give you that foundation and I believe it does. I know how to handle a heavy patient load, but it left me wanting more, like ICU. I would say if it's offered take it don't get comfortable and take that experience right on to ICU!

[TX_Engr2RN]

Dear "Not Settle,"

I agree with others who have posted about:

- Not stating patient ratio as reason you prefer ICU.

- Easier to transfer to other units.

- Benefits to starting in a less acute environment of med-surg.

I knew that I wanted to be an ICU nurse when I had my clinicals. I had the opportunity to start as a GN in the ICU, but I opted to start in Telemetry instead. I was afraid that having too many new things to learn may put a patient's life at risk. I have no regrets in my choice.

I was on a great telemetry unit where they valued teaching and grooming me to be a good nurse. It helped me learn the hospital and unit rules/protocols, computer charting system, basic nursing skills, anxiety in dealing with frustrated doctors and patients, learn the meds and diagnoses /conditions that easily can lead to quick turn into ICU status, and most importantly, prioritization and time management. Nursing assignments can "suck" at times (6 patients), but usual assignment was 4-5 patients with discharges/new admits.

I stayed in Telemetry longer than I had planned, 2-3 years, because I loved the people I worked with. Once I transferred to the ICU, I knew I was finally in the right place. Being a transfer within the same hospital definitely helped because I could focus on leaning the skills of an ICU nurse without the burden of what I listed above.

Many people think "ICU has it nice, 1-2 patients only." But the condition of your patients can change quickly. You have to be diligent and check on your patients often. I love ICU because it provides learning opportunities all the time. But with the low ratios, it CAN get challenging when both your patients are going bad at the same time, you get 2 very confused/combative patients, dying patients who are still full code because family isn't ready to let go, and the list goes on and on.

So congratulations on becoming a nurse. May your journey be fulfilling. It may not start where you think you want to ultimately be, but find alternate paths to get there and cherish the learning opportunities at each stepping stone. Good luck!

[Nurse Beth, MSN]

I normally carry a load of 5-6 on telemetry "successfully," (in quotes because I meet all their immediate needs but rarely have time to do additional education or ambulation for high fall risk patients, more time intensive things that no one will call you out on if you skip but are important at the heart of nursing, etc.) but research does show that every patient over four leads to increased morbidity/mortality even in med-surg.

This is true! Legislation to mandate nurse-patient ratios include a 1:4 nurse patient ratio for Med Surg. I support this. Patients acuity is only going to continue to get higher.