Bad Rep for Med Surg

[kellyskitties]

Any med surg nurses out there have any ideas or input about why med surg has such a bad reputation and what could possibly be done about it? We see so many new nurses and experienced come and go (before completing orientation). We see new nurses doing everything possible to avoid that "year of med surg." I know there's short staffing woes, but that can only be fixed if we get some good nurses to stay. I know there's the eat your young thing - but isn't the buffet open on all units in some way? Why are we so bad? I love it. I try to show why and what I love about it, but nobody works with me hardly unless they are eagerly watching for the chance to jump ship to another dept! We hear on our floor that we need to learn to work as a team better - I said, that would be easier if the players didn't change so fast.

How do we make med surg less of a nightmare and help nurses choose this field?

[kellyskitties]

Our hospital sets a max goal of 8 pts per nurse. Due to short staffing this winter there was one night I had 13 - just one night and our manager did stay almost the entire night to help us get through that. It wasn't as bad as it sounds like. At times we have 10 and at others we may have 3 or 4 - during the summer and currently we are running at about 6 per nurse.

I've learned the trick to the heavier loads is to work smarter not harder. I make a note on my assessment lap at the beginning of my night next to each pt what they ask for - then a take those things as I pass my meds or I delegate a few items to a CNA if possible. A lot of times the pt is just glad you didn't forget the blanket or snack they asked for. A lot of the time everything doesn't have to be right now. That's helped me be more efficient.

I also try to make a list of what I need to do that night and what time I expect to do it. Helps me organize and plan my night a little. Even when I get off plan - I have a clear list. That helps when I know I need to follow up on pain for a pt at say 0200, but I also know from this list they asked for blanket and they are due an Iv antibiotic at 0300 - well, one trip at 0230 will suffice for all three and save some running.

I just thought maybe I could help a few folks frustrated with med surg with my tips for how I'm doing it.

Keep the input coming. I enjoy the responses and read every one of them.

[st4wb3rr33sh0rtc4k3]

Where I work, the max for a nurse is 5 patients......... what are the ratios elsewhere? I too am a new grad and feel a little overwhelmed at times, but I like the challenge. My feet and back hurt at the end of the day, everytime I work.

I have had up to 7 in Med/Surg and up to 60 in Long Term Care.

[yumaRN1990]

I have worked med-surg for a very long time, (somedays it feels longer than others), but it is the place I want to work. I have seen a lot of changes in our unit over time. We have gone from one aide on each hall to total of five. Our equipement is getting better all the time. All that said and done the work is hard, and the acuity is very high, our patients no longer have only one or two things wrong with them. Our patient load on days is 4 to 5 and we really try to keep it at that. In the winter our population doubles and our beds are full all the time with peiple waiting to get into them. I might add that we are the only hospital for at a 250 mile radius. Our aides do all the lab work, ekgs, and accu checks. I agree that the work load is hard and the morale is not what it should be. Our schedule is for a 4 week period, and most of the nurses have chosen the days that they want to work and it is set that way. A few work 3 days one week and 2 the next, for an example. Being one of the two day charge nurses, I am always trying to think of ways to keep the moral up. A bag of candy for the nurse with the first discharge, because odds are they will get the first admit. One day I brought a flower in a vase with a note that said the flower was to brighten your day for one hour and then to pass it on. That flower went around for a couple of days. Nice to see the smiles on the faces of the nurses as well as some doctors. We have also had drawings, everybody who wants to donates thier change and thier name is entered in a cup. Who evers name is drawn get all the change for the day.

Do any of you have any good ideas of little things that can be done to help keep the moral up? I might add that the candy doesn't just go to a nurse, if the person cleaning the room gets the room done right a way a bag of candy goes to them, the CA who helps get the room set up for a new patient or gets a hard lab draw, gets a bag of candy. I am open to ideas that you come up with.

[Kelly_the_Great]

Hey yumaRN1990,

I love your suggestions for boosting morale! So much so, I just created a new thread (https://allnurses.com/forums/f8/boosting-morale-228536.html#post2236308) in the general nurse discussion area in hopes it would generate more responses.

I'm new to the hospital environment and am working in med-surg in a small rural hospital. So far, it's been pretty good, one of the best things about it is the team approach that I see there that I didn't see @ the bigger hospitals where I did my clinicals.

In med-surg, I'm thinkin' "it takes a village," ya know?

Anyways, as far as addtl. suggestions - today, one of the nurse aides brought healthy snacks for the staff that she had prepared b/c for some reason Tuesdays can be particularly busy there and lunch is hit or miss.

Well, in addtn. to already having told her thank you, I've got a funny thank you card that I know she'd like that I can have the nurses sign and give to her tomorrow.

Seems simple - a thank card but, honestly, I probably wouldn't have thought of it before your post.

Thanks! :flowersfo

[RNinSoCal]

I work in med/surg on a floor that has a max of 48 beds.

We have a very low turnover. We lose nurses when they move away from the area, retire, or decide to be stay at home Moms. We have not lost a single nurse in 1 1/2 years. None of our new grads quit. One is moving to another unit to get off of night shifts, but she would have stayed if a day shift was available on our unit.

Here are the perks that retain nurses where I work.

Max of 5 pts per nurse every shift. Days and evening have CNA assistance, Night shift has no CNAs.

A nurse manager that allows creative scheduling. For example: If I decide or need to work Tuesday instead of Wednesday and the number of nurses scheduled is above 8 I don't need permission to change my shift. This only applies to weekdays of course.

Full benefits at 24 hours per week.

No mandatory overtime.

A good hourly rate. We have 2 former computer engineers on our unit that switched to nursing because the pay is better.

A positive environment on the unit. Nurses actually help each other and are kind to each other as well as the pts.

An overlap nurse that works from 1000 am to 7 pm who does the admission and initial assessment on ER admits and fresh post ops before handing the pt over to regular staff.

I am the lowest in seniority with only 1 year and 7 months on my shift (days). Many nurses on my shift have been there 15 years or more.

The solution is simple.

Pay people a competitive wage for the city they live in with regard to all professions.

Give people flexibility and choices for scheduling and number of hours worked.

Provide benefits at a lower number of hours to retain mothers and older nurses who need to spend less time at work.

Work on creating an atmosphere of team work and kindness toward other nurses as well as pts. A helping hand can make the worst shift bearable.

Provide an overlap nurse for high census days when regular staff are too busy to admit new pts.

I know that this is shooting for the stars in many hospitals, but why not try?

I love med/surg, but I don't know if I could handle some of the conditions that many nurses have to deal with.

I used to have to take 8 pts and "cover" for the pts of LVNs and it was hell.

I am a firm advocate of "voting with your feet" if you are able to. A hospital that loses its staff to a better run facility is quicker to change.

[NurseCard, ADN]

You know, here's the thing... I'm currently doing psych nursing. I miss certain things about Med/Surge. I miss doing dressing changes. I miss placing foley catheters. I miss educating patients on how to care for themselves. I miss placing IV's. I miss being on my feet all of the time, and being busy. I have considered going back to M/S many times in the past eleven months that I've been in psych because I miss all of those things.

Here are the reasons why I have not done that:

--Disrespectful doctors.

--OVERWHELMINGLY acute patient loads.

--"Feast or famine". Very rarely STEADY, like I like it. Either overwhelmingly busy, or nerve-racking-ly NOT busy... in other words, waiting until the storm is going to hit!

--Overall terribly stress filled ATMOSPHERE.

--Cattiness of coworkers.

--No diversity in med/surge. I've found that med surge is about 99 percent white women, at least where I live. Drives me nuts.

Which leads to the things I love about the psych hospital where I work. First of all, doctors are employed by the same agency that we nurses, MHT's are all employed by; and therefore they must be respectful of us or face the consequences. VERY diverse employee population... blacks, whites, Mexican's, Jamaicans, Indians, etc.., and lots of men as well as women. Laid back atmosphere.

So... VERY hard for me to want to go back to med surge. I actually miss that type of nursing though, as far as practicing those skills... and I miss those patients enough.. that I'm thinking about going back and doing it about one shift a week, or every two weeks. Full time though? Ehhhhh... no.

[bluwavyhat]

Thank you for the suggestions in these threads, but I feel less than efficient somedays, and the patient's attitudes in the acute/chronic care setting are too negative. I understand the diagnosis cannot be cured one hundered percent. I have a silly idea about improving a patient's quality of life. If I can educate myself and the patient too on this theme things could turn around. Is there such a language as patient speak?

The cattiness is only the tip of the iceberg on a med surg floor. I have cinical attitudes from coworkers, patients, and family, but this is an accepted norm on the floor.

I like med surg work, but I need to polish up my skills first, and only then will I believe that I can seem effective in my work. I am there for the work, and as far as I can see any unnecessary drama from all parties referenced above can stay off the floor.

Do not get me wrong I find some coworkers truly inspirational to work with each day, but I will feel silly for sharing this observation, so I keep my nose to the grindstone. Med Surg is tough because you can get bogged down into two deliberate areas being patient care and medication administration. Unfortunately I feel my skills suffered from tunnel vision, and only I can make up for this alone.

I feel there are a great deal of misgivings about working a med surg floor. You forgive yourself for the stuff you signed on for and tell yourself not to quit. I am looking for a second wind. No lie...:smackingf

[kellyskitties]

You are correct, you can't always turn around the patients and make them better. But sometimes you can. I distinctly recall moments I have really made a connection or caught an illness going terribly wrong and saved a life. I also enjoy interacting with all the personalities I run into, even the negative ones. I feel good if I handle a negative person with a good outcome. They don't have to turn into a positive person, but I am often told how much they appreciate my kindness or time I gave them. Yep, if you get your act together, sometimes you can find that time even on med surg.

Right now I have a lot of new nurses - some nights it's just me and 3 new grads on my floor. WOW. What a chance to influence their attitudes!

Thank you all for the suggestions and keep them coming.

[nursesaideBen]

I've only been working as a nurse on the MCU for 3 months now but I've come a long way. I'm starting to really love working, it's such a variety of pts and diseases, everything from UTI's to meningitis. I think the trick most nights is trying to keep a step ahead, getting enough of your work done so that if you have admissions or a patient go critical you aren't chasing your tail for the rest of the shift, but of course that's not always possible.

[Turk182]

As the manager of a Med Surg floor, I have read and fully appreciated every posted comment relating to this subject. I think everyone has hit on a valid point of some aspect or another, and for the record, I know how hard you work!

I'm not so sure Med Surg nursing itself has the bad rap, but more like the working conditions and expectactions that are asked of you each shift. Add to that a changing census every few hours, the co-morbidities for each patient, and the endless change and ever more difficult to meet regulatory agency requirements, ....well you take all that and then be the lowest paying hospital in your "region", (or lower paid nurse because it's not perceived as difficult as ER/ICU) I can see why the new grads are hesitant to sign on.

Med Surg doesn't have that "glamor" of the drama and trauma that is perceived with ER or ICU nursing. But it can, if we promote it. You know all the hype now about "Rapid Response Teams" ? Well who did that before they came on the scene? The Medical Surgical Nurse, who sensed that "something wasn't right" or just felt like " if this one crashes, it'll be fast." The Med Surg nurse "saved their life" then and continues to be the first in line to do so now. Pull a new nurse in on a "bad" patient as soon as the opprotunity comes up, let them place a second IV line, or document. But get them involved and they'll get the same Adreneline rush the ER nurse does with a priority one patient.

A quick after thought, I was in the ER for several years, and LOVED it, becasue I loved the drama and trauma.... the having to think quick on my feet. Since transferring to a Med Surg Managers position, I've found the same number of opprotunities of turning around a bad situation. And while I certainly do not want to encourage "speciality nursing bickering", do you know an un-recognized difference between and ER nurse and a Med Surg Nurse ? The ER nurse knows their patient is there for a finite amount of time and will be going somewhere before their shift is over (usually)... the Med Surg Nurse will continue to have a case load for 12 hours, with ER admissions, direct admits, discharges, transfers, etc....because if the patient load isn't there for them to care for, guess who gets placed on call? Not the ER Nurse.

I applaud your dedication, and hope we can all work to promote the "coolness" of this specialty nurisng. Thank you from all the Med Surg Managers out there who are really trying to do right by the staff and the patients!

[ohmeowzer RN, RN]

i have worked med surg for 9 years now .. and i can tell you i know exactly why people leave. it is stressful and so much pressure .. it wears on your mind and wreaks havoc on your body.. i don't know just stress .. i am leaving soon .. i have seen new nurses on the verge of tears because they are so overwhelmed and the pressure keeps coming.. you get 3 or 4 admits a shift plus your other patients.. i had 6 patients .. 2 were getting blood , one had a CBI , 1 was sent to emergency surgey and i think i had a code and a admit.. i was so exhausted by the time i got home.. i never wanted to step foot in that hospital again. but i did ..

[NurseCard, ADN]

I just want to say, that I worked in Med/Surge for 7 years... 4 as an aide, 3 as a nurse... I was so convinced that I hated it. Now I'm in psych and getting ready to return to med/surge.

Why? Well, I never thought I'd really say this, but.... I'm BORRRRED... actually, I wouldn't say psych is boring all the time... it goes from boring to horrendously stressful, with no in between. At least in med/surge, some nights you are lucky enough to be steadily busy without any crises. Psych in my experience isn't like that. Plus I'm tired of having NO hands-on work with the patients.

So.... while I like psych in very limited doses, I'm ready to go back to med/surge. I miss it!!!! =) I'm very excited.