Do you recommend a year of med/surg in 2021?

[FolksBtrippin, BSN, RN]

Had a conversation with a couple of retired nurses and a nursing student that got a little heated last night. 

Basically the retiree nurses were saying you must have 3 years of med surg before doing anything else as a nurse.

I said that was not the way it works anymore, that you need to find a facility that hosts new grads appropriately with a residency… and that this is happening in home care as well as the hospital on various types of units.

I pointed out that I went straight into psych and I’m competent. The retired nurses were saying that psych is a different animal and therefore doesn’t apply. As though I’m not an actual nurse.

The whole thing was frustrating and I think each feels the other is out of touch.

Please weigh in. 

[Wuzzie]

I think there are areas where having some experience is of benefit but 3 years is over the top. However, any job where there is no immediate backup is not the place for a new grad. 

[RNNPICU, BSN, RN]

I think by saying that everyone needs Med/Surg before going somewhere else also downplays the important role of Med/Surg - you are basically telling people to leave, Med/Surg needs experienced nurses and not just nurses out of school who leave in two years because they got their two years.  Who are  precepting these new nurses, nurses with less than two years of experience?  Yikes! All areas need experienced nurses and by encouraging people to leave Med/Surg after a year or two really disregards Med/Sur nurses who do not leave after two years.

I do not think that Med/Surg prior to another speciaility is really needed.  The important thing is to ensure there is a robost orientation program to support new nurses as they transition from nursing school to that first job. Anything other than Med/Surg will have specifics about that speciality and the new nurse will learn the assessments, meds, care needed for that area.  All Units have the "sick" "not sick" patient load and the new nurse will learn to recognize emeregencies and deteriorations based on that Unit, and even to some degreethe hospital.  

[chare]

I agree with @RNNPICU, an appropriate orientation is more important that some designated time in med surg.  And, I find it interesting how the number of years that are deemed appropriate to prepare your for another specialty seems to be a moving target.

[JBMmom, MSN, NP]

I think that everyone is different and there's no one size fits all answer for this. I started in long-term care and gained what I think are some very valuable skills in that area. Then I moved into acute care med-surg where I worked for almost a year, and again I found skills that I think were key to my career success. Moving into critical care after the base that I had developed in my previous nursing jobs was important for me because it's how I learn best. One of my best coworkers never worked a day other than in critical care and did it for 23 years. Certainly I was no better than she was because I had started in LTC and med-surg, but maybe my introduction to nursing wasn't as big a leap as hers. 

Personally I would recommend a start in med surg because you see the widest range of patients in a normal non-emergent state. So it's an excellent way to learn to evaluate patient conditions, become in tune with how patients progress throughout hospitalization, some improving and some requiring a higher level of care. You also gain great time management skills. But does everyone need that? No. Does everyone need three years? No. 

And psych nurses are TOTALLY actual nurses. I couldn't do your job, and I recognize a great importance in having those of you that can. I think one of the biggest problems in nursing is people that thinks there's some hierarchy and with nursier nurses out there. We're all needed for the patients we serve.  

[Emergent, RN]

That is the old school approach. I agree with you. Us old people sometimes are inflexible and can't accept that times are changing. 

[Sour Lemon]

Psych was my first choice, but they wanted med/surg experience, so I did med/surg for seven years. Now, I do both.

I think a solid block of med/surg experience is extremely helpful for getting your foot in the door elsewhere. Is it absolutely necessary? No ...but I'm glad I have it.

Now if your goal is something like NICU, I think I think med/surg experience can actually be a bad thing. Or at least not very helpful.

[anewsns]

I think if it is needed for your future that its a good idea, but if it is not required for your future then no. In many nursing jobs, youve got to pay some dues first, but if you have a definite future in mind that does not require med surg, then don't do it.  If you want to keep your options open for your future (not everyone needs to), then it is helpful to go into it right away while the school experience is still fresh in your mind. I don't think other careers do this. Like I imagine not every single employee at a big company with all these roles HAD to start in the same role first. There are many ways to the top of the mountain. 

[OUxPhys, BSN, RN]

This is a fallacy. It's why some nursing schools still are behind the times when it comes to ER and ICU clinicals. They say you need experience first to go to ICU/ER but then we are forced to learn OB and PEDS in nursing school.....both specialties in their own right. Same can be said regarding the OR. Times have changed. They have new grad programs for the OR that are like 9 months long. I don't think ICUs should hire any and every new grad (although some do because they have no other choice) but some nurses can handle the ICU right out of school. Some hospitals also offer really good ICU orientation programs for new nurses. Same can be said for the ER. 

I never did M/S. I did stepdown (but never got the benefit of stepdown ratios). I still was able to get really good time management skills while working with some pretty sick pts and having the additional responsibilities that come with being a stepdown nurse. I knew during clinicals I did not want MS. If I couldn't get stepdown it was probably off to the OR for me. 

So no. You do not always need MS first before going to ICU or even the ER.

[HiddencatBSN, BSN]

I started in a peds er as a new grad. Everything is so specialized now and I don’t think it’s a particular benefit to do med surg first not to mention it’s insulting to med surg as a specialty by considering it particularly more entry-level than another specialty. What matters is an appropriate orientation and support for a new grad. 
 

Were there things I didn’t learn in the ED as a new grad that I would have learned in med surg? Absolutely. But are those things I’d need as an ED nurse? Not particularly or I would have learned it in the ED.

[NightNerd, MSN, RN]

3 hours ago, HiddencatBSN said:

not to mention it’s insulting to med surg as a specialty by considering it particularly more entry-level than another specialty.

As someone who plans to do med-surg/tele as long as I stay at the bedside, I agree! I am always impressed by what others know and are capable of within their own specialties, and I hope they can find something to appreciate about mine as well. It requires its own unique skill set for sure.

I do think med-surg is a great place to start if you're not sure what you want to do in nursing, simply because you see a variety of situations and patients and may find what clicks with you there. I've worked with not only med-surg patients, but elements of psych, hospice, etc. show up all the time; you even get a little taste of what it might be like to do critical care during the occasional rapid or code. I like to do a little bit of everything, so I choose to stay put. That being said, if you know what you're interested in and passionate about, just go for it, especially if the unit and hospital will effectively support your training.

[dogmombyday, RN]

I strongly disagree with that, and very much agree with the other poster who said it turns med/surg into nothing more than a stepping stone. There are nurses who have worked med/surg for 30 years and that is their specialty. I think that way of thinking—that you must start there—is old and I’ve heard it less and less, which is good. I started in ICU straight out of school and I don’t regret it one bit. I knew I did not want to go the med/surg route and, to me, I felt that it would be a waste of my time as well as whatever floor I ended up in’s time, to train and orient a nurse who did not want to stay in that specialty. I think, at one time, there was a lot more division between the patient populations seen on different floors and maybe that’s where some of that idea comes from? I’ve heard that starting there is supposed to give you good organization and time management skills, but for me, nothing taught me better time management than having two vented patients who needed to be seen in the hour before rounds began and oh-by-the-way, you have to know everything about them both otherwise that one intensivist no one likes will rip you apart in rounds. Trial by fire, I guess!

I also think, on a different note, that people are just now starting to realize the true value of psych nurses. When I was in school, I worked on a children’s behavioral floor and was offered a spot when I graduated and got my RN. I turned it down because, one, I knew psych and especially that floor wasn’t where I saw myself going with my career but two, because I was worried that I wouldn’t get to work on skills like IVs and physical assessment. Looking back, now, it’s kind of funny to me that I was so concerned about that, but also how unaware I was that patients  anywhere can, and do, have psych issues. I think nursing school woefully underprepares most of us for the pervasiveness of mental health issues. I so appreciate psych nurses now, because we do get quite a bit of that on our unit (suicide attempts, drug abuse, schizophrenia, etc) and I know how difficult it is to manage these patients for the time they’re with us, let alone for years and years with these problems. You are absolutely a “real” nurse and I think, also, pretty badass for serving that population!