Does every new nurse need to start on med surg?

deeDawntee, RN · Feb 25, 2008

In answer to your question, you certainly do not need to start on med surg in nursing. Also, know that is very common for new nurses to change jobs often in those first couple of years to find that perfect niche. Personally, I had 6 different positions in the first 2 years or so that I was a nurse and it never got in the way of finding my next position. I believe it is an accepted part of the nursing culture to search for your niche. It is different than a lot of other industries where longevity is stressed. In nursing you can keep changing the rest of your career. So please let go of any guilt or "shoulds" about not staying where you are at.

Since I have never been specifically a med surg nurse, though I have floated there a lot in my career, it is obviously my opinion that you definitely do not need to start out in med surg. I think it is for the brave-hearted as a new grad, because of how tough it can be. I started in ortho (in the hospital setting) and although it was great experience, I was dying to know what the heart was doing and found that telemetry was invaluable. Those couple of years in telemetry really helped in learning heart rhythms and drugs, participating in codes etc, and was the best place to develop ICU skills and ER skills. In medsurg, you deal with a lot of GI issues.... I liked focusing on organ systems a little above the GI system, if you know what I mean.... hehehe

Keep searching, go for telemetry, if you can!! Tell us what you decide!!

:yeah: :yeah: :yeah: keep searching!!!

Miami NightNurse · Feb 25, 2008

this is just not safe practice!!!!

You are absolutely right jc449. I work on a Cardiovascular floor. I am overwhelmed and I've been doing this over almost 20 years and then I think these poor new nurses they must be freaking out. And then the cute part is management says we have to make the new people want to stay. Right!!! How about give them less patients!!!! Not in the budget, but that new waterfall in the lobby sure looks great.

Virgo_RN, BSN, RN · Feb 25, 2008

I started working on a cardiac unit immediately after getting my LPN, and I plan on staying there after I have my RN. My typical patient load is four, and the teamwork is great. I have not been treated badly by any of my coworkers, and everyone is willing to pitch in and help. As an LPN, my scope of practice is limited, so I have to get RNs to do things for me sometimes, like if I have a patient on a specialty drip and I need a rate change or a new bottle hung, or if I have a patient getting blood. If I get an admit, I can do the admission assessment, but I need to have an RN enter the care plans.

I don't like med-surg, but I really like cardio. This is where I plan to stay for a while. Things get overwhelming, some nights are so busy I don't get a break and have to stay late to finish charting, and I frequently second guess myself when I go home and try to sleep. But I think this speaks more to the nature of nursing than to the specific specialty that I am in.

NeoNurseTX, RN · Feb 27, 2008

I say NOOOOOO. I just started in NICU and I don't really see how med/surg would have helped me out there.

joeb1, ASN, BSN, RN · Mar 3, 2008

Some thoughts-

Whatever opinion you have is fine. There is no right or wrong way. If you come out of school able to learn quick to become that vascular intensive care nurse, more power to you. And some specialties, like the poster who mentioned NICU(I'm jealous by the way), would not have the slightest parallell to Med Surg. I myself started in Peds. This worked well, as med surg probably doesn't paralell a ton, except our rare peds surgeries or diabetes, etc. Not many Medsurg floors see RSV or Rotavirus. As for procedures, if you can start an Iv on a dehydrated 2 month old, you can usually do the rest. Anyway, L/D and well nursery now. Would med-surg have helped? Definately, we see tons of post op c sections and GYN surgeries, but most of my job, Labor and Delivery, has a unique skill set to that area. In short, do what you want, no matter what me or anyone else says. :specs:

NURSESOMEDAY? · Mar 3, 2008

I think your implication was best, it's a hazing! I have not even applied to nursing school as yet but hear the horror stories the past 20 + years from my RN husband. Which is why I haven't just jumped in. Now the kids are older etc, timing is good.

Cinnamongirl · Mar 3, 2008

I asked this question alot while still in school and it always seemed to be split down the middle, half said yes, half said no.

I have been struggling with this myself as I am on a busy med/surg (mostly surg) floor and don't really like it. I'm still in my 6 month period and also looking to transfer. I also have interest in the OR, outpatient, and clinical research. We have 6 at night, adults only, I can't imagine 7. Anything over 5 is too much, and 5 is too much if they are really sick.

I don't know that bedside is right for me, either. I like patient contact, but I'm not one of those people that I feel it is the #1 reason for being a nurse. Everyone also keeps saying, "oh, give it a year, it will get better". Well, what if it doesn't? A year is a long time to waste being unhappy, especially if you feel your job is taking over your life.

Does anyone know- can you go straight into ambulatory surgery from med/surg or do you need peri-op experience?

Anyway, I digress- OP, the number one thing to know is you need to do what is best for you. If you aren't happy on your floor, go somewhere else if you can. It is all experience. You mentioned OR, I am also thinking of the OR, but know that some hospitals require 1.5-2 year contracts for their OR training programs.

There are so many different types of nursing, it is hard to know what you will like until you are there. We will figure it out, hopefully sooner than later!

Good luck!

Cinnamongirl · Mar 3, 2008

oh, one more thing.

If you work in a hospital who is really interested in retaining their nurses, and trust your HR person, go talk to them. I did. Your HR person can possibly help direct you toward a better direction. Also, you can find out what classes your hospital offerst (ie, ekg interpretation, concious sedation, etc) to make yourself more marketable for different positions.

yellow finch, BSN, RN · Mar 6, 2008

Thanks to all that replied with their thoughts. An update for me... I talked to my nurse manager and told her how I was feeling. She said she would give me the "ok" to transfer before my 6 months. I am considering a job as a circulating scrub nurse, but I haven't made up my mind yet.
Last night-- 8 patients for me. 8 for the other nurse that was working and we had to call in a float to take the other 7. We had 2 nurses and one tech call off--(hmmm burnout??) One of the nurses who called off was "charge nurse". Ok, so that left just myself and another rather newer nurse. Just an example of the kind of patient load...One child's O2 level kept dropping in the high 80's (85-93), one guy who was receiving constant bladder irrigation, one post-op (complete bowel resection (3 hrs post-op) patient with a PCA. Somehow I feel that I am going to have to protect my new license and really consider to transfer. One of our rather scarier surgeons :bowingpur came up in the am to check on his post op patient. He saw the mess we were dealing with and called and demanded our scheduler more help. He commended us for the good job we had done. Somehow I feel my manager should have been there to help. I mean...this is just not safe practice!!!!

Is this some sort of small, community hospital? The mix of patients is highly unusual! I have a few years of experience and wouldn't touch that job for all the money in the world!

Transfer out! Fast!

Silver_Girl · Mar 7, 2008

I don't think so. I've had the opposite experience of some other people on here...I'm a brand new grad in my first year in the ICU, and I love it. I couldn't imagine working on another floor. Yes, it is incredibly stressful and scary at times and overwhelming, but I'm learning SO much and the experience is wonderful. I think that it's the quality of support on your nursing unit, rather than solely the type of unit, that impacts the experience. I work at a teaching hospital, so the senior nurses in our ICU are encouraged to precept and are incredibly supportive and always there to help or answer any questions...no hazing involved whatsoever. Our hospital also has a great orientation program with 2 weeks of classes and 12 weeks of having a preceptor, which also made a huge difference in the transition. There are always new batches of med students/interns around too every few months, so the doctors are also used to teaching and most are willing to answer questions. So...yes, it's the ICU, and I'm still constantly afraid of messing up and I feel really new and the patients are really sick, BUT because I have all these supports and resources in place on my unit, I feel okay with it, even without the medsurg experience. In a real emergency when lightning-speed-skills that I don't have yet are required, I do what I can but there are a million people at the bedside anyway, so the expert people step in...and each time as I gain more experience I just participate more and more.

Also, here are a couple inherent qualities of an ICU (vs. a medsurg unit) that I find extremely reassuring as a new grad:

1) excellent nurse: patient ratio!! Yes, they're very busy and sick, but here we only have 1-3 patients. Personally I much prefer to have a couple patients that I know really really well and do everything for, rather than 8 patients that I know sort of well. I'd feel really scattered with that many patients.

2) continuous monitoring! The second any vs starts to go sour the alarms go off. I was sort of scared by horror stories of nurses finding the patient at the end of the hall dead for who-knows-how-long at the end of their shift in nursing homes & such. And it kind of scares me that you can't see everyone at once on a regular unit, so something acute can happen to any patient at any time without you immediately knowing it. So I find the monitoring very reassuring.

Just weighing in. So in my opinion, if you find a GOOD ICU, go for it :) Much ICU love!

imanedrn · Mar 9, 2008

Everyone also keeps saying, "oh, give it a year, it will get better". Well, what if it doesn't? A year is a long time to waste being unhappy, especially if you feel your job is taking over your life.

That's exactly how I feel right now!... so I'm looking elsewhere... :sofahider

Mr BSN · Oct 14, 2008

I don't think so. I've had the opposite experience of some other people on here...I'm a brand new grad in my first year in the ICU, and I love it. I couldn't imagine working on another floor. Yes, it is incredibly stressful and scary at times and overwhelming, but I'm learning SO much and the experience is wonderful. I think that it's the quality of support on your nursing unit, rather than solely the type of unit, that impacts the experience. I work at a teaching hospital, so the senior nurses in our ICU are encouraged to precept and are incredibly supportive and always there to help or answer any questions...no hazing involved whatsoever. Our hospital also has a great orientation program with 2 weeks of classes and 12 weeks of having a preceptor, which also made a huge difference in the transition. There are always new batches of med students/interns around too every few months, so the doctors are also used to teaching and most are willing to answer questions. So...yes, it's the ICU, and I'm still constantly afraid of messing up and I feel really new and the patients are really sick, BUT because I have all these supports and resources in place on my unit, I feel okay with it, even without the medsurg experience. In a real emergency when lightning-speed-skills that I don't have yet are required, I do what I can but there are a million people at the bedside anyway, so the expert people step in...and each time as I gain more experience I just participate more and more.
Also, here are a couple inherent qualities of an ICU (vs. a medsurg unit) that I find extremely reassuring as a new grad:
1) excellent nurse: patient ratio!! Yes, they're very busy and sick, but here we only have 1-3 patients. Personally I much prefer to have a couple patients that I know really really well and do everything for, rather than 8 patients that I know sort of well. I'd feel really scattered with that many patients.
2) continuous monitoring! The second any vs starts to go sour the alarms go off. I was sort of scared by horror stories of nurses finding the patient at the end of the hall dead for who-knows-how-long at the end of their shift in nursing homes & such. And it kind of scares me that you can't see everyone at once on a regular unit, so something acute can happen to any patient at any time without you immediately knowing it. So I find the monitoring very reassuring.
Just weighing in. So in my opinion, if you find a GOOD ICU, go for it :) Much ICU love!

Thank you for your input Silver_Girl, I hope to emulate your experience in a few months. I (and perhaps other readers) would be interested in hearing more about what drove you to ICU, and what you wish you had known before walking through that door for the first few times.

Best of wishes for all the new and nearly grads here!