Exploring the Role of Medical-Surgical Nursing

Med surg nurses, short for medical-surgical, care for adult patients with acute and chronic conditions. They work in multiple settings, from inpatient hospitals to outpatient clinics. As the largest specialty group in nursing, medical-surgical nurses play a vital role in healthcare.

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Exploring the Role of Medical-Surgical Nursing

What is Medical-Surgical Nursing?

Medical-surgical nursing, also known as med-surg, or med surg, nursing, is the largest nursing specialty in the United States and focuses on patient-centered care for medical and surgical patients. As the foundation of nursing care, the medical-surgical specialty is an entry point to nursing practice for many.

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Medical-surgical nurses care for adult patients with injuries, acute or chronic medical conditions, and surgical patients before and after an operating room (OR) procedure. Medical-surgical nurses are proficient in caring for and treating various conditions and are knowledgeable about multiple disease processes and comorbidities.

Med-surge nurses are an integral part of the healthcare system. Because medical-surgical nurses spend a great deal of time with patients, they serve as the eyes and ears for the interprofessional healthcare team.

Medical-Surgical Nursing Job Duties

Medical-surgical nursing follows the nursing process to establish a nursing diagnosis and care plan. The following is a list of just some job duties for a medical-surgical nurse.

Nursing process

The nursing process is a five-step systematic approach to identifying patient care needs. The process includes assessment, diagnosis, planning, implementation, and evaluation.

1. Assessment

The nursing assessment is the very first step in the five-step nursing process. Medical-surgical nurses complete a patient's health history, perform a physical, psychosocial, and neurological assessment, and document the findings.

2. Diagnosis

The nurse generates nursing diagnoses from the nursing assessment findings. The medical-surgical nurse can focus on the patient's key health issues with a working nursing diagnosis. Once the patient has a nursing diagnosis, the nurse uses clinical judgment to create a care plan and determine interventions that will lead to the best patient outcome.

The nursing diagnosis differs from the medical diagnosis because nursing aims to treat the patient's response to an illness and how it affects different areas of their life. An example of a nursing diagnosis versus a medical diagnosis may be type 2 diabetes mellitus, while the nursing diagnosis is a risk for unstable blood sugar.

3. Planning/Outcome

The medical-surgical nurse sets treatment goals and expected outcomes in the care planning stage. The nursing care plan should support nursing and medical diagnoses. A care plan is a written action plan for the patient, and the nurse can update the plan at any time during the patient's hospital stay.

Interventions in the plan should be measurable and include the expected outcome of the intervention. For example, if pain management is part of the nursing care plan, the intervention may be pain medication administration, and the nurse measures the outcome with the patient's report of pain relief.

4. Implementation

The implementation step is the action phase. The medical-surgical nurse carries out the interventions in the care plan, which can include administration, bathing patients, and performing bedside procedures, such as starting an IV, inserting a Foley catheter, or inserting a feeding tube.

5. Evaluation

Medical-surgical nurses evaluate their interventions for effectiveness. For example, if a patient's pain level has not changed an hour after the nurse gives the prescribed pain medication, the nurse should request an order to increase the dosage or change the medications.

Infection Prevention and Patient Safety

Medical-surgical nurses aim to prevent infection and keep patients safe. Nosocomial or hospital-acquired infections can be a risk factor for hospitalized patients. Medical-surgical nurses use evidence-based practices to prevent infections, such as catheter-associated urinary tract infections.

Monitoring

Medical-surgical nurses monitor patients' vital signs, mental status, and any changes in a patient's overall condition.

Medication Administration

Medical-surgical nurses spend a great deal of time administering medications. A critical element of medication administration is a deep understanding of the pharmacodynamics of each drug and monitoring for side effects.

Documentation

Medical-surgical nurses document all clinical care they provide to each of their patients. The patient record is a legal document, so it is essential to maintain real-time, accurate charting for each nursing intervention. A medical record is also a place where interprofessional team members communicate with each other.

Procedures

Medical-surgical nurses perform basic bedside procedures, such as starting an IV, inserting a Foley catheter, blood draws, wound care, and dressing changes.

Patient teaching and Education

Medical-surgical nurses empower patients to improve their health through patient teaching. Patient education supports patient safety and improves outcomes.

Advocacy and Support

Medical-surgical nurses take part in both patient and political advocacy. Nurse advocacy has the power to affect patient care and nursing practice.

Where do Medical-Surgical Nurses Work?

Medical-surgical nursing involves working in a fast-paced environment. While acute care hospitals are the leading employers of medical-surgical nurses, there are opportunities to work in a wide range of healthcare settings.

  • Acute care hospitals
  • Ambulatory care centers
  • Home Health
  • Hospice
  • Private practice
  • Rehabilitation facilities
  • Skilled nursing facilities
  • Telehealth

What Type of Patients are on a Medical-Surgical Floor?

A medical-surgical floor is a fast-paced environment that admits patients with various conditions. Medical-surgical patients require acute care interventions such as surgery or intravenous (IV) antibiotic administration to treat an infection. Below are some common conditions for someone on a medical-surgical floor:

  • A person with diabetes admitted for elevated blood glucose
  • A person with congestive heart failure (CHF) with fluid overload
  • Orthopedic injuries or postoperative care for knee replacement surgery
  • IV antibiotics for Infectious diseases such as methicillin-resistant Staphylococcus aureus (MRSA) or COVID-19
  • Sepsis treatment with IV fluids and medications
  • Telemetry for cardiac patient monitoring

Advancing Your Career as a Medical-Surgical Nurse

To become a medical-surgical nurse, you must first graduate from a nursing program and obtain a license as a registered nurse (RN), licensed practical nurse (LPN), or vocational nurse (LVN). There are multiple educational pathways available for you to enter the nursing profession. 

Deciding on what type of nursing degree you want means you must consider several variables, such as the nursing program requirements, the length of the program, time commitment, and cost.

To become a registered nurse, you must attend an accredited nursing school. Ultimately, the accredited degree program you chose will prepare you to sit for the National Council Licensure Examination for Registered Nurses (NCLEX). Below is a list of certificates and degree programs available to aspiring nurses.

Associate Degree Nurse (ADN)

ADN programs are usually two years long and offered by community colleges and technical or trade schools. Once you have graduated from an ADN program, you can sit for the NCLEX exam.

Bachelor of Science in Nursing (BSN)

The BSN is a four-year degree offered at traditional colleges and universities. Besides the nursing curriculum, you must complete lower-level general education coursework required by all university students. You can enter a BSN program as a first-year, transfer, or accelerated program student.

An RN-BSN bridge program may be a good option for a registered nurse with an ADN degree. For high school student applicants, some BSN programs may also require a standardized admission exam such as the scholastic aptitude test (SAT) or American College Testing (ACT).

Master of Science in Nursing (MSN)

An MSN is a master's degree in nursing that usually takes two years to complete. For candidates interested in becoming a registered nurse with a non-nursing degree, there are direct-entry master's degree programs.

Students who apply to direct-entry MSN programs are usually interested in advanced practice registered nurse (APRN) roles. However, the coursework prepares you to sit for the NCLEX exam.

Now that you know what options are available, it's time to determine if you fulfilled the requirements to apply for a nursing program.

First, you must be a high school graduate or provide high school equivalency exam scores for your General Education Development (GED) or Test Assessing Secondary Completion (TASC) test.

Once you decide on your desired degree, you can apply to an accredited nursing school. You can search your prospective school's website to find out if the program is an appropriate agency-accredited program. You can also check with your state nursing board for accredited nursing programs. Accreditation is crucial because it speaks to the quality standards of nursing education.

Patience is vital when beginning your nursing journey. That said, gaining admission to a nursing school can take some time, depending on the program's competitiveness. Nursing programs have prerequisites you must satisfy before beginning your nursing coursework. The pre-admission requirements depend on your program. Here are some common courses:

  • English composition
  • Mathematics
  • Psychology
  • Anatomy and Physiology
  • Statistics
  • Microbiology
  • Chemistry

Some programs may require a standardized entrance exam. The exams aim to measure critical thinking and comprehension, skills necessary to complete nursing school. The following are some of the most common nursing school admission exams:

  • Health Education Systems, Inc. Admission Test (HESI A2)
  • National League for Nursing Pre-Admission Exam (PAX)
  • Nursing Entrance Test (NET)
  • Kaplan Nursing School Admission Test
  • Test of Essential Academic Skills Exam (TEAS)

Once you complete the coursework and graduate from an accredited nursing program, you can take the NCLEX exam. In addition, you can take your initial RN licensure exam in the state you plan to practice nursing.

Professional Development

Nursing research and new practice standards in medical-surgical nursing are constantly developing. The Medical-Nursing Journal, published by the Academy of Medical-Surgical Nurses (AMSN), is a great resource to stay up-to-date with the latest innovations in medical-surgical nursing practice.

For medical-surgical nurses who want to take their careers to the next level, professional nursing organizations offer board certifications (RN-BC). An RN-BC is a great way to show your specialty expertise and commitment to learning and growth as a medical-surgical nurse.

The following is a list of the medical-surgical nursing certifications available. Certification eligibility requirements may vary, so check the organization's website for more information.

Medical-Surgical Board Certified (MEDSURG-BC)

The American Nurse Credentialing Center (ANCC) awards the MEDSURG-BC credential, which is valid for five years.

Certified Medical-Surgical Registered Nurse (CMSRN)

The Medical-Surgical Nursing Certification Board (MSNCB) offers the CMSRN. The credential is valid for five years.

Care Coordination and Transition Management Certification (CCCTM)

The CCCTM credential is retired. However, if you currently hold this certification, you can renew it through the ANCC.

Med-Surg Salaries and Job Outlook
While there are no specific statistics on salaries for medical-surgical nurses, according to the Bureau of Labor Statistics (BLS), the registered nurse employment rate may grow six percent between 2021 and 2031.

Overall, the BLS projects the average number of job openings for RNs is about 203,200 yearly over ten years. Job vacancies result from retirement or nurses leaving the profession.

As of May 2021, the median salary for RNs was $77,600.

Success in Med Surg, Soft Skills

While nurses must develop highly technical skills and knowledge within the specialty, soft skills are also essential when caring for patients. Some valuable attributes of medical-surgical nurses include the following soft skills.

Effective Interpersonal Communication

Medical-surgical nurses communicate with patients, family members, fellow nurses, and other patient care team members. Therefore, mastering effective communication skills as a med-surg nurse is crucial. In addition, medical-surgical nurses ‌must adapt their communication style based on the message and the receiver.

Compassion, Patience, and Empathy

For patients, dealing with illness or awaiting a surgical procedure can be stressful, so showing compassion and patience is vital in medical-surgical nursing care. Empathy means imagining yourself in someone else's situation gives you a better understanding of what they are going through.

Organizational Skill

Medical-surgical nurses organize and coordinate patient care. As a result, they can set priorities to ensure patients receive timely nursing interventions.

Critical Thinking

Critical thinking in medical-surgical nursing involves understanding logical connections between concepts and thinking clearly and rationally. Critical thinking drives the decision-making process when developing a nursing care plan.

Collaboration and Team Player

As a member of the interprofessional healthcare team, medical-surgical nurses collaborate with others to work toward the best patient outcomes.

Cultural Competency

Medical-surgical nurses show cultural competency by respecting culturally diverse patients' values, beliefs, and attitudes.

Final Thoughts

Medical-surgical nursing is both challenging and rewarding, as no two workdays are alike. It is the foundation of nursing practice and the cornerstone of healthcare. As a medical-surgical nurse, you improve the health and quality of care for your patients with your vast knowledge and skills. You also sharpen your pathophysiology and pharmacology skills. With solid medical-nursing experience, you can also move into other nursing specialties.

STAFF NOTE: Original Community Post 

This article was created in response to a community post. The comments and responses have been left intact as they may be helpful. Here's the original post:

Quote

Hi! Could anyone please explain to me what is med/surg nursing? Should new graduates start off doing med/surg?

I was offered a job on a general medicine unit and neurology/ neurosurgical unit. I don't know what to choose. I heard from other people that it's good to start of on med/surg so you'll get exposure to various of things. Would neuro nursing be too specific for a new grad? Or does neuro count as med/surg? Please help!

References

1. Academy of Medical-Surgical Nurses. (n.d.). What is medical-surgical nursing? https://www.amsn.org/about-amsn/what-med-surg-nursing

2. Murphy, H. (n.d.). The importance of "soft" skills in nursing & healthcare professions. Elsevier. https://evolve.elsevier.com/education/expertise/faculty-development/the-importance-of-soft-skills-in-healthcare-professions/ 

3. Toney-Butler, T.J., & Thayer, J.M. (2022, April 14). Nursing process. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK499937/ 

4. Cachón-Pérez,J.M., Gonzalez-Villanueva, P., Rodriguez-Garcia, M., Oliva-Fernandez,O., Garcia-Garcia, E., & Fernandez-Gonzalo, J.C. (2021). Use and significance of nursing diagnosis in hospital emergencies: A phenomenological approach. Int J Environ Res Public Health, 18(18), 9786. doi: 10.3390/ijerph18189786

5. Centers for Disease Control and Prevention. (2019, November 6). Patient safety: What you can do to be a safe patient. https://www.CDC.gov/hai/patientsafety/patient-safety.html 

6. National Council of State Boards of Nursing (NCSBN). (n.d.). NCLEX: The pathway to practice. https://www.NCLEX.com/ 

7. Academy of Medical-Surgical Nurses. (n.d.). MEDSURG nursing journal. https://www.amsn.org/publications/medsurg-nursing-journal 

8. American Nurses Credentialing Center. (n.d.). Medical-surgical nursing certification (MEDSURG-BC™). https://www.nursingworld.org/our-certifications/medical-surgical-nurse/ 

9. Academy of Medical-Surgical Nurses. (n.d.). Certification. https://www.amsn.org/certification 

10. American Nurses Credentialing Center. (n.d.). Care coordination and transition management certification (CCCTM). https://www.nursingworld.org/our-certifications/care-coordination-and-transition-management

11. U.S. Bureau of Labor Statistics. (2022, September 28). Registered nurses. https://www.BLS.gov/ooh/healthcare/registered-nurses.htm

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Kimberly_Madison

About Kimberly_Madison, RN

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Kimberly Madison is a freelance health content writer with over 13 years of experience as a registered nurse.

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Specializes in Med/Surge, Psych, LTC, Home Health.

Hmmmm.... first off, congrats on graduating!!!!

Med-surge nursing, in my opinion, is rather hard to define actually. Everyone who has ever done it may have their own opinion. I have two definitions:

A med-surge nursing unit would be defined as any inpatient unit in which just about all of the basic skills that you learned in nursing school are put to the test. On a med-surge unit you are likely to insert foley catheters, start IV's, change all different kinds of dressings, give lots of different types of medications, do lots of charting, admit patients, discharge patients... in addition, on what I would define as a TRUE med-surge unit, you will encounter MANY different types of patients of many different ages, with many different problems. To me, the neurology/neurosurgery unit DOES sound a bit more specialized than the general medicine unit; however I myself still believe that you will get great experience on the neurology unit. I believe that on that unit, you will definately still use most, if not all, of your nursing skills.

Here's another way that I define med-surge... a more generic, yet perhaps controversial definition.

If you are working in:

An ER

A Labor/Delivery Hall

A Nursery

An Operating Room

An Endoscopy Unit

A Psychiatric Ward

A Dialysis Clinic

A Nursing Home

... than you are NOT a med-surge nurse. I believe that in a lot of these specialties, many learned skills go by the wayside. They are GOOD specialties mind you, but they won't give you the experience honing all of the practical skills, that med-surge nursing will.

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Hi RealNurseWitch! Thank you for your reply! I was wondering, what kind of patients (diagnosis) would be in a general medicine unit?

I'm hoping to work in a postpartum (maternal-newborn) unit in the future. Would general medicine be more useful than neuro since I get more exposure to things where as neuro is more specific???

I heard there is a high turnover rate in med/surg...is it because many nurses use med/surg as a stepping stone and then they switch to another unit? Or it is because med/surg is very stressful and not a good unit to work on?

Thank you!

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Specializes in LTC, assisted living, med-surg, psych.
NCLEX_CareBear said:
Hi RealNurseWitch! Thank you for your reply! I was wondering, what kind of patients (diagnosis) would be in a general medicine unit?

I'm hoping to work in a postpartum (maternal-newborn) unit in the future. Would general medicine be more useful than neuro since I get more exposure to things where as neuro is more specific???

I heard there is a high turnover rate in med/surg...is it because many nurses use med/surg as a stepping stone and then they switch to another unit? Or it is because med/surg is very stressful and not a good unit to work on?

Thank you!

I'm a med/surg nurse in a small city hospital, and I see just about everything on my unit.......cardiac patients on telemetry, diabetics (LOTS of them), bariatric pts, detox, psych, cancer, orthopedics, even a pt with porphyria who comes in for a few days every 6-8 weeks. Personally, I like surgical nursing much better than medical......the medical pts are there generally because of lifestyle issues (obesity, smoking, ETOH use etc.) or because the nursing home needs a break from them, and we see the same people over and over again. Caring for these pts can be very frustrating, and I think it's what causes a lot of nursing burnout. However, I love med/surg because it's NEVER boring, you just never know what's going to come up to your floor from the ER, and sometimes you really can make a difference in someone's life.

I won't deny that it's very stressful........pts who aren't wanted by other units tend to get 'dumped' on us, and since we aren't staffed as well as the so-called 'specialty' units, we often have to scramble like mad to meet their needs as well as those of our more traditional pts. But there's nothing like med/surg nursing to teach a nurse those all-important critical thinking skills, and it gives you such a broad view of the conditions that can afflict human beings........I would recommend at least trying it for a year or two, who knows, maybe you'll learn to love it! ?

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Specializes in Med/Surge, Psych, LTC, Home Health.

Yeah, I was gonna say that on a general medicine unit, you are likely to see mostly persons with exacerbations of COPD (emphysema, asthma, etc), diabetes, heart disease, etc.. And yes, I too have found that many of the people on our general medical unit are there because of poor lifestyle choices, and it IS frustrating because they are there once or twice a month. And yes, our general med. unit does see a lot of nursing home patients.

Now, I work on a post-surgical unit. I mostly take care of persons who are recuperating from hip surgery, knee surgery, gallbladder surgery, bowel resection surgery, etc.. Our unit also receives all urology patients, MOST oncology patients, and all pediatric patients. PLUS, we receive the "spillover" from the general medicine unit.

I'll tell ya... if you want some really good experience... go work in a community hospital! You will REALLY see everything then, because the hospital is just too small for specialized units! (Other than OB, the ER, OR, etc...)

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