To the veterans-
The conventional wisdom on this board, with my instructors, and others seems to be that the best place for a new grad to start out is on the Med-Surg floor.
I don't understand this. It seems to me that you would need more experience to work Med-Surg than a specialty.
To wit: as a Med-Surg nurse I would have 6 to 10 patients, each with their own issues, this one a NG tube, that one a chest drain, etc. each with their own chart and meds. The other floor nurses have their own charges, so back-up is limited, and the Doctor is on the other end of the phone.
As an OR nurse, RR nurse, or other lower ratio nurse/patient position, I would be sitting on top of the patient, watching them with both eyesballs wide open, as would the Doctor next to me, and perhaps a number of other medical specialists. Yes, additional training and skills would be required, but it seems a more focused and straightforward environment.
What am I missing here, could someone give me a clue? Thankx. V-
Mar 3, '01
Yes it's true that you may only have 1 or 2 patients in the settings you described, and yes you can sit there wide eyed and stare at them. What do you learn? You learn 1 or 2 major systems, and how to take care of the problems of those systems. What you don't learn are skills like time management and priority of care. Medical-Surgical nursing is a great way to see the world of nursing. You get a variety of disease processes to help you understand each system. You learn what to worry about and what can wait to be worried about. You get a very good education in lab values and various procedures in short you get hands on nursing. New grads are desperately trying to figure out where they fit in the web of nursing and med-surg gives them a good idea of what will be expected of them on the units. I would rather have a nurse who started out on med-surg with maybe less critical patients move on to the sicker patients on the units. The m/s nurse will have a better understanding of why this patient is as sick as they are because he/she has seen the lesser degree and knows the difference.
Mar 3, '01
Med-surg is the make or break of acute care. If you can make it on med-surg for at least a year without going nuts, you can head into pretty much any specialty unit with confidence. School gives you just enough knowledge to be dangerous. Its the real life experience that makes that license mean more than the paper its printed on. If the only knowledge you get is what you learn in a specialty area, what happens when you burn out in that one area? You have to start all over from scratch somewhere new. If you have a strong med-surg base, minimum 1 year, you have honed assessment skills for everyone from 18 to 100, all body systems, about all major diagnoses, and become comfortable in your nursing skin.
In this day of nursing shortage you can certainly skip med-surg. But be very careful about the specialty you choose: you won't have the mobility that the med-surg-experienced nurse has earned.
Mar 3, '01
THE LEARNING EXPERIENCES PROVIDED IN THE MED SURG SETTING WILL HELP YOU THROUGHOUT YOUR CAREER IN NURSING.
Mar 4, '01
Hi V SPN,
Think of Med-Surg as a foundation to a house. If you have a solid foundation you will have a solid house. Those individual systems all mesh together. A PACU nurse needs to think about an open-heart patient's kidneys. What if they fail because of a blood clot? Would she know what to look for? A med-surg nurse would. I work both med-surg and out-patient hemodialysis. I use my med-surg experience alot. Imagine the day an experienced (CNN) hemo nurse asked me to listen to a patient's lungs. Know why? Becuase she wasn't sure if the patient needed further dialysis and she hadn't listened to lungs for 5 years ( since her school days). I listened to the lungs and charted lungs crystal clear to auscultation. I was rewarded later that day when the CXR proved me right. Don't think you can take the easy road because you can't. Get all the knowledge you can you'll be glad you did....... TTFN Some things worth doing are worth doing right....
[This message has been edited by 3651bht (edited March 04, 2001).]
Mar 4, '01
All of the above replies are accurate and correct. The one thing that I have found to cause the most problems with new grads and Critical care is the equipment.
There is still so much to learn about pt assessment when we graduate. If an RN goes from school to the ICU, they often become too dependent on the machinary for assessment of the patient. But when I trained RN's who had worked med/surg, they always looked at the patient first. And they used the machines to confirm their hands on assessments. I still don't like working the "floors". But I could never get that essential experience as fast any other way.
Mar 4, '01
In addition to providing a broad base of experience and exposing you to many phenomena, conventional wisdom has had it that you are less likely to be thrown into frequent and devastating "life or death" experiences in med surg. Most of us just don't come out of school with the capacity for rapid response and some people find it very hard to forgive themselves when they get into a situation and discover to their dismay that they weren't born with this capacity. I've seen people devastatingly burned out in critical care situations and they left doubting their ability to respond to any situation, ever, at all. Nurse managers with a conscience regret their complicity in setting new grads up for this kind of personal devastation when they see someone leave their employ (and usually their agency) sure that they don't have "what it takes" to be a nurse. You won't be hearing from those nurses at this web site. They may be too ashamed or no longer in nursing. You will only hear from the nurses who started in critical care and had the chutzpah, professional support or blind unawareness to see the destruction left in their wake to say that they "made it".
I frankly think that this "benefit" of starting med surg is a little diluted from what it formerly was because acuities are higher than ever on med surg and low staffing ratios have diminished units capacities for giving new grads support.
I agree with the poster that said that you benefit from that base of med surg experience all your life; I certainly pull on it, even though I am no longer in the hospital. If you do end up in critical care, it gives you empathy for your sisters and brothers who are "out there" on the units.
Ultimately, even your instructors and these posters know that you will do what you will do, but I would guess that all of us here are people that did the "groundwork" of a medsurg stint first. Good luck in your choices.
Mar 4, '01
I think it depends on what area you want to work in and how applicable your med-surg time will be. For instance, if you want to go into public health or forensic nursing, I don't see a huge benefit in doing med-surg. If you want to go to ICU then try to put in at least a few months. I worked med-surg for three months after grad waiting for a spot in L&D and I don't find it hurt me that I didn't stay longer, but that could be because we did a lot of clinical time in school. Hats off to the med surg nurses though, they are AMAZING!
Mar 4, '01
Wow! Thank you all!
I suspected, but was not positive, that the lower level of patient acuity on a Med-Surg floor was enough to 'compensate' for a new grad at risk of dropping a ball or two. OUCH! The director of my program says, in effect, 'God forbid she ever sends nursing students out into the real world thinking they've learned all they need know instead of just getting started'. Still, I am so very uneasy about using real live patients as a training ground without 'back-up' (and I'm an A student).
TracyRN said it best "School gives you just enough knowledge to be dangerous." That's exactly how I feel.
Again, thank you all for your time and consideration.
Mar 4, '01
As always, I am usually the one who disagrees. I guess I will do so here as well. I recommend new graduates go to the field they choose. I did the obligatory year of med/surg. nursing. Want to take a guess of how much of it I remember?
Medical/surgical nursing does not have the universal applicability many nurses think it has...I have met many 'expert med/surg' nurses who didn't know beans about caring for the critically ill older adult. Geriatric patient's don't present with the same s/s of acute illness that young people do- the treatment is never the same [due to co-morbidity they can't always tolerate certain treatments, i.e., certain antibiotics because of renal impairments, etc.]. I have seen many acute behavioral changes [which often signify underlying physiological pathology in a demented older adult] treated with a rear-end full of haldol by 'seasoned med/surg nurses.'
I remember some patients returning from acute care after an acute episode with such severe EPS that their scores were off the AIMS scale!
Fish, statistics, med-surg skills-- all have one thing in common... none keep well if not used. Go into the field that makes you happy. Learn all about it that you could and become an expert in your field.... BUT remember, if you choose to go into something else later, you may have to re-learn other skills... but then again, isn't that the concept of 'life-long' learning?
Must Read Topics