Surgical vs General Medical Unit

Long Term Care Columnist / Guide · Apr 4, 2008

I really enjoyed the surgical patients for the most part when I was on med/surg.....sure, the ortho pts. were hard because of pain and heavy equipment (if I never have to deal with another CPM machine again, it'll still be too soon), but mostly it was more rewarding than dealing with frequent-flyer medical pts. If I had to go back to acute care, I would definitely choose working on a surgical unit over a medical unit any day.

DolphinRN84, MSN, RN, APRN, NP · Apr 4, 2008

I work in a surgical unit (vascular). IMO, though it may be alittle biased because I'm used to working in a surgical floor, floating to medical units seemed a little bit easier than my floor. We get a lot of diabetics, pts on tons of cardiac, HTN, and cholesterol meds, pts with renal issues etc. etc. Our floor gets a lot of patients with a lot of co-mobidities and can get heavy at times. Some post-ops or post-angios require frequent monitoring depending on their stability. But then again I've floated to other surgical units and they were nice...I think my floor is just the "worst" in the hospital in terms of the types of patients that we get..so we definitely work hard. Though some nurses have said if you could work our floor, then you can work anywhere.

november17, ASN, RN · Apr 4, 2008

The surgical unit I work on generally has patients that have cardiac clearance and are otherwise healthy before they go to surgery...so there are less issues to deal with. We deal with less of the general medical stuff in general except when our census is low they give us all kinds of admits from the ER.

pebbles, BSN, RN · Apr 4, 2008

Medical patients can be a lot more chronic in terms of their personalities, and that's one reason I chose to work on surgical floors.

Medical pt puts on her call light and asks for help to go to the bathroom. I say "does it usually take one person or two people to help you to the bathroom?". Blank non-comprehending stare. I used to find the medical pt's either thought everyone knew how to take care of them and could anticipate all their needs, or were very controlling and could be manipulative at times. There was much less of that on surgical floors.

On surgical floors, you see people get really BETTER and send them home to live their lives a lot more than on medicine. As they go through their hospital stay, they need less from the nurse and so they become "lighter" as patients than when they first came in. You don't see that on medicine.

Surgical patients, you have more interaction teaching and explaining, rather than just managing the pt and her coping.

rnmi2004 · Apr 4, 2008

I work on a surgical floor that gets med overflows at times. I much prefer the surgical patients. For the most part, their problem has been fixed surgically & they're getting better & go home in a few days. When we get medical patients they seem to just linger for days and days without getting better, and that's frustrating to us. This is, of course, just my experience.

RNperdiem, RN · Apr 4, 2008

I have also worked with both. I do prefer the surgical patients.

Medical patients tend to have more chronic illnesses and are usually older. There is no surgical fix for all that ails them. Good nursing care makes a bigger impact on the quality of their life than medical care.

Piki · Apr 4, 2008

I work on a surgical unit and if anything, it is not easier than a medical floor. We still get medical pts with chronic diseases (where do you think they go when they have surgery??). We get patients that have surgery and then debilitate and stay there for a month (sometimes longer) We also get the occasional ortho pt that needs telemetry (we are also the only med/surg unit with tele besides the cardiac units). I've yet to hear of any of our nurses being pulled to the medical units coming back and complaining how hard they are - in fact if anything they tell us how much easier it is. There are no wounds to assess (except possible decubiti), no wound packing, no dressing changes, no charting on the incisions and dressing changes, etc. No assisting the dr in removing staples or sutures, no applying steristrips, etc. Many of our patients fit the elderly, chronically ill profile, and often mix in anesthesia and post-surgical pain meds and you get disoriented and confused pts. A good number of our patients are also in contact isolation, fall risks, low beds, and bed alarmed. Yes we do also get the occasional younger pts but often you'll find out the younger patients are more whiny and demanding than the older ones (is it a generational thing? sometimes I wonder... lol).

But I have to say, for me personally, I really enjoy it. I enjoy the fast pace and having stuff to do. We also are treated as the ICU stepdown and get practically all the ICU transfers. I honestly do not like dealing with the strictly medical patients, just not my cup of tea. But for sure, I would not classify surgical patients as easier than medical. Just different, and sometimes much more complex. They are often dealing with new diagnoses of cancer, or having to deal with new ostomies, etc.

RNsRWe, ASN, RN · Apr 4, 2008

Are surgical units any easier than general medical units? I've been working on medical units with the occasional surgical patient and am considering employment on a surgical unit. I have found the surgical patients typically easier - they are younger, A&Ox3, pleasant, few scheduled meds - altho some have lots of PRN needs between pain and nausea. On medical units, seems like I typically have mostly confused patients that are huge fall risks - who are on 10M meds, are slow at taking meds, want to talk endlessly, on isolation precautions, need lots of help to BSC or restroom, on restraints or bed alarms that go off continually, etc, etc.

Well, I work on a med-surg unit that is primarily (90%) surgical, and the exact problems you quoted with the medical patients ARE the problems with the surgical ones! The surgical patients often have multiple co-morbidities. They are frequently demented (many times it's what led to them being screwed up enough physically to require the surgical intervention). They need help with everything, and require lots of pain interventions, dressing changes, drains emptied, checked, lots of meds, including those that get crushed or diluted to go through tubes (alot slower than waiting for someone to take a pill).

The medical patients are really no different, in my opinion. We get reasonably healthy young med patients (r/o surgery) who whine about everything, since they've not been sick before they think they must be about to die now. And we get the chronic abusers of drugs and hospital treatments, too. The surgical patients make up the same population, IMO, as the medical ones, only they've gone the extra mileage to get the surgeries. And if you're unfortunate enough to have a chronic med patient who has FINALLY managed to earn him or herself a surgery, look out: they are now a resident on your unit for weeks or months!

All in all, I do prefer the surgical patients to the straight med ones, but only in that at least I can point to the reason that they are still there!

floatRN · Apr 4, 2008

I have worked on a general surgery unit and on medical/surgical units. I like the surgery unit best and found it the most interesting. With surgical patients, you often see a noticable progression over a couple days or even the course of a shift. There are alot of opportunities for patient teaching. The patients do tend to be a bit younger and there are more walkie talkie patients than on a medical unit. The only downside is that surgical units usually have fast turnover of patients. Patients might only stay 1-2 nights. Which means you might have 3 discharges in the morning out of a 5 pt assignment and get 3 more post-ops or admissions in the afternoon. Med passes are sometimes lighter but you will be busy with giving alot of pain meds.

RNsRWe, ASN, RN · Apr 4, 2008

The only downside is that surgical units usually have fast turnover of patients. Patients might only stay 1-2 nights. Which means you might have 3 discharges in the morning out of a 5 pt assignment and get 3 more post-ops or admissions in the afternoon.

Wow, your unit is NOTHING like ours! Our surgical patients are frequently there for many days, and longer. Colon resections, creations of colostomies and ileostomies are there for some time. Even ortho patients (hips and knees) are there three or four nights.

The only patients we discharge that fast are the 23 hour admissions (rotator cuffs, lap cholys).

Patients lingering TOO long is one of my pet peeves; it'd be a real switch to see them leave before we could teach them enough!

PreOpNurse · Apr 4, 2008

Have you thought about doing preop or PACU? They are both med/surg related but have a lot of advantages over floor nursing. In my facility the hours are great (6-4:30 Tuesday - Friday). Plus you have interaction with patients but its usually only for 1-3 hours then you get to send them to the floor. You still see the contact precautions and fall risks but for the most part you have relatively healthy people having surgery. I love it. Maybe you could float and try it out.

Jess