What is a med/surg - neuro floor like?

Nurses General Nursing

Published

Hello! I have an interview for a med surg neuro floor and just wondering what it is like? Turn over rates? Types of things I'd mostly see ?

1
Up Vote Up Vote ×

Bump..

Up Vote Up Vote ×
Specializes in Psych.

We get back/neck surgeries, falls, and yeah everything else

Up Vote Up Vote ×
Specializes in ICU.

I don't work on a Neuro M/S floor, but I work in a neuro ICU and we send patients out to them. Lots of post craniotomies, stroke patients after their 24 hour TPA window, patients who have seizures/are on EEG monitoring, neuro disorders like MS, etc. Turn over rates in terms of staff? Those will be specific to each unit. I know that the neuro unit we send patients out to gets some non-neuro Med/Surg admissions too. Lots and lots of bed alarms/fall risk patients on the neuro floor.

1
Up Vote Up Vote ×
Specializes in Neurosurgery, Neurology.

Depends on the hospital and specific type of unit. I work on a neurosurgery stepdown unit where we have general/floor and stepdown patients. Although we're "neurosurgery", we care for complex neurological, neurosurgical, and a few medicine patients. Common diagnoses on our unit include patients pre and post-op tumor craniotomy resections (i.e. glioblastomas, meningiomas, astrocytomas, etc), spinal cord tumors, pituitary tumors, hydrocephalus, ischemic and hemorrhagic strokes, arteriovenous malformations, epilepsy, post-status epilepticus, multiple sclerosis, myasthenia gravis, autonomic storming, aneurysms, encephalitis, etc. We have pts on mechanical ventilation (trached), trach collar, continuous cardiac and oxygen monitoring (stepdown), continuous EEG, lumbar spinal drains, chemo and anticonvulsant IV infusions, IVIG and IV albumin, pts receiving plasmapharesis at bedside for autoimmune disorders, etc. Yes, bed alarms will become your friend. You will also see pts suddenly start seizing right in front of you. You'll become skilled at performing neuro assessments and the NIH stroke scale (NIHSS). With time, you'll learn to pick up on subtle changes in the patient that point to some acute neurological event.

Overall, neuro can be challenging, but if you have a good team, and you're interested in it, it's great! I wanted to do cardiac when I was applying to jobs, and ended up on this unit, and it's safe to say I love neuro at this point.

Good luck!

2
Up Vote Up Vote ×
Specializes in NICU.

Pure chaos :D

Up Vote Up Vote ×
Specializes in CCU, SICU, CVICU.

Mursejj really hit the nail on the head. Neuro can be different if it's Neuromedical -- altered mental, dementia, seizures, strokes with no intervention, etc OR neurosurgical -- lumar drains, complex neuro patients, s/p crainies etc. Many places will combine them together, some may be separate!

Up Vote Up Vote ×

Strokes, r/o strokes, seizures, back/neck surgeries, craniotomies (although they spend a good amount of time in the ICU... You'd see them before they go home though). In the one I worked, there were also a fair number of patients with endocrine disease/abnormalities since electrolyte derangement can present with changes in mental status, weakness, etc.

What that mix means is you'll have a lot of bed alarms going off, have patients in posey beds or other types of soft restraints, total cares type patients with swallowing troubles... your nonconfused patients will have some incisional care, post op vital monitoring, pain management issues.

I tend to dislike detailed neuro assessments and constant bed alarms so its not my favorite population but it would be good experience.

Up Vote Up Vote ×
Specializes in SICU, trauma, neuro.

As a PP said, it depends somewhat on the hospital. My first position was on a neuro floor; we had lots of post-op neuro oncology, but really no TBIs. It was an excellent university hospital, but in close proximity to two level 1 trauma centers. I now work at one of those, and we send lots of TBIs to the stepdown/floor.

Back to my floor job: we had a fair amount of 24-hr EEG monitoring (some were pts with known seizure disorders to evaluate their regimen; some were to diagnose GTC seizures vs psychogenic pseudoseizures), pts receiving plasmapheresis for MS, MG etc., gamma knife surgery for brain tumors, deep brain stimulator placement for Parkinson's. We also had a fair amount of spinal surgeries and VP shunt revisions. Occasionally we'd have a big mystery pt -- as in, sx/tests didn't point to a definitive dx. After many weeks, one turned out to be some rare fungal meningitis, one was likely ecstasy (the drug -- this was in the early 2000s) induced, and the other spontaneously recovered.

So lots of variety, lots of teaching, lots of emotional support. Lots of impulsive behaviors unfortunately, due to the brain insult. On the floors, we generally did a full neuro assessment every 4 hrs, sometimes every 8. My unit had a two-bed stepdown room, whose pts would be on the monitor and could need a neuro assessment every 2 hrs. (that RN would have fewer pts. If the pt needed any invasive brain monitoring such as an EVD, fiberoptic ICP monitor, or Licox; neuro assessments more often; or on vasoactive drips, they would be in the ICU.)

Up Vote Up Vote ×
Specializes in SICU, trauma, neuro.

A couple more things --

being a big oncology hospital, we got a fair amount of blood-brain-barrier disruptions. If I remember correctly, chemo-certified onc RNs administered the actual anti-neoplastic meds.

We also had lots of aneurysm coilings/clippings. In my experience, they go to the ICU first though, due to high risk of vasospasm which requires closer assessment and medical intervention.

Some meds to read up on are nimodopine (frequently used to prevent that vasospasm), hydralazine and labetalol (frequently used prn to keep BP under control), and dexamethasone (preventative for CNS edema). 2% NaCl is used on the floors as well...stepdown may give 3% also -- I'm not 100%. I've never given Mannitol on the floor, but in case of emergency prior to ICU/OR transfer it would be good to have some idea. Every time I have given it, the MD ordered a dose that was a portion of the bag, so we need to do actual med math to figure how many mL the pt needs.

Permissive hypertension for ischemic strokes is another thing; it seems counterintuitive to want a systolic BP OVER 180. ;)

Up Vote Up Vote ×
Specializes in Neurosurgery, Neurology.
A couple more things --

being a big oncology hospital, we got a fair amount of blood-brain-barrier disruptions. If I remember correctly, chemo-certified onc RNs administered the actual anti-neoplastic meds.

We also had lots of aneurysm coilings/clippings. In my experience, they go to the ICU first though, due to high risk of vasospasm which requires closer assessment and medical intervention.

Some meds to read up on are nimodopine (frequently used to prevent that vasospasm), hydralazine and labetalol (frequently used prn to keep BP under control), and dexamethasone (preventative for CNS edema). 2% NaCl is used on the floors as well...stepdown may give 3% also -- I'm not 100%. I've never given Mannitol on the floor, but in case of emergency prior to ICU/OR transfer it would be good to have some idea. Every time I have given it, the MD ordered a dose that was a portion of the bag, so we need to do actual med math to figure how many mL the pt needs.

Permissive hypertension for ischemic strokes is another thing; it seems counterintuitive to want a systolic BP OVER 180. ;)

Yeah, on our unit, nurses from the medical oncology or BMT units administer the IV chemo. We monitor the patient and contact the chemo RN once the infusion is complete. We administer oral chemo agents and also IV rituximab (monoclonal antibody).

Our stepdown patients can get 3% NaCl. Yep, tons of IV hydralazine and labetolol. We can do IV amiodarone for rapid a-fib for 24 hours.

Neuro is great if you're interested in it. I love it! Close monitoring is a must. I also love seeing patients recover. Recently I had a stepdown patient that I went in to assess, and noted the patient was slightly convulsing on one side. Pt was less responsive to commands. We ended up giving a lot of ativan, started multiple IV anticonvulsant drips, put him back on the vent (was on trach collar), and on continuous EEG. An hour later pt became hypotensive. Was supposed to transfer to neuro ICU on my shift but went later in the day. Pt is now back on our unit, doing better, talking (wasn't verbal during the time prior to ICU the pt was on our unit), etc. Love seeing that.

Planning on going to neuro ICU in 2 years or so. Brain multimodality monitoring sounds pretty fascinating to me.

1
Up Vote Up Vote ×
+ Add a Comment