General Surgery/Post-Surgical Unit Vs. Cardio thoracic step down Unit

Ruby Vee, BSN · Dec 15, 2017

Hello all :)
I'm a new nurse and in about 2 weeks, early January, I have an interview in two specialties/units: General Surgery/Post-Surgical unit & Cardio thoracic step down unit. Can someone shed a light on these two areas or either one. What should I expect, what are the pros or cons, if you work in these areas (or one of them) what's your advice...do you like it? Which one is better & why? Which one would be better for future opportunities or endevours? I'm doing my own research & wanted to ask the forum here as well.

Your first year of nursing is going to be such a learning opportunity -- you will learn an amazing amount of valuable things regardless of which unit you choose. The most important thing is to work in an environment that feels supportive/friendly/helpful to you. I'd advise paying close attention to how you FEEL when you interview in each of the two units. Does the manager seem supportive? Is orientation well thought-out and planned? Do the staff seem friendly and welcoming? What about scheduling? Can you see yourself living with the scheduling model for the next year?

The patient population is a part of your consideration, of course. And further on down the road, when you're an experienced nurse, it may be the main consideration. But for right now, you're going to learn to be a nurse. I'd vote for learning in the most congenial environment possible.

dianearc, BSN, RN · Dec 17, 2017

Your first year of nursing is going to be such a learning opportunity -- you will learn an amazing amount of valuable things regardless of which unit you choose. The most important thing is to work in an environment that feels supportive/friendly/helpful to you. I'd advise paying close attention to how you FEEL when you interview in each of the two units. Does the manager seem supportive? Is orientation well thought-out and planned? Do the staff seem friendly and welcoming? What about scheduling? Can you see yourself living with the scheduling model for the next year?
The patient population is a part of your consideration, of course. And further on down the road, when you're an experienced nurse, it may be the main consideration. But for right now, you're going to learn to be a nurse. I'd vote for learning in the most congenial environment possible.

Thank you for your encouragement. I am also hoping for a friendly and supportive environment. Not knowing what to expect on these floors or the patient population is a little nerve wrecking but keeping a positive and confident attitude and hoping to learn. I was asked to go to the interview in scrubs as I would shadow each shortly after, I am hoping I get a feel of the floors from that. Still waiting to see if anyone can give a run down of what goes on, on these floors & the patient population. Again, thank you.

AJJKRN · Dec 17, 2017

I'll take a whack at it because as a float nurse I work in both areas. Keep in mind this is all dependent on each hospital and how they are set up though.

Our gen surg floor takes complicated abdominal surgeries, aka the butts and guts, that are anywhere from simple appendectomies to higher stakes whipples and major bowel surgeries. We also through in any type of traumas, fresh tracheostomies, neck dissections, radical mastectomies, wounds/flaps to name a few. The normal IV drips other med-surg-cardiac floors can take like cardizem, heparin, insulin (not DKA though), lasix, amiodarone with a few others. Add in a bunch of different tubes, drains, and other random surgical paraphernalia.

Cardio-thoracic stepdown gets more heart and vascular stepdown patients as well as any stepdown overflow. Up the ante on the IV drips and the tubes and drains like tPA drips and a-lines, transvenous pacemakers, cardiac windows, and much more.

Hope your shadowing goes well and gives you a feel for the best unit for you. I like them both as I gravitate towards surgical and trauma patients but really finding the most stable and welcoming work environment (because your peers can make or break you in the next few years) to help you build and strengthen your foundation as a new nurse may be a more important key to your success. I was thrown to the wolves and while I survived, I wouldn't wish it on any new nurse.

dianearc, BSN, RN · Dec 18, 2017

I'll take a whack at it because as a float nurse I work in both areas. Keep in mind this is all dependent on each hospital and how they are set up though.
Our gen surg floor takes complicated abdominal surgeries, aka the butts and guts, that are anywhere from simple appendectomies to higher stakes whipples and major bowel surgeries. We also through in any type of traumas, fresh tracheostomies, neck dissections, radical mastectomies, wounds/flaps to name a few. The normal IV drips other med-surg-cardiac floors can take like cardizem, heparin, insulin (not DKA though), lasix, amiodarone with a few others. Add in a bunch of different tubes, drains, and other random surgical paraphernalia.
Cardio-thoracic stepdown gets more heart and vascular stepdown patients as well as any stepdown overflow. Up the ante on the IV drips and the tubes and drains like tPA drips and a-lines, transvenous pacemakers, cardiac windows, and much more.
Hope your shadowing goes well and gives you a feel for the best unit for you. I like them both as I gravitate towards surgical and trauma patients but really finding the most stable and welcoming work environment (because your peers can make or break you in the next few years) to help you build and strengthen your foundation as a new nurse may be a more important key to your success. I was thrown to the wolves and while I survived, I wouldn't wish it on any new nurse.

Thank you for your insight. I also hope I find the work environment welcoming, & supportive. This gives me a general idea of what I'd see/expect on the floors. So the term "stepdown"....what does that term really mean? Does it ideally mean patients who've slightly stabilized & are prepping for discharge soon?

AJJKRN · Dec 19, 2017

Thank you for your insight. I also hope I find the work environment welcoming, & supportive. This gives me a general idea of what I'd see/expect on the floors. So the term "stepdown"....what does that term really mean? Does it ideally mean patients who've slightly stabilized & are prepping for discharge soon?

Stepdown in my world means that the patients are not quite as critical to still be ICU status (and taking up an ICU bed that a sicker less stable patient is waiting on) but are not yet considered stable enough for floor status. So it's like a stepdownâ€ from ICU status. Make sense?

dianearc, BSN, RN · Dec 30, 2017

Stepdown in my world means that the patients are not quite as critical to still be ICU status (and taking up an ICU bed that a sicker less stable patient is waiting on) but are not yet considered stable enough for floor status. So it's like a "stepdown" from ICU status. Make sense?

Makes sense. Thank you! This clarifies it finally.

dianearc, BSN, RN · Feb 19, 2018

I forgot to update everyone. But I chose general surgery in the end. I went with that gut feeling, following the interview, peer interview and shadowing on both general surgery and cardiac step-down units. I like a busy floor and cardiac step-down seemed too slow for me and the vibe did not feel right. They seemed unhappy on that floor as well, and weren't certainly welcoming. Meanwhile, I had a great experience on the general surgery floor and bonded well with the nurses, nurse manager and clinical resource nurse. I had to go with general surgery. Funny thing was when I went for the interview, my mind was set on the cardiac step-down unit. Oh my, did I change my mind quite fast after having the interview/shadow process through both units. I emailed my recruiter and told her I would only like to be considered for the general surgery position. I got the offer on the spot for the general surgery turns out they liked me on the unit as well i.e the recruiter called me back shortly after both interviews and my email, with an offer. I am looking forward to much learning and offering the best to my patients and the unit/hospital as a whole. Thanks all for your contributions!

ps: Through this process, as a new grad, I learnt that you may have your mind set on a unit to work on but until you can interview, shadow and see the unit culture with your soon-to-be colleagues, it is hard to decide and only that opportunity to decipher through vital aspects of the unit/floor (interview and shadowing experience), will you really be able to decide appropriately.

Ruby Vee, BSN · Feb 19, 2018

I forgot to update everyone. But I chose general surgery in the end. I went with that gut feeling, following the interview, peer interview and shadowing on both general surgery and cardiac step-down units. I like a busy floor and cardiac step-down seemed too slow for me and the vibe did not feel right. They seemed unhappy on that floor as well, and weren't certainly welcoming. Meanwhile, I had a great experience on the general surgery floor and bonded well with the nurses, nurse manager and clinical resource nurse. I had to go with general surgery. Funny thing was when I went for the interview, my mind was set on the cardiac step-down unit. Oh my, did I change my mind quite fast after having the interview/shadow process through both units. I emailed my recruiter and told her I would only like to be considered for the general surgery position. I got the offer on the spot for the general surgery turns out they liked me on the unit as well i.e the recruiter called me back shortly after both interviews and my email, with an offer. I am looking forward to much learning and offering the best to my patients and the unit/hospital as a whole. Thanks all for your contributions!
ps: Through this process, as a new grad, I learnt that you may have your mind set on a unit to work on but until you can interview, shadow and see the unit culture with your soon-to-be colleagues, it is hard to decide and only that opportunity to decipher through vital aspects of the unit/floor (interview and shadowing experience), will you really be able to decide appropriately.

Congratulations!