Is Med Surg Pre-cursor for Critical Care Success?

Lennonninja, MSN, APRN, NP · Jan 29, 2014

I did my first year in M/S and hated every single day of it. I was that new grad who was totally overwhelmed and cried every night at work, and would get anxious 24+ hours before my shift even started. I was just miserable. After a year I left and went to the ICU (which was my goal ever since nursing school) and I LOVE IT. I got my first year jitters over with, I don't cry at work, and I don't get anxious beforehand. I brought with me some fantastic time management and basic skills, and it's helped me out tremendously. I don't feel confident 100% of the time in the ICU but I know what to ask, and who to ask. My floor also hired several new grads at the same time as me into the ICU and now that we've all been off of orientation a little over a year, we're all staying afloat just fine :)

I would say that no, M/S as a pre-cursor isn't necessary for ICU success, but it does help!

nurseprnRN, BSN, RN · Jan 29, 2014

Precursor means "something that indicates an outcome or event beforehand." So, for example, yeast growing in bread dough is the precursor to the dough rising.

I think what you meant was "prerequisite," meaning "something that has to happen before something else can happen." I think you were asking, "Do I have to work/succeed in med/surg before I can work/succeed in critical care?" There's a difference. (For my money, the answer is, "Maybe not, if you are very quick on the uptake, very organized, and rock-solid in physiology and pathophysiology, anatomy, and meds.")

"Precursor" is not hyphenated, either; it's not "before the cursor," like "pre-Columbian history."

Carry on. :)

HoneyBeGood · Jan 30, 2014

Grntea,

"something that indicates an outcome or event beforehand."

That is just what I meant.

I did not not mean prerequisite AT ALL. Don't get it twisted. Like the other posters who got it...

i know one does not HAVE to go through med surge but as I asked earlier is one's success or not, in MED surge something that would be an indication of how one would fair on an ICU?

That is what I meant…but thanks for the clarification. It is good for those who did not understand my question.

ThePrincessBride, MSN, RN, NP · Jan 30, 2014

no that was the ratio in 70s in acute care hospital.

Seven hells! Are you serious? :nailbiting:

HoneyBeGood · Jan 30, 2014

Thanks for the post. Very encouraging. I am putting in my ICU apps in pronto! Even if I have to go to critical access area or out of state.

I feel I have semi wasted a year of my life suffering on med surg. It is not a waste in that i got experience but 2013 was a bad year, a depressing year, and stressful year. No dating, no flirting, no fun. I am too stressed out all the time. I work 12hours shift, full time. My days off are spent recuperating from the days I was there. I feel like a zombie. My social life down the drain. I am too young to be sucked this dry.

Got so bad, stopped wearing make up to work or even bothering doing my hair in the first couple of months, just tie my hair back and wear a surgical cap and plain scrubs. No time, no pleasure. What is the point in looking cute if I am miserable every moment I am there. I just want to get in and out of the building. I can't get out of work soon enough, even an extra 5 minutes spent there is too much…But when I transported my patient to ICU, I was blown away. Organized efficient, calm. But I know they are ready for action if it comes.

HoneyBeGood · Jan 30, 2014

I don't mean to be a downer about med surge but it is truly drudgery. Even to the women and men who work it and can find themselves never working some place else. It's like a love hate relationship so they stay even though they are over worked and stressed. I tip my hat to them for staying for those many years.

There are few med surge units that will staff properly and don't cut corners. Rather where I work they are pile it on and on the nurses' shoulders.

IDK.

There are so many things wrong with med surge…as well as health care…if you want to point a finger at the cause…you can point it in many directions.

Ruby Vee, BSN · Jan 30, 2014

Hi Guys,
Is one's success in med surge an indicator of how well one will fair in critical care? If one is not successful or not very good at med surge, will they not likely be successful in critical care?

Yes and no.

If one isn't successful at Med/Surg, I'd want to know why not. If you cannot learn to prioritize, plan ahead and think critically, no you won't do well in critical care. If you cannot learn to come to work on time, limit breaks to a reasonable length and limit your "mental health days," you won't be good at critical care or Med/Surg.

There are folks who don't do well at Med/Surg because they want to spend all their time with one patient -- those folks may do OK in critical care. But in general, if you don't do well in Med/Surg I'd be really leery of hiring you for critical care.

Ruby Vee, BSN · Jan 30, 2014

Precursor means "something that indicates an outcome or event beforehand." So, for example, yeast growing in bread dough is the precursor to the dough rising.

I think what you meant was "prerequisite," meaning "something that has to happen before something else can happen." I think you were asking, "Do I have to work/succeed in med/surg before I can work/succeed in critical care?" There's a difference. (For my money, the answer is, "Maybe not, if you are very quick on the uptake, very organized, and rock-solid in physiology and pathophysiology, anatomy, and meds.")

"Precursor" is not hyphenated, either; it's not "before the cursor," like "pre-Columbian history."

Carry on. :)

And since you started it, it's Med/Surg, not "Med Surge". And I think the OP meant "How will I fare?" and not "how will I fair?"

Ruby Vee, BSN · Jan 30, 2014

Wow Esme,
22:1, that is insane, that sounds more like a LTC or ECF.

Nah -- that sounds like a typical ratio when I started on Med/Surg in the 70s.

HoneyBeGood · Jan 30, 2014

Ruby Vee….how is it I find all your responses so gratingly irritating? If you are looking to count spelling errors on an informal website…I rather you NOT respond to my posts. One thing I find irritating about some posters online…in general... are those that distract from conversations or arguments to point out minor errors in informal settings, in which it is obvious what the other poster or posters are trying to convey. It's like they have nothing else to say or don't have a solid argument so they point out little insignificant typos to discredit the other party. But it does not work. It just makes the other person look pretentious. (Just saying)

If I am in an English class or writing an essay and you are my professor…have at it. All day, everyday…correct me. But if it is a minor error that resulted from my auto correct on my comp or a slipped finger….seriously save it for those dusty English profs that care. Your comments are coming off as snarky. I hope they are not but that is tone I am perceiving.

And by the way IT IS Med Surg….NOT Med/Surg look it up. But honestly I think either one would suffice. Seriously. I don't care much either way…but you kept on going on about it so I thought I would let you know. SMH. OMG. (Sigh).

I am really trying to be good.

I apologize if I sound like a ******* in this post…but it had to be said.

Caffeine_IV · Jan 30, 2014

My answer would be, it depends.

It depends on what made you be unsuccessful in med surg...poor time management? Missing signs of patient crashing? Personality? Unable to prioritize?

Rude, impatient and unrealistic people exist in critical care also often in the form of the family which is no less difficult.

HoneyBeGood · Jan 30, 2014

That is true…Lil'mama, you have good points but in ICU you are not being pulled in 5 different directions and having to know what's going on for 4-5 or in some cases 20 different patients, who not only need their meds, but their blood sugars, toileting, ambulation, physical therapy, pain management, procedures, etc….the list goes on and on.

Successful can mean a lot of things but at the end of the day the nurse knows that med surg is not a good fit. and they are better at juggling 2 patients instead of 5.

I have been told by a few of ICU nurses when they come on my floor...how they can't believe all that we have to do and the patients we have to juggle. And they hate being floated to med surg.

Though I work in med surg, I despise being there. Never ever happy to walk through those doors. I can juggle them but I hate not knowing everything that is going on with my patient. There is so much that is always going on…I am not a walking computer…there is no time to slow down and process everything that is going on with your patients. You just have to keep moving…keep doing… so many tasks …tasks…tasks… feel like a cross between a robot and waitress a lot of the times.

I feel in ICU I will know everything that is going on, I will have 1-2 patients whom I am completly focused on and can give them the attention they need. I will constantly be aware of their breathing changes, EKGs, ABGs, Vitals, etc.

On med surg you are spread so thin, every thing is on the fly when you have time to go in to one of your patient's rooms.

It is everything about med surg that makes me uneasy. Every one on the floor is running around like chickens with their heads cut off. You go into one patient's room…a surgeon or a specialist has popped into your patients room…you have no idea…hospitalists wants to know when the surgeon/specialist has seen the patient…you have to dig for clues asking the patient…see if they charted notes (which they usually don't till hours after they have seen the patient) or you need to ask someone if they have seen this doc on the floor, Or they took your patient off the floor when you were in another patient's room and did not inform you. This is just one of the many examples I am giving.

It is just too much and I don't see the pay off in terms of fulfillment. I am losing my pip and zest.