Is this what MedSurg nursing is really like?

evolvingrn, BSN, RN · Feb 2, 2016

Our floor is nothing like that in terms of experience. Few if anyone in the charge role has been there less than 5.

The acuity is def inappropriate at times and there is certainly stress .... But people stay

Karou · Feb 2, 2016

That shouldn't be the norm. My unit (thankfully) is very different. The main problem y'all seem to have is in nurse retention. Why is that, I wonder? I hope your manager can recognize the problem and attempt to repair it.

It's incredibly difficult to work in a setting like you described. You learn hard and fast, unfortunately. Until your unit can retain its nurses you will have the issues of new grads being charge and a lack of experienced resources.

As for the critical patients being sent to the floor... Oh dear. The following advice applies to only the truly unstable patients.

If you or the charge nurse are able to look up this patient before they arrive, or even if you realize during report that they are unstable, then perhaps you can advocate for they patient to go to a critical care area instead of medsurg. If that does not work, calling the house supervisor might. Last resort, the unstable patient arrives and you call the admitting with the situation (including what the critical care team said, if applicable) and get them sent to ICU ASAP. Incident report for any unstable patient received who had to transfer quickly.

You work in a rough unit. This is not ideal anywhere. Medsurg doesn't have to be this chaotic at all.

chacha82, ADN, BSN · Feb 15, 2016

Sounds rough, you have my sympathy. See if you can make the most of your first year and migrate. On my floor you have to be "invited" to be charge which they say happens after a year but some have been there for a few years and not "picked" for charge (some are not happy about this).

thekidisback · Feb 19, 2016

Sounds like the floor I am on now. We can't retain any nurses. Nurses come and go as fast the patients do. The turnover of nurses is crazy! They don't last more than 6 months. I lost count how many nurses we lost on our floor. We barely have any seasoned nurses on the floor. I was already orienting new nurses when I was less than a year on the floor! Some shifts they will schedule brand new nurses together with no seasoned nurse. Or if there is a seasoned nurse that nurse ends up being pulled to the critical care floors because they're short as well!! I don't know how I lasted this long. The management know what's the problem. We have no support staff sometimes. They're hiring nurses but the problem is they're hiring brand new nurses straight out of school. Seems to me that hospitals are more worried about numbers and saving money rather than patient safety. It's scary. It puts a strain on us nurses, which in turn affects patient care and the desired outcomes are not achieved.

HAPPY NURSES = HAPPY PATIENTS = HIGHER SATISFACTION SCORES = REIMBURSEMENT FOR HOSPITAL!

favthing, APRN · Feb 20, 2016

I worked about 3 months on a med-surg unit where I made a decision to leave. The unit had all the elements you described and more. I wrote my 2-week notice and hand-delivered it, with certainty. I had the opportunity to talk with managers, and I was honest. I have been a nurse and manager in a sub-acute care center for years prior, and so I had developed my standards for my own professional practice.

My situation is a little different because I was able to rely on a very solid nursing work history and I have great references from those years, so I felt more confident about speaking about the unsafe environment. My heart goes out to newer nurses who feel they need to put up with the abuses put upon them in some settings. It is horrible. I commend you if you can stay for the experience, but make sure to protect your heart and soul for your personal nursing passion and profession.

My current hospital is a completely different experience. My interview was amazing, as I was interviewing them, truly. I think they saw my dedication to nursing, and thankfully, I fit in with the culture. My advice is to somehow stand your ground and look for a better position and get out of that toxic environment as soon as possible.

woundnurse4u · Feb 21, 2016

I worked med-surg for 2 years- a year in 2 different hospitals. Yes, you are going to see a higher turnover rate. Many nurses enter the acute care arena in med-surg and move up to a different level of care once they have some experience under their belts. It's normal.

Yes, you are going to be exhausted. Six or more patients to manage is difficult. Having one or more of your assignment "go south" is beyond stressful. This means that you will need to stay on top of labs, trends, and even patient cues. Listen to your patient. If they are anxious, making statements about dying, and showing other unusual symptoms- pay attention. I can honestly say that in every unexpected code I have ever born witness to- that was all there and the staff ignored it.

Transfers to ICU are going to happen. Just follow the policies and procedures and document that you did it. Nobody likes to have that interruption in their day. Comes with the territory and there isn't any great way to handle it other than strong teamwork. You could propose a system to handle those unexpected transfers (such as a buddy system where one nurse will keep the other nurse's patients on track with meds, IVs, answering call lights and addressing the patients needs while the other nurse is dealing with crisis management).

Follow the policy for admissions. While your goal is not to leave admission work for the next shift, it is going to happen if you have to deal with a crisis. Again, having a "buddy" who will step in and get the ball rolling can be helpful.

Keeping contact with your patients is very important. They are going to be happier if you are honest with them. I always made sure to touch base with them when it came to scheduling (ie I will be at lunch from 7-7:30 and nurse Suzy will be covering for me, your next pain med dose will be available for you at 8:00, you will need to finish your test prep by 3:00, you can't eat or drink after midnight, etc).

To that end, the units I worked on always scheduled a lunch buddy. We would give a brief report to our lunch buddy before taking lunch and that buddy would keep things running smoothly while we had our lunch. The lunch buddies were assigned at the same time patient assignments were made so there was no confusion.

There are strategies that can be used to minimize chaos. Of course, you need to have the buy-in to make it work. One of the best units I worked on had a strong team. Everyone would step in for crisis management and then report off to the nurse when things settled down (ie I gave Mr. Smith his pain med at 900, I called the doctor over that critical lab and he ordered XYZ, etc.