Is working on a Med-Surg unit necessary?

Editorial Team / Admin · Jun 19, 2017

If you search, you'll find plenty of opinion on this matter from both sides. I am of the thought that med/surg is not needed for all nurses and that it is a specialty in its own right.

SaltySarcasticSally, LPN, RN · Jun 19, 2017

I agree with PP. It just depends on a variety of factors and where you want to end up. I am a new grad and am about to start on a tele floor, I chose this because I ultimately would like to do cardiac ICU, ER, or cath lab. I need a good foundation of the basics for my confidence and I figured working on a tele floor would help. Not everyone needs that starting out level though, it differs for everyone.

Lauraingalls, BSN, RN · Jun 20, 2017

I started out on labor and delivery. No med surg experience here.

Cvepo · Jun 20, 2017

Go through some of the critical care forums here and see how many topics are about new grads in ICUs who feel they are drowning, that their jobs are at risk, coworkers being mean, etc. and you may find your answer. For adult critical care, I truely believe a year of M/S or Tele should be a requirement. These patients are too sick and too fragile to be cared for by someone with no experience.

cleback · Jun 20, 2017

It depends on the person and the employer. Some icus are more supportive of new grads than others. Some students do really well in a high pressure environment.

I would not have succeeded in an ICU as a new grad. I just would not have had the confidence to navigate those difficult discussions with the families and providers.

Medsurg is a specialty in itself but it does give new nurses the opportunity to get their feet wet with assessments, nursing culture, professional care coordination with less acute patients. Theoretically, that would give the new grad more "wiggle room" while learning.

Shorty11, BSN, RN · Jun 20, 2017

I started as a new graduate in a Medical ICU. I did a new graduate internship program with a 6-month training period. While I was very intimidated in the beginning, my coworkers went above and beyond to make sure I was catching on and learning things daily, even once I was complete with training. While it is not for everyone who is a new graduate, working in an ICU is possible. The learning curve is steep and you must be willing to put the extra time and effort in to keep up with the fast pace. I have been working in my unit for 3 years now and I love it everyday. I am so happy I made the decision to just go for it right out of school. The hard work has payed off for me. It definitely depends on the environment and mentality of you and your coworkers, but I feel that working in MedSurg as a new grad is not a "must". Not to brag at all, just to give you some insight, but I became a charge nurse after two years and I precept new graduates now. I truly love my job and my unit.

ThePrincessBride, MSN, RN, NP · Jun 21, 2017

Med-surg is great place to start off if you are unsure of what it is you want to do. It opens up a ton of doors.

I also think for most new grads, it is the best place to start only because ICU and ED have an extremely steep learning curve as the stakes are higher and the margin for error is narrower.

The exceptions are in super specialties such as psyche, NICU, OR, etc.

Eta: I'm also of the opinion that if one can handle med-surg and its crazy workload, one can handle just about anything. Med-surg nursing is hardcore, and I can't stand the disrespect it receives from snotty ICU and specialty nurses who wouldn't survive a shift on the floor. I find my neonatal ICU job to be a cakewalk (and 95% of the time, it is extremely chill).

RNNPICU, BSN, RN · Jun 21, 2017

I started off in PICU and would not have it any other way. Had a great orientation and good support.

Isakolistic · Jun 21, 2017

Necessary? No. Beneficial? Very.

If you absolutely despise it, there are ways to get experience without starting off on a med-surg floor. Many have done it and are amazing nurses. Personally though, I think the med-surg floor is a good way to work on your basic nursing skills, so it would be a good starting point for just about any other specialty.

drkshadez · Jun 21, 2017

Med-Surg gives you a good foundation. Consider this, though:

1) some who start out in med-surg really don't want to go elsewhere, so they stay there. These are your nurses who have been there for over 10 years.

2) there is a lot of turnover in med-surg. management knows this and prepares accordingly.

3) most clinical programs in colleges / universities give you one patient (some give you 2), tell you to work on time management and communication skills, and usually tell you that you will pick up technical skills on the floor. HOWEVER, you really need those clinical skills when you go to ED/ICU/CC units. That is the benefit of med-surg.

If you have a decent staff that has good synergy and teamwork, med-surg can be a really good place to strengthen your tech skills and communication with patients. Night shift is the best for working on this stuff because you are not distracted as much with other events - like 500 doctors orders that say "STAT" or having 2 discharges and 3 admits during your shift with a new admit coming up during shift change.

If you want to go in ED now without med-surg, do you know ACLS protocols? Are you certified? How do you get an IV in someone who is completly swollen all over? What if they come in intoxicated and are dehydrated - how do you get IV access then? (calling the PICC team is NOT the answer - it's 330 AM and the guy is a vet with PTSD and ETOH level of 0.10). Patient is COPD / HF with history of ACS and complains of chest tightness - what do you look for first? There are so many co-morbidities these days with patients that you have to really think quickly and efficiently on what you are going to do first for these patients.

Let me give an example. Patient came up to med-surg from ED and told he was 96% on room air with stable vital signs and up ad lib. Patient came up in a wheelchair from transport. Patient gait was unsteady getting patient in bed, vital signs 170s/100s bp and heard crackles in lungs throughout. Resps were 26 and SaO2 was 84%. dr. came and was given this information. CXR was ordered - showed pulmonary flash edema.

med-surg helps you hone in your assessment, implementation and evaluation skills - not just the tech skills.

drkshadez · Jun 21, 2017

OK i am curious: how do you get experience without starting off on med-surg?