what is med/surg like after doing long term care?

I<3H2O, BSN, RN · Oct 9, 2009

Just reading your title I was gonna come here and say Med Surg could be really hard to get used to. However, after reading your post, if you can handle Med Pass, FSBS, etc on 60 pts I think you could probably handle any MS unit.

raindrop · Oct 9, 2009

Two different worlds and I"ve done both. GO for M/S! Once you get used to the hospital enviroment, I think you'll be much happier. But do expect to dislkike m/s for about a year. It is stressful having 8 very sick patients (and their families) and there is so much chaos on a m/s unit. It is noisy, very busy, your phone/pager will constantly beep and it's just a very fast enviroment. But, I like it a lot better than working in nsh homes.

itsmyturn · Oct 9, 2009

If you are organized and have good assessment skills you will be fine in m/s. I work at a hospital and it is still all about med passing with sick patients depending on you to relay info they won't give right out to the DR. I think the worse part of hospital for me is the paperwork! And I work in a hospital that has EMRs. Then, you have the Dr. taking your chart and writing even more for you to do. Then you have the pharmacy taking their sweet time getting your meds to you. Then there are the family members who mean well but expect their member to be treated as if they were the only one on the floor. My day goes like this:

I start passing meds at 0730. I then turn back around and collect the 0900 meds. After that, I try to work on my assessments for the 6-7 pts I have. While doing this, my pts are racking up tasks for me and my CNA . By the time I get this done, it is time to pass meds again. I then try to get dressings changed, vitals again and look at the charts to see what the Dr. wrote on his/her rounds. I have to fax the orders to the pharmacy and verify orders I can't read. THEN.... there is the wonderful admissions and discharges. Yesterday, we had 9 admissions on a 21 bed floor. Talk about rough. A long, drawn out process with lots and lots of paperwork. I am on my feet all day long, the only time sitting down is at lunch which usually offers me a 15-20 min break before someone is paging me to get something done for a pt. Now, that is where I work. I am sure that every hospital is different but I have worked in two and they were pretty much the same. Bedside nursing is hard, fast and wears you out even if you manage to get it real organized. It burns you out quick. Just try it... some people love it and were made for it. Others soon realize that it s not for them. Good luck in whatever you decide.

thekid · Oct 9, 2009

thank you very much for the input..I don't mind a fast stressful pace if there is a good support (or good DON) . So..a lot of med/surg is still med passing and treatment/tasks? Is tele any different? I'm not sure what I'm looking for..I'd like to sharpen my clinical skills but am unsure if a really fast pace place is the best way to do it ( I get nervous) .

What about evening shift can it be a bit slower? My body clock won't allow me to do nights. I'd like confidence with clinical skills so that I can choose where to work in the future. Not sure if long term hospital work is for me but I'd like to nail the skills so that I have the choice.

Thanks for the feedback from folks..yeah I feel pretty confident I can handle the fast pace of 8 patients after dealing with 60 :)

thekid · Oct 9, 2009

ps I've been out of nursing for almost 9 years but just started on the floor again..am already ready for a change from ltc . I used to work home hospice and really liked it but there aren't currently any openings here besides , again, I'd like to sharpen clinical skills.

My assessments are excellent :yeah: I can also read patients well and love talking with families.

Daly City RN · Oct 9, 2009

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I don't know which state you are practicing nursing, but here in California each acute care nurse is by law cannot have more than five patients in the Med-Surg unit. I had worked in Med-Surg for almost 28 years and tried long tern care for three months about four years ago just to get the feel of it.

In LTC your pretty much know your patients even though you have up to 60 patients at a time. Their meds. are the same week after week with a few changes here and there. It is hard work and the pay is not commensurate to the heavy workload as far as I'm concerned.

In the acute care setting, you may have different patients every week. The condition of your patient could change any minute. You have to have good, preferrably excellent, assessment skills. Apply your organizational skills you already have to the new setting, remember to prioritize your work and I think you will adjust to Med-Surg just fine.

In big hospitals here in California and elsewhere in the country, many hospitals are or have switched to computerized charting. Believe me, once you get the hang of it, you wouldn't want to go back to paper charting again!

If you work in the daylight hours, you will be sending patients for CT Scan, X-Ray, , MRI, PT Dept., etc. Doctors would be everywhere writing and re-writing orders. Supervisors, some are nice, some are not, some with normal egos (well, you get the message) will be watching your tail. As one respondent wrote, give it 'one year' and I think you will be "fine". In nursing "fine" is a relative term, because as you well know, nursing is a very stressful profession but at least in the acute care setting you will be better compensated.

After 28 years in Med-Surg I retired (I'm 53yo with a lifetime pension from the hospital) and am now in a different setting. To the younger nurses reading this, you may want to consider public hospitals. I think the work is harder compared to private hospitals, but you will have the option of early retirement with pension.

I'm sorry I can't reveal what my new job is until I finally retire from nursing in about 5 years or so. I love my new job. This job is perfect for "older nurses" with lots of experience, and it is relatively easy. That's why I love my new job!

Good luck to you.

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SunnyAndrsn · Oct 9, 2009

It's been a very easy transition in many ways for me as far as the physical tasks go. It will also depend on the med/surg unit you're working on. I usually have 3-4 pts on med surg, where as I have 24 in my LTC, or 12 when I'm on the TCU side.

The thinking process is different. You use different critical thinking skills. You're doing more detailed assessments, a full head to toe assessment. At lot less scheduled meds, a lot more PRNs. Different skilss, IV's, IVP meds, less wound care, just as much catheter care, confused pts, and different surgical care. I'm used to lots of ortho, where I'm seeing a lot more GI/ABD surgeries. I've had practice with NG tubes, we do our own EKGs if the our tech doesn't have time. Learning tele has been interesting too.

It's just different. Not harder, but challenging in refreshing skills I haven't used much since school and then only under supervision. I like it, I feel like it's keeping me from getting in a rut.

I've worked in facilities that give me up to 60 patients at a time ..their care may not involve as many tasks and labs and other situations that come up in med/surg, but caring for that many patients at a time with a heavy med pass, plus treatments, plus accuchecks and everything else, is a huge stress.
I like to organize patient care in my head and understand the diagnosis and treatment in a methodical way. With so many long term care patients I find it very difficult. Aside from that I really don't want to push meds for the rest of my life.
I'm not asking if med/surg is any easier than long term care but, well...is it easier to deal with a smaller patient load? Is it easier to stay on top of individualized care? I feel stretched in so many directions with long term care patients even if the day goes rather 'smooth' and it's just a med pass and treatment.
help? I feel like I want to at least try out a hospital setting but am worried I'll end up working at another place that is lighter patient load but just as crazy.

07302003, ASN, RN · Oct 9, 2009

#1 Ask about patient ratios at the hospital - 4-6 is much better for med surg

#2 I would hold off on Tele until you get the hang of acute med surg, it can be a much faster paced environment

#3 Evening shift, IMO, is the craziest and busiest! But for me it was better than midnights.

I like the hospital environment. Lots of opportunities for learning, more flexible schedule, in a big hospital system lots of room to grow and advance. I like the critical thinking, reviewing labs, putting the big picture together. And you'll have more RN co-workers to bounce stuff off of and learn from (hopefully) in a hospital setting.

Best of luck!

thekid · Oct 9, 2009

is it normal to feel like a dummy in a med surg area when all you have done is ltc? I mean, we see transfers from med/surg once in awhile , and do labs and xrays too, not sure if I would feel overwhelmed with the shift or just go with the flow. Doing it will tell I suppose :)

thekid · Oct 9, 2009

...stayed up late reviewing wound care and the recommended products for each, of course while watching Greys Anatomy :)