Med-surg or specialize first?

PacoUSA, BSN, RN · Mar 25, 2015

I am currently traveling on a med/surg/tele staff nurse background, and I can tell you that if I had to do it all over again, I would travel as an ICU nurse (and I hear ICU nurses that travel make more $ than travel med-surg RNs). I was never fond of entering nursing in med/surg/tele, but at the time I graduated I was desperate for a job and this was the first thing that opened up for me after graduation, so I grabbed it. I did not want to be a statistic and still be unemployed a year after graduation. Thankfully, I shed the new grad umbrella quick by doing that, really have no regrets about it -- in hindsight I did learn a lot of skills and about basic nursing. After just over 2 years as staff, travel nursing for me was my way out of that unit (which bottom line suffers from terrible management, inadequate appreciation for staff, and an uninviting environment for male nurses). So traveling for me is the biggest perk of what I do now and I am willing to continue tele nursing while I am doing it. But what bothers me the most about my specialty is the ratios. 5 patients is something despite 3 years in nursing that I still have trouble wrapping my head around. At times I have had 6 patients when staff has been short on my unit (let alone floated to units where 6 patients are the NORM .. !!!!) and those have always been very stressful. But then again, the environments have not been as micromanaged as my prior staff job so it has been a tad bearable. What I am trying to do is learn as many new skills as I can while I am traveling so that I can somehow re-label myself as an exclusive tele nurse as opposed to a plain med-surg nurse. This way I can try to get on board to more specialized units like cardiac tele, which I thoroughly enjoy more despite the ratio issue while traveling.

Getting back to being an ICU nurse, it's very likely where I picture myself the happiest. I have no problem being busy and am by no means a lazy nurse, I enjoy working through shifts and realizing that time is flying by while I work. What I dislike very much is keeping track of 5-6 patient details as opposed to just 2-3. With 5-6 patients, most of my nights tend to be focused on just getting crap done as opposed to having time to think about what the patients really need and working with the doctor to improve care. I suppose I don't have the penchant to work with high ratio of patients personally, but I am willing to do it for now in exchange for travel opportunities. But I know I won't last very long doing it as a tele nurse, which is why at some point I will opt to return to staff nursing to retrain in critical care as a cardiac ICU nurse. I am however undecided as to whether I will return to travel as an ICU nurse thereafter, because I may be interested more after that in settling down and planting roots somewhere. Then again, I don't know what the future holds.

But if you are willing to say that your interest in travel nursing is bigger than waiting to specialize in another area of nursing, I say go for it now because life is not getting any longer for any of us. You can always travel for a year or even 3 months and see how that works out for you. If however you decide that the thought of traveling as a med-surg nurse is not appealing at all, then I suggest changing specialties and waiting it out until you have the experience in that specialty to then travel. Only you can decide this.

You're never too old to do travel nursing!

NedRN · Mar 25, 2015

Let's see... you don't like your specialty. What was the other question?

I think you are best off looking for training in a specialty you do like at a teaching hospital now. I think that will be harder to do as a traveler.

RNAvatar · Mar 25, 2015

I am currently traveling on a med/surg/tele staff nurse background, and I can tell you that if I had to do it all over again, I would travel as an ICU nurse (and I hear ICU nurses that travel make more $ than travel med-surg RNs). I was never fond of entering nursing in med/surg/tele, but at the time I graduated I was desperate for a job and this was the first thing that opened up for me after graduation, so I grabbed it. I did not want to be a statistic and still be unemployed a year after graduation. Thankfully, I shed the new grad umbrella quick by doing that, really have no regrets about it -- in hindsight I did learn a lot of skills and about basic nursing. After just over 2 years as staff, travel nursing for me was my way out of that unit (which bottom line suffers from terrible management, inadequate appreciation for staff, and an uninviting environment for male nurses). So traveling for me is the biggest perk of what I do now and I am willing to continue tele nursing while I am doing it. But what bothers me the most about my specialty is the ratios. 5 patients is something despite 3 years in nursing that I still have trouble wrapping my head around. At times I have had 6 patients when staff has been short on my unit (let alone floated to units where 6 patients are the NORM .. !!!!) and those have always been very stressful. But then again, the environments have not been as micromanaged as my prior staff job so it has been a tad bearable. What I am trying to do is learn as many new skills as I can while I am traveling so that I can somehow re-label myself as an exclusive tele nurse as opposed to a plain med-surg nurse. This way I can try to get on board to more specialized units like cardiac tele, which I thoroughly enjoy more despite the ratio issue while traveling.
Getting back to being an ICU nurse, it's very likely where I picture myself the happiest. I have no problem being busy and am by no means a lazy nurse, I enjoy working through shifts and realizing that time is flying by while I work. What I dislike very much is keeping track of 5-6 patient details as opposed to just 2-3. With 5-6 patients, most of my nights tend to be focused on just getting crap done as opposed to having time to think about what the patients really need and working with the doctor to improve care. I suppose I don't have the penchant to work with high ratio of patients personally, but I am willing to do it for now in exchange for travel opportunities. But I know I won't last very long doing it as a tele nurse, which is why at some point I will opt to return to staff nursing to retrain in critical care as a cardiac ICU nurse. I am however undecided as to whether I will return to travel as an ICU nurse thereafter, because I may be interested more after that in settling down and planting roots somewhere. Then again, I don't know what the future holds.
But if you are willing to say that your interest in travel nursing is bigger than waiting to specialize in another area of nursing, I say go for it now because life is not getting any longer for any of us. You can always travel for a year or even 3 months and see how that works out for you. If however you decide that the thought of traveling as a med-surg nurse is not appealing at all, then I suggest changing specialties and waiting it out until you have the experience in that specialty to then travel. Only you can decide this.
You're never too old to do travel nursing!

Thanks for the insight! I am leaning towards specializing in what I want to first and then maybe travel later in my specialty. I am terrified that I may end up miserable traveling in med-surg, since I don't particularly like it. I just hate to specialize/work in a new unit and then up and leave in a year or two to travel, but I'll see how I feel in the future.

RNAvatar · Mar 25, 2015

Are you saying it will be harder to travel and then stop and specialize after having been a travel nurse? Or, harder to specialize in a new specialty as a travel nurse? And, how would it be more difficult?

ixchel · Mar 25, 2015

I imagine it would be very hard to gain comfort enough within 13 weeks (or whatever your length of contract) at a new facility to then be able to focus on learning a new specialty. When I was a landlord working with travel staffing agencies, I got to know the reps pretty well and learned a lot about what they wanted in their travelers. They always preferred at least a year of experience in the specialty the nurse would contract in.

If you think about it, as a permanent employee, a good hospital would pair you with a preceptor if you changed specialties with them. A hospital hires travel nurses with the hopes of filling a staffing gap. They're not going to want to teach you the stuff they expect you already know. It's hard enough, I'm sure, to orient you to all of the things they know you don't know, like their charting system or where to find gauze.

I say this out of speculation and very little first hand knowledge, though. I am not a traveling nurse, nor have I ever looked into it as an option for myself.

PacoUSA, BSN, RN · Mar 25, 2015

Thanks for the insight! I am leaning towards specializing in what I want to first and then maybe travel later in my specialty. I am terrified that I may end up miserable traveling in med-surg, since I don't particularly like it. I just hate to specialize/work in a new unit and then up and leave in a year or two to travel, but I'll see how I feel in the future.

You would only pick up and leave a new unit without any problem if your main intention is to get experience to travel (like some people whose full intention on working in ICU is to get the experience for CRNA school, which is not my goal). It is quite possible that you will end up loving your new unit and not want to leave, and that is ok too. I guess it is the risk you have to take when you start a new unit. I of course would take the risk too. I will probably lean towards wanting to stay on my new unit as staff and then grow with that unit, but then if I want to leave later on I will have to decide whether I want to travel or continue as staff at another hospital, now that I have that experience. But either way I would definitely never leave a new unit/specialty in less than 2 years which to me is my personal minimal time to be comfortable in any specialty before moving on.

Are you saying it will be harder to travel and then stop and specialize after having been a travel nurse? Or, harder to specialize in a new specialty as a travel nurse? And, how would it be more difficult?

It is definitely harder to specialize in a new area while a travel nurse (it is actually impossible in the case of drastic changes such as from med-surg to L&D for instance, you can never travel in a specialty you have never worked). However, in my case since I wish to transition to critical care in the future, I would like to get more assignments that hover into intermediate care where possible. In my present assignment, I have floated to step-down units and have had some exposure to skills that are done in step-down units. What is funny is that on my cardiac tele unit now, I am working with drips and machines that are standard in some step-down units in other hospitals, and my home unit is not considered a step-down. No experience with vents, so would not ever accept assignments that deal with them UNLESS they are willing to train me well on them. So I am hoping that experience will be an advantage for me to get more focused assignments and eventually a spot in an ICU as staff.

michlynn, BSN, RN · Mar 25, 2015

Are you saying it will be harder to travel and then stop and specialize after having been a travel nurse? Or, harder to specialize in a new specialty as a travel nurse? And, how would it be more difficult?

From what I have gathered from my experiences no hospital will hire you under a travel contract in anything but your specialty. For example, I'm trained in cardiac/tele so they aren't going to hire me to go work in maternity or the ICU with vented patients and a bunch of other things that I'm not familiar with. Think about it, if you switch your specialty at another job you're going to have to go though another 8 weeks of training to be "proficient enough" to be on your own. When you travel you only get 1 or 2 weeks of hospital/floor orientation so they aren't going to stick you somewhere where you have no clue what you're doing.

So I think if you're looking to switch things up you need to do it for a couple years before you start traveling or travel first and then switch your specialty after you've traveled for a while.

NedRN · Mar 25, 2015

Are you saying it will be harder to travel and then stop and specialize after having been a travel nurse? Or, harder to specialize in a new specialty as a travel nurse? And, how would it be more difficult?

Well, I certainly didn't mean changing your specialty while still traveling and learning on the job! Sorry about that.

The deal with a new specialty is the training at a good teaching hospital will be a minimum of 6 months. That is a lot of money to toss on nurse without some expectation of a reasonable return. Of course there will likely be a two year contract, yet potential employees will be screened carefully. A travel nurse may be a great candidate and really looking for a permanent situation, but it raises some red flags. So what I meant is before you look like a gadabout going traveling, it will be easier to convince a teaching hospital of your good intentions as a two year staff member.

And since you hate your specialty... it only makes sense, doubly.

RNAvatar · Mar 25, 2015

Well, I certainly didn't mean changing your specialty while still traveling and learning on the job! Sorry about that.
The deal with a new specialty is the training at a good teaching hospital will be a minimum of 6 months. That is a lot of money to toss on nurse without some expectation of a reasonable return. Of course there will likely be a two year contract, yet potential employees will be screened carefully. A travel nurse may be a great candidate and really looking for a permanent situation, but it raises some red flags. So what I meant is before you look like a gadabout going traveling, it will be easier to convince a teaching hospital of your good intentions as a two year staff member.
And since you hate your specialty... it only makes sense, doubly.

I have thought about this as well, and you do make a good point that it would be better to specialize now before becoming a travel nurse..in case it raises red flags. Thanks for the advice and I plan on specializing now for a couple years and see how it goes from there.