Med-surg a stepping stone?

redhead_NURSE98!, ADN, BSN · Apr 16, 2013

Of course a med surg floor is a perfect place for a new grad. You learn to hone your prioritization skills and deal with physicians, coworkers, family members, drug seekers, manipulative patients, etc. Extremely valuable experience.

I have heard though that there is somewhat of a tipping point, that if you spend "too much" time in med surg you become less attractive to more specialized areas. I can see how you could lose touch with more focused assessment and paying very careful attention to labs, vitals etc. Someone with more experience than me will have to say whether I'm right on this or not, as I've only heard it from one person, and I just don't spend that much time picking people's brains about it - not ready for critical care since I watched my father in law die in front of me in CVICU last spring. :down: I could barely stand the hospital at all for awhile, let alone think about being in more critical situations.

westieluv · Apr 16, 2013

I'm SMH on this one. A Med/Surg nurse doesn't do a "focused assessment or pay very careful attention to labs, vitals, etc."? If anything, a Med/Surg nurse has to do the most comprehensive assessment of all, since her patients all vary in their diagnoses and could have an issue with any of their body systems or multiple ones simultaneously. Med/Surg patients have more chronic conditions to contend with than, say, an OB nurse's patients as well, so tack on day to day knowledge of conditions such as COPD, acute renal failure, CHF, and diabetes, just to name a few. A Med/Surg nurse also has to pay very close attention to labs and vitals because these things are critical in fresh post-op patients or patients who are chronically ill and at higher risk than the general patient population. Med/Surg nurses have to know telemetry and know when a patient's rhythm turns potentially critical. That is not simple stuff.

I don't know where people get this odd and patently incorrect idea that Med/Surg nurses are half-witted, unskilled nurses working on simple "stepping stone" units. Med/Surg is hard, it kicks your butt on a daily basis, and you have to know not just about one body system but all of them. If I were in a terrible car crash, you can bet I would want a Med/Surg nurse there first before an OB or Psych nurse. Wouldn't you?

Maybe you didn't mean it that way, but these posts are insulting to all of the hard working, dedicated, and extremely knowledgeable Med/Surg nurses out there who happen to enjoy the challenges of their specialty (and yes, it is a specialty, with the oppportunity for certification and everything!) and don't consider it just a "stepping stone".

Nurseinthemaking20 · Apr 16, 2013

You are taking my post for advice entirely too personal. Why are you getting so defensive on something that obviously doesn't apply to you? I am going to be a new grad in a few years and am simply asking for advice from some experienced nurses. I am by no means down-playing med-surg. If you read my post you will see that I said "I have heard the horror stories" meaning that I know how crazy it can get. I volunteer on a med-surg floor, I have witnessed myself how skilled the nurses are and how much they put up with. Nothing in my post ever suggested that med-surg was merely a stepping stone. I'm asking if it could be a stepping stone for me. I am simply inquiring whether med-surg experience will be good experience for other specialties, and whether other units would hire me with that type of experience. Clearly you missed the whole point of this thread.

redhead_NURSE98!, ADN, BSN · Apr 16, 2013

I'm SMH on this one. A Med/Surg nurse doesn't do a "focused assessment or pay very careful attention to labs, vitals, etc."? If anything, a Med/Surg nurse has to do the most comprehensive assessment of all, since her patients all vary in their diagnoses and could have an issue with any of their body systems or multiple ones simultaneously. Med/Surg patients have more chronic conditions to contend with than, say, an OB nurse's patients as well, so tack on day to day knowledge of conditions such as COPD, acute renal failure, CHF, and diabetes, just to name a few. A Med/Surg nurse also has to pay very close attention to labs and vitals because these things are critical in fresh post-op patients or patients who are chronically ill and at higher risk than the general patient population. Med/Surg nurses have to know telemetry and know when a patient's rhythm turns potentially critical. That is not simple stuff.
I don't know where people get this odd and patently incorrect idea that Med/Surg nurses are half-witted, unskilled nurses working on simple "stepping stone" units. Med/Surg is hard, it kicks your butt on a daily basis, and you have to know not just about one body system but all of them. If I were in a terrible car crash, you can bet I would want a Med/Surg nurse there first before an OB or Psych nurse. Wouldn't you?
Maybe you didn't mean it that way, but these posts are insulting to all of the hard working, dedicated, and extremely knowledgeable Med/Surg nurses out there who happen to enjoy the challenges of their specialty (and yes, it is a specialty, with the oppportunity for certification and everything!) and don't consider it just a "stepping stone".

You know what, I've worked in med surg for over two years, so it was most obviously NOT my intention to picture them as half-witted unskilled nurses. What I SAID was, " I can see how you could lose touch with more focused assessment and paying very careful attention to labs, vitals etc." On a med-surg floor vitals are taken 1-3 times a shift depending on the orders, and labs are done daily, for the most part, except maybe a q6 H&H on a GI bleed, or if an electrolyte is being replaced we will take a new level about an hour after replacement. Therefore, I have ONE SHOT on labs and 1-3 SHOTS on vitals for the day, unless someone starts showing some change in condition and I choose to take vitals more often, or I have a post-op. I need to know very little telemetry for my job, personally. A monitor room calls me if there's a change in rhythm or rate. I've got 4-6 patients, and it's not uncommon for each nurse to discharge 2-3 and admit 1-3 new ones within a 12 hour period. If you put it in that perspective, maybe you can understand my statements.

From my limited exposure to CCU, there are way more labs to look after & way more often in a critical care unit than med surg, vitals are being monitored constantly, b/p every 15 minutes, and your patients can tank fast. If you don't agree that a CCU nurse must pay MORE careful attention to labs, vitals etc. and do more focused or "in-depth" assessments because they are less stable than a med-surg patient (or should be), I must be WAY off on what a CCU nurse does.

ParkerBC,MSN,RN, PhD, RN · Apr 16, 2013

Each specialty requires a specific assessment. For example, a neurological floor would conduct a cranial nerve assessment versus med/surg. A Psych nurse’s assessment would be more specific to mental illnesses. Critical Care nurses must have the ability to pick up on settle changes/warnings that a patient may be heading south. While I agree that patients can take a turn for the worse on a medical surgical floor, the likelihood is less than a critical care unit. Hence, the fact that the majority of code blues occur in a critical care or emergency room setting.

I love Med/Surg. The postings I see for Critical Care Nurses generally require 1-2 years in that specialty. I would venture to say the reason is because there is a rather large applicant pool of RN’s today. Therefore, the hospitals can be picky and raise the position requirements given the current applicant pool. I have also seen postings state that facilities are willing to accept applications from Student Nurse Externs who worked in Critical Care during nursing school.

But as always, there are exceptions to the rule.

EaglesWings21, ASN, RN · Apr 16, 2013

Hmm k yeah I want to do critical/constant care but I do think I would like to work on Med-Surg. I look at nursing as my licensure at stake when I finally get it and I want to be very competent and well prepared for my practice. So yes Med-Surg is a good place to start. I also don't want to get hired on at the ICU or ED just to be told I need more experience.. so yes you are thinking about this in the right way!

tokmom, BSN, RN · Apr 20, 2013

I have to chime in here, even though I wasn't going to. I have to defend westieluv, and I'm going to surmise what I think what was insulting because it is for me. As someone who has over 20 yrs of med/surg experience I feel as though I can speak for med/surg in general, so please, hear me out. This may behoove you in your nursing profession.

Never, EVER refer to med/surg as a stepping stone. It really irritates med/surge nurses. It makes us sounds like we work on some general floor and are too stupid to work anywhere else. Med/Surg nurses are intelligent and hard working nurses (Yeah, I know you didn't say otherwise..), but that is what we hear. I don't think a CCU nurse likes to be called a stepping stone for a nurse that want's to be a CRNA or FNP. It makes one feel as though their unit, what they do on a daily basis, doesn't matter.

Believe it or not, med/surg is a specialty. Did you know there is a certification test for med/surg?

As for vitals, tele, etc..every hospital is different. I have worked in hospitals that had tele techs. You never even knew what your patients rhythm was, unless the tech told you. In my current facility, we have to be tested on 21 different strips ever year. The test is a 100% pass, or you get to sit in a 2 day remedial class. It is the same test as the ICU nurse. We have to monitor and interpret our strips, 3 times a shift.

Med/Surg nurses also have to know pediatrics and geriatrics and every system in between. Not all hospitals have specialized ped floors. We have to do all the other multi tasking things that other nurses do, just like any other floor.

For what it is worth, I have floated to various floors in float pools and have horror stories in every department. I have worked understaffed in PCU, OPS, mother/baby, ED, nursery, psych, ortho, renal...OMG, everywhere...etc. S**t happens in all hospitals. That is the angst of all nurses, everywhere. Don't ever think you won't work short in the departments you mentioned. Some days you will wonder how in the hell you even got through the day.

Now with that being said. Every hospital is different. Our staffing on my med/surg floor runs at a PCU level. 1:3 or 1:4. 1:5 on a bad day.

If you ever want to work in a hospital and have other plans, don't tell some hiring med/surg manager that you have higher aspirations other than just med/surg. When you do, you have cut your own throat and insulted the manager. How do I know this? Because I have worked mid-management and still sit in on interviews. Your resume will be filed in the round circular file faster than a paper airplane can fly.

As for the comment of med/surg nurses being not of value because they are 'only' med/surg nurses. Well, that simply is not true. Again, I have worked in a variety of areas as a float nurse, med/surg nurse, etc..It has been of value to get my foot in the door.

The nurses that are pigeon holed are those that are very specialized. The psych nurse, nursery, labor/delivery, mother baby (I'm sure there are more). Those nurses can come out of their areas and get a med-surg job, because I have seen it. However it's one heck of a learning curve and I feel sorry for them. There assessment skills aren't up to par, because they have lost them.

Good luck to you in your nursing career and may you find your niche in nursing.

Nurseinthemaking20 · Apr 20, 2013

Tokmom- I really appreciate and respect your response. Thank you for approaching the situation in a non-hostile way. I understand how you feel and I apologize for any offense taken. I think this is a case of not understanding each other so I'm glad things can be clarified. I think med-surg nurses are great! The ones I've met seem so intelligent and competent and I have never thought of them or med-surg as inadequate. For me, the whole stepping stone figure of speech was not intended to suggest that that's all that med-surg is. In fact, it's really a complement. The truth is, many jobs in nursing want you to have some med surg experience and that is because you can learn so much and gain so much knowledge from med surg because it is so broad. I recognize that med surg is a specialty just as much as any other field of nursing. And just like some specialties fit nurses some specialties don't. Or some nurses enjoy a specialty while others don't. In my original post I made it clear that I don't know what the heck I want to do. I havnt had enough exposure to anything to know. I can only go off of what I hear, and what I hear is that med surg is good for new nurses. So, I didn't mean it as med surg is nothing but a stepping stone, I am just speculating as whether it could be a stepping stone for me. Since I don't know what I want, I know that there's a chance that I might not like it. Just like there's a chance to not like any specialty. That was the sole purpose of my post. Can I get hired into other specialties with a med-surg background? It's as simple as that.

Anyways, I really want to thank you again for your feedback and also for saving me from what could be a really bad interview in the future!

tokmom, BSN, RN · Apr 20, 2013

You are very welcome.

So yes, you can get hired in other areas with a med/surg background. It will behoove you. Get your experience and then start interviewing other nurses in areas of interest. It would be great if you could shadow. Ask them the good and bad of their job.