Med-surg for all?

NephroBSN, BSN, RN · Mar 26, 2006

I am graduating in May. I have visited 3 hospitals and will have interviews with all 3. I am getting very different stories. My local hospital where I have done my clinicals starts all graduate nurses with at least one year in Med-Surg. They say this is the way it is always done.
The other hospital, which is working for magnet hospital status and seems very progressive, starts their graduate nurses in "career pathways" linked to what they are interested in. I am applying for critical care pathway and will interview with telemetry. They say the the med-surg idea is outdated and a new nurse is better off in the area the nurse wants to work in.
I haven't visited the third hospital yet, so don't know what they do.
Any ideas which course is best? Is my local hospital out of date?

As an old nurse both chronologically and career wise I will say that the tried and true method has some merit.

Let's think of it this way. A house needs a good foundation and without it it will topple.

I don't believe it's so much M/S as it is the lessons learnt there in general nursing concepts and skills along with priority setting, organizaitonal skills etc.

And who knows you might like. I also doubt any other unit will turn you away with one year of M/S experience.

Good luck. If you absolutely hate M/S don't go there. But I believe it would be a mistake to avoid it. IMHO

mawlvn · Mar 26, 2006

I agree Med-Surg give you a solid foundation in skills and time management. I have found in the hospital I work in, new graduates who start in the icus are limited. When the are burned out or just want a change they find themselves in a position of only having icu experience. It's a difficult place to be.

NephroBSN, BSN, RN · Mar 26, 2006

I agree Med-Surg give you a solid foundation in skills and time management. I have found in the hospital I work in, new graduates who start in the icus are limited. When the are burned out or just want a change they find themselves in a position of only having icu experience. It's a difficult place to be.

That's a very good point. I hadn't thought of. With a year's M/S under you belt you could go back there if you get burnt out in a UNIT.

Jolie, BSN · Mar 26, 2006

Check the archives for endless passionate debates on this very topic :).

I will offer another perspective. I graduated from nursing school 20 years ago with a passionate interest in maternal-child health. I didn't detest adult health, but it didn't hold any real interest for me either. I vowed I would not be railroaded into med-surg, and I am so thankful that I wasn't. Don't get me wrong, it med-surg interests you, then by all means do it! If not, don't.

I started out as a new grad in a 45 bed Level III NICU in a large teaching hospital. The unit regularly hired new grads and had an extensive and thorough orientation which went a long way toward promoting the success of the new hires in the unit. After 2 years, my hubby was transferred to another (much smaller) city, where I would not have had the opportunity to work in maternal-child health without my prior experience. If I had started out getting a year or two of med-surg experience, I probably would have NEVER made it into my area of interest. What an unsatisfying career that would have been!

Many people argue that med-surg is necessary for prioritization, organization, and time management skills. I respectfully disagree, as my NICU babies require me to be just as efficient in my care as any other type of patient. These are skills that can be and are learned in any unit.

And finally, there are some specialty areas in which adult med-surg experience is not only unnecessary, but undesirable. Pediatric and neonatal patients are not little adults, and many things have to be "unlearned" by mes-surg nurses transferring into these areas, making such a transition difficult for some.

It concerns me that some hospitals are adopting a med-surg only policy for new grads as a means of ensuring staffing for units that may have high turnover. In my opinion, adult med-surg is the most physically demanding type of nursing care, one reason that some nurses don't stay long in the specialty. If there is always a ready supply of new grads to staff such units,

staffing concerns are minimized. But working on a unit comprised mostly of inexperienced staff has as many pitfalls as a poorly staffed unit.

What ever you decide, ask the following questions during your interviews:

1. What is the average length of service of nurses on this unit. Anything under 3-4 years is not good, in my opinion.

2. What is the ratio of experienced (more than 2 years on this unit) staff to inexperienced staff on the unit, and on the shift to which I will be assigned? Run away from any unit with less than 50% experienced staff.

Good luck!

Tweety, BSN, RN · Mar 26, 2006

Both schools of thought have merrit.

I do not think that med-surg has to be the launching ground for specialities, especially for those who have not interest in med-surg. I'd rather see new grads who are committed to med-surg pick med-surg rather than come in with the idea they are going somewhere else.

Someone can get a good foundation in specialities with a good training/orientation program. That way specialties that are short staffed get interested nurses sooner, and interested nurses get where they want to be quicker without being tortured with an area they don't care about.

Long Term Care Columnist / Guide · Mar 26, 2006

I used to believe that all nurses working in acute care should do at least a year in Med/Surg in order to get their skills and learn prioritization.

Now, I'm not so sure. M/S has chewed up and spat out many a fine new (and used) nurse, and as a result we are seeing RNs and LPNs---even some with less than a year's experience---leaving the bedside, if not the profession. The complaints are universal: there's too much work, too little time, too many distractions, too many acutely ill, unstable patients, and too few staff to give them proper care.

That's just not a good way to begin a career IMHO, particularly if one's interests lie in another direction such as peds or ICU. I wouldn't recommend enduring M/S for a year or more just to get experience; if one is interested in adult nursing, or merely has no real certainty about the sort of nursing s/he wants to do, s/he should definitely pursue it. Otherwise, I think new nurses who know where they want to be and what they want to do should just go for it, and not bother with M/S if it's not their 'thing'.........it's hard, hard work even when you love it, and if you don't it's merely an endurance contest.

opalmRN · Mar 27, 2006

bjb wyo,

Any experience you gain is valuable in one form or another. Follow your interest. If you get there and that one turns out not to be what you truly desire, finish your commitment and move forward. You will always take the experience with you. Med surg is for a great number of nurses but not for all just as ob, peds, NICU, etc. You won't know until you experience it whether it's for you or not.

IMHO, insisting on med surg for new employees is unproductive.

Best wishes in your career!

bjb_wyo · Mar 29, 2006

Thanks to everyone who answered. I see that both views have validity. I think I will probably choose the hospital with the most welcoming attitude.

TheCommuter, BSN, RN · Mar 29, 2006

When I was a student, the majority of my nursing instructors said, "You all must get at least 1 to 3 years experience on a med-surg unit in a hospital. If you can do med-surg, you can do anything."

However, I ended up hating my med-surg clinical rotations. To be perfectly honest, I was never passionately interested in ever working in med-surg. I do not see the point of working in an area that I detest for the sake of being exposed to the valuable experience it will bring. Med-surg would have exposed me to virtually every situation as well as get me to manage time, but I need to avoid the burnout. After all, I hope to work another 30 years or more.

I am content with the steady pace of long-term care. LTC might not be good for my career, but it is good for my soul.

GooeyRN, ADN, BSN, CNA, LPN, RN · Mar 29, 2006

A hospital insisting that all new grads start in med/surg may have problems with staffing in med/surg. Its an easy fix to their staffing problem. And since new grads tend to be flexible since they are afraid they won't get hired, the staffing problem gets fixed until those new grads burn out. But by then the next group of nurses graduates... Its easier/cheaper to insist everyone start in med/surg than correcting the problems of understaffing/heavy workloads in med/surg. Go where your heart is. I started in LTC, then psych, THEN went to med/surg. It can be done. I am now looking to get back into psych...

ImaERtraumaRN · Mar 29, 2006

I say listen to your instructors, your mentors and your heart.

If you are someone who adapts to an environment quickly, has good organizational skills and learns quickly then a specialty area might be the way to go. You will understand that every patient is a learning opportunity, and there may even be research/reading you will need to do on your own time (without prompting) in order to make your practice stronger. Many times I find myself going home and looking up something I ran into that day that I didnt know about. I was a new grad in the ED and the choice was the right one for me. I also had a very good orientation with 20 weeks of classes and preceptorship.

On the other hand, if you had clinical instructors tell you that you need to work on organization, or you need more work in a specific med/surge area, then you may want to go for the foundations first. Our hospital will allow you to transfer w/in the first 6 months if your position is not a good fit. If you find yourself stressed out, burned out or overwhelmed transferring does not equal to failure.

I would have been miserable in med/surge. It isnt for me and I know that. That doesn't mean that it isnt a great place for others. I had to follow my heart and commit to doing everything I could to ensure my own success.

Good Luck!