Med-surg for all?

[bjb_wyo]

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 They say the the med-surg idea is outdated and a new nurse is better off in the area the nurse wants to work in.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 Is my local hospital out of date?

[SharonH, RN]

First of all, as a med-surg RN I really resent the idea that med-surg is "basic" nursing where new graduates learn their stuff before they go on to the real hard stuff. Med-surg is a specialty and a pretty tough one and it is not the one to park new grads while they learn so the other specialties can get seasoned nurses. Secondly, I don't like the idea that they are putting nurses into an area who have no intention of staying. How fair is that to the existing staff and people who have to staff the area to put people over there who they know do not intend to stay? If you have an idea of where you want to work, then go for it. Personally I started out in pediatrics and then went to med-surg.

[allthingsbright]

I say go for what you want...

I have worked with and met many nurses who have gotten "stuck" (stuck because they wanted a diff. specialty--not stuck cuz med surg is nec. bad) in Med/Surg. There is such a need there that many hospitals discourage changing units, and then getting a job outside Med/Surg is hard when you've been labeled a "med/surg" nurse. This is what I have seen and been told! I am sure you will hear lots of views on this! GL!

[RN34TX]

First of all, as a med-surg RN I really resent the idea that med-surg is "basic" nursing where new graduates learn their stuff before they go on to the real hard stuff. Med-surg is a specialty and a pretty tough one and it is not the one to park new grads while they learn so the other specialties can get seasoned nurses. Secondly, I don't like the idea that they are putting nurses into an area who have no intention of staying. How fair is that to the existing staff and people who have to staff the area to put people over there who they know do not intend to stay? If you have an idea of where you want to work, then go for it. Personally I started out in pediatrics and then went to med-surg.

I totally agree with this post.

It's not fair to either the new nurse or the staff.

It takes a lot of time and energy to precept a new grad. Even once they are off orientation, the vast majority still need a lot of help, guidance, and supervision from the charge and other staff nurses because so many situations come up that didn't come up during orientation.

New grads are just plain needy and taxing, as well they should be. (The ones who aren't asking questions or needing help worry me much more).

To tax the preceptor as well as the rest of the staff with one new grad right after another, only to find them leaving in a year or so for other areas (where the new grad wanted to be to begin with) would make me, if I were the preceptor, wonder why I should even bother devoting so much time and energy with precepting the new folks when it won't be much benefit to my unit or even my med/surg specialty because they all plan to jump ship in a relatively short period of time.

By the time they start becoming more independent and more of an asset to the unit, they're gone.

It's bad for the new grad as well in that they are wasting their time being trained in an area where they have no intention of staying, and often learning things that are not relevant to the areas where they really want to be in the future.

Some even have such bad experiences in med/surg, that they leave hospital nursing altogether instead of going to an area that interests them because they got so turned off by it.

I too, resent the idea of med/surg being looked at as "learning the basics."

My years of med/surg served as an excellent foundation, but it certainly was not intended to be any "launching pad" to get me to other areas. I fully intended to stay in med/surg, but eventually I had to make a choice to either leave it or I was leaving nursing altogether. Too many med/surg units have become dumping grounds for train wreck patients without safe staffing levels.

[ZASHAGALKA, RN]

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.

You're right, but wrong.

Can you go into say, NICU right out of school? People do it, all the time.

But it pigeon-holes you into that specialty. Let's face it, five years out of nursing school, if you haven't honed the time management and skills to do med/surg, not only med/surg, but a whole host of jobs that build upon those skills will be lost to you.

Use it, or lose it.

If you use it for a year, it will come back to you later, if you decide on a different route in nursing. If you never use it, you WILL lose it.

Ask around for those that went straight into their specialty skills about how well they think they'd do on a med/surg unit. I work in critical care, and the foundation of 3 yrs of med/surg was and is invaluable.

And, even though it's been 10 yrs, I can still pick up an extra shift on med/surg, if I want, and hit the ground running. . .

In my opinion, adult med-surg is the most physically demanding type of nursing care

Exactly! If you can make it here, you will learn the skills to help you make it, anywhere.

~faith,

Timothy.

[ZASHAGALKA, RN]

First of all, as a med-surg RN I really resent the idea that med-surg is "basic" nursing where new graduates learn their stuff before they go on to the real hard stuff. Med-surg is a specialty and a pretty tough one and it is not the one to park new grads while they learn so the other specialties can get seasoned nurses. Secondly, I don't like the idea that they are putting nurses into an area who have no intention of staying. How fair is that to the existing staff and people who have to staff the area to put people over there who they know do not intend to stay? If you have an idea of where you want to work, then go for it. Personally I started out in pediatrics and then went to med-surg.

I knew going into my first job on a medical unit that I would eventually move on.

I worked on medical 3 yrs and learned lots of stuff. I think med/surg is an important foundation. I don't believe it's 'basic' nursing. It's tough and seasoning work.

In the three years I was there, I was a valuble asset, just as I am now, in critical care. It's not completely fair to say that, if I don't want to make it a career, I am 'using' med/surg for my education in nursing experience. The benefit to both me, and the units I worked on, was mutual.

~faith,

Timothy.

[NephroBSN, BSN, RN]

First of all, as a med-surg RN I really resent the idea that med-surg is "basic" nursing where new graduates learn their stuff before they go on to the real hard stuff. Med-surg is a specialty and a pretty tough one and it is not the one to park new grads while they learn so the other specialties can get seasoned nurses. Secondly, I don't like the idea that they are putting nurses into an area who have no intention of staying. How fair is that to the existing staff and people who have to staff the area to put people over there who they know do not intend to stay? If you have an idea of where you want to work, then go for it. Personally I started out in pediatrics and then went to med-surg.

I'm sorry if I gave the impression that M/S is easy or basic. As a former 15 year M/S LPN/RN I know it's neither.

One of the reason's I tout M/S as a stepping stone is because it is such a good experience.

I'm sure many won't like it. We all have to do things we don't like.

Many times when we do things we don't think we'll like we find out we like it after all.

Congratulations on your NP. Will you be staying in M/S or moving on?

[ZASHAGALKA, RN]

One of the reason's I tout M/S as a stepping stone is because it is such a good experience.

Exactly.

The fact that I tout it is a compliment to just how essential I think those skills are to nursing, generally.

~faith,

Timothy.

[Pitbullgirl]

I think you should go where your interests lie. Especially for some of us older "nontraditional" students, we've had other experiences and careers that help make the leap into a new area a bit easier, i.e. maturity, assertiveness, and other skills that may translate across professions (time management, prioritization, etc.)

However, if you are determined to go into a specialty area as a new grad, I do believe you need to find a position where the orientation is very thorough. For example, I graduated in December with my BSN and started in the OR last month in a very structured 6 month internship program. I'm doing as well, or better, than the others in my group. Do I have 1 year med-surg? Absolutely not. I've got 10+ years working first in law firms, then as a journalist, and most recently 2+ years as a tech in a busy Level 1 ED.

I agree that med-surg can provide good experience, but it's not for me and I did not feel it was necessary, either. I think the decision depends largely on two things: the individual and their background, and the hospital's orientation.

[NephroBSN, BSN, RN]

I totally agree with this post.

It's not fair to either the new nurse or the staff.

It takes a lot of time and energy to precept a new grad. Even once they are off orientation, the vast majority still need a lot of help, guidance, and supervision from the charge and other staff nurses because so many situations come up that didn't come up during orientation.

New grads are just plain needy and taxing, as well they should be. (The ones who aren't asking questions or needing help worry me much more).

To tax the preceptor as well as the rest of the staff with one new grad right after another, only to find them leaving in a year or so for other areas (where the new grad wanted to be to begin with) would make me, if I were the preceptor, wonder why I should even bother devoting so much time and energy with precepting the new folks when it won't be much benefit to my unit or even my med/surg specialty because they all plan to jump ship in a relatively short period of time.

By the time they start becoming more independent and more of an asset to the unit, they're gone.

It's bad for the new grad as well in that they are wasting their time being trained in an area where they have no intention of staying, and often learning things that are not relevant to the areas where they really want to be in the future.

Some even have such bad experiences in med/surg, that they leave hospital nursing altogether instead of going to an area that interests them because they got so turned off by it.

I too, resent the idea of med/surg being looked at as "learning the basics."

My years of med/surg served as an excellent foundation, but it certainly was not intended to be any "launching pad" to get me to other areas. I fully intended to stay in med/surg, but eventually I had to make a choice to either leave it or I was leaving nursing altogether. Too many med/surg units have become dumping grounds for train wreck patients without safe staffing levels.

]

Because once in a while you might catch a good nurse who wants to stay.

Also, some of the one's who want M/S and start there can't hack it.

It works both ways. Some even leave for ICU ACU PACU or ER and return.

It's really a crap shoot. Every one can't work in critical care either coming out of school.

That would hurt M/S just as much.

[RN34TX]

]

Because once in a while you might catch a good nurse who wants to stay.

Also, some of the one's who want M/S and start there can't hack it.

It works both ways. Some even leave for ICU ACU PACU or ER and return.

It's really a crap shoot. Every one can't work in critical care either coming out of school.

That would hurt M/S just as much.

Closing the door of opportunity in other areas to basically funnel new grads into working med/surg isn't going to help med/surg.

It's not a good way to "catch a good nurse who wants to stay" once in a while when you're making a ton of others miserable with their career choices.

It may hurt med/surg in the short run, but I think that having more and more nurses refusing to work the floors because of working conditions is exactly what med/surg needs in the long run.

Some nurses do return to med/surg after moving to the other areas you listed.

I've met a grand total of 2 in 9 years of nursing.

The vast majority are trying to get out of med/surg, not trying to get back in. And who can blame them?

[NephroBSN, BSN, RN]

Closing the door of opportunity in other areas to basically funnel new grads into working med/surg isn't going to help med/surg.

It's not a good way to "catch a good nurse who wants to stay" once in a while when you're making a ton of others miserable with their career choices.

It may hurt med/surg in the short run, but I think that having more and more nurses refusing to work the floors because of working conditions is exactly what med/surg needs in the long run.

Some nurses do return to med/surg after moving to the other areas you listed.

I've met a grand total of 2 in 9 years of nursing.

The vast majority are trying to get out of med/surg, not trying to get back in. And who can blame them?

Maybe we could spread that ton of nurses around.

I've been in nursing for 26 years. I've seen many come back to M/S.

How will nurses refusing to work M/S help. Where will those patients go. To ICU, ER, OB etc.????

Just curious.

[RN34TX]

Maybe we could spread that ton of nurses around.

I've been in nursing for 26 years. I've seen many come back to M/S.

How will nurses refusing to work M/S help. Where will those patients go. To ICU, ER, OB etc.????

Just curious.

They'll have to go somewhere no doubt.

Maybe, just maybe, if we stop making excuses as to why we continue to accept jobs with unacceptable working conditions we'll actually get somewhere.

Nurses have children, and nurses have mortgages to pay, thus they accept jobs with insane working conditions and we all simply hope that it will change without us individually having to sacrifice and walk out on our jobs.

We all want our children to be comfortable in their nice private schools and we all want a decent house to live in decent suburbs and make the mortgage payment every month.

Thus we continue to settle for less than what we are actually worth.