Med-Surg

live4today, RN · Apr 26, 2008

i started out in med/surg as a rn 21 years ago, and haven't regretted one moment of it. med/surg gave me the grounding i needed, the excitement of many different diagnoses to work with, a great variety of different cultures and their ages to gain experience in working with, the ability to multi-task and multi-think w/o much time in between. hectic? absolutely! for me, inpatient nursing did not become hectic until around 1993 or 1994, and it's not stopped since that point. i don't really know what happened to the inpatient nursing units, but one thing i know is the dizziness must stop! too many patients are being denied their right to receive the best possible nursing care due to the acuities, the nurse to patient ratios, the increased psychological illnesses that seems to have increased tremendously in the past four to five years especially. i find that i really am using my "psych" nursing as equally as i use my skilled nursing...constant triaging one aspect or another moreso today with patients. our patients enter the hospital with far more stress on them than in years past (jmo from the patient population i've cared for since spring of 1987).

unless each rn is given a cna to help care for the five to six patient load on days in civilian hospitals (especially), it's next to impossible to give each patient our 100% best. is it all about how many beds the hospitals can keep filled for the power of the almighty dollar??? i think so! it's not really putting the patients first...it's all about how much money is coming in...how much is being lost...how much more can we make...at the expense of the "top of the hospital's payroll staff".........that's us nurses and the patients we care for. jmo...and not the end of how i feel on this topic, but for time sake...nuff said for this post. :twocents:

i do believe at least one to two years on a med/surg unit following graduation is a great idea! med/surg is a specialty in and of itself...in my opinion. what other unit can a nurse work on and gain a total patient population education with so many different diagnoses and medical treatment plans/procedures to learn from? because of my med/surg experience, i feel more confidant when i work in other aspects of nursing. med/surg is an education in and of itself. hats off to every med/surg nurse. we do work our buns off, yet the rewards of having all that stored knowledge to pull from in any given situation with each patient presenting with various diagnoses is awesome indeed! :yeah:

jjjoy, LPN · Apr 26, 2008

I started out in med/surg as a RN 21 years ago, and haven't regretted one moment of it. Hectic? Absolutely! For me, inpatient nursing did not become hectic until around 1993 or 1994, and it's not stopped since that point....Unless each RN is given a CNA to help care for the five to six patient load on days in civilian hospitals (especially), it's next to impossible to give each patient our 100% best.... I do believe at least one to two years on a med/surg unit following graduation is a GREAT idea!

Given the difference in level of acuity and increased hectic-ness of today's nursing, and considering what today's nursing students' clinical experience is compared to that of yesterday, how would you feel starting out on a med-surg floor as new grad today compared what it was like when you started out?

mkalizmoore · Apr 27, 2008

Given the difference in level of acuity and increased hectic-ness of today's nursing, and considering what today's nursing students' clinical experience is compared to that of yesterday, how would you feel starting out on a med-surg floor as new grad today compared what it was like when you started out?

Do you think student's clinical experience today is less than it should or used to be?

jjjoy, LPN · Apr 28, 2008

Do you think student's clinical experience today is less than it should or used to be?

I can't personnally compare but I do think many experienced nurses seem to be of the opinion that new grads should be more prepared clinically when they start working than than they are. I'm asking cheerfuldoer (or anyone else) if she observes differences in today's nursing school clinicals (eg what students are expected/allowed to do) compared to when she was in school. I know that some students are quite restricted in what they are allowed to do and may not spend much time on any one floor such that the working nurses and the students have no chance to become familiar with each other. Of course, each school runs their clinicals differently.

crunchymomx3 · Apr 28, 2008

I just took my first job on a med/surg floor. It's definitely NOT where I want to stay, but I know the skill that I get there were be worth it in the long run. For me, a good orientation and a year in med/surg are an addition to the schooling I have received that will make me a better RN in the long run.

With that being said, after working 8 hour shifts on med/surg floors in one of the biggest city hospitals in my state for clinical I know I couldn't do it long term. It's very hectic and stressful. I give any nurse who can do it lots of credit. :)

JRD2002 · Apr 30, 2008

I am currently on a med/surg floor that does a lot of surgical/trauma patients. I really like it. As many have stated the wide range of patients makes it very interesting. There isn't a night where I am not solving a problem with one of my patients. If you feel that med/surg is overwhelming and you don't have time to think you might need to go onto nights. It is still overwhelming but because you don't have the docs there you become much more independent and are forced to work out many situations collaborating with your fellow nurses. I can't tell you how many times that we have had issues with patients and have had three nurses in the room trouble shooting. I think med/surg is really either a love or hate thing...but I do agree that it it's a good idea for everyone to have a little med/surg background.

live4today, RN · May 1, 2008

given the difference in level of acuity and increased hectic-ness of today's nursing, and considering what today's nursing students' clinical experience is compared to that of yesterday, how would you feel starting out on a med-surg floor as new grad today compared what it was like when you started out?

thank you for asking me to address this question. i probably wouldn't last long...to be honest. i see the stress in the new grads faces, and my heart hurts for them because i know exactly how overwhelmed they feel...only they feel that nursing is what it is today, it's all they know since they've not known any other type of nursing, and that's what they have to put up with in order to become the nurse they've all dreamed of becoming, or that they've all strived so hard to become. any new grad who can survive the medical/surgical units will either grow into one great and strong nurse, or one that will need therapy within his/her first year or two of med/surg nursing. it's a very tough unit to work on in today's nursing, but i still love taking care of patients, and giving it my very best. i used to be a patient many times before i became a nurse, so i'm always striving to give back to my patients what i know they will need to survive their hospitalization, the bad news many receive about their health status, the anxiety/stress that comes with being removed from their comfort zone to being invaded by strangers from the time they are admitted to the time they are discharged. it's not a comfortable calm situation to be in. :nurse:

i can't personnally compare but i do think many experienced nurses seem to be of the opinion that new grads should be more prepared clinically when they start working than than they are. i'm asking cheerfuldoer (or anyone else) if she observes differences in today's nursing school clinicals (eg what students are expected/allowed to do) compared to when she was in school. i know that some students are quite restricted in what they are allowed to do and may not spend much time on any one floor such that the working nurses and the students have no chance to become familiar with each other. of course, each school runs their clinicals differently.

if this weren't a public forum, i would name the community college i attended bragging to the highest degree about my alma mater. :up: every professor throughout the college (not just in nursing) was required to have a masters degree in the area they were hired to instruct...many even had their phd. the school has always had a 97 to 100 percent first time pass rate on nursing state boards...much higher pass rate/percentage than the local four year schools. i received a top-notch education at that college, and i'm thankful to this day that i went to that college. i had great teachers in my non-nursing and nursing classes. i had excellent experiences in the clinical aspect of the program as well. i couldn't have asked for better. still today, i would begin in a community college to become a nurse because of the excellent education i received. i felt totally confidant and well-prepared to hit the inpatient floors well-prepared to assume responsibility for the patients assigned to me, and had all the "critical thinking skills" necessary to assess my patients.

having shared that............even when i was young in my nursing years, the students that shined the best after graduation were those who came from community colleges. when precepting new grads, it was very obvious to me which new grads were community college grads vs. four year grads when observing or orienting them in the inpatient settings. i still think the same today. i'm all for progression in the nursing field educationally speaking, but if any program were to exist, it should always be the community colleges prepping students to become nurses. more and more four year schools are catching on to the "magic" of turning out great nurses from the community college nursing programs, and so are incorporating more clinical time into their programs. of course, this depends on what part of the country the schools are located in, and the number of colleges available to choose from for nursing students to receive their education. the more clinically prepared the nursing students are, the better their success rate once they hit the floors running.

dustbnnetta · May 1, 2008

I thought med-surg was perfect when I applied for my job, there is telemetry and vents on my floor so I thought I would learn alot. The floor is hectic...I work nights so the nurse to patient ratio is higher. On a good day we have eight patients a nurse. We hold up to 54 patients at a time and usually have 3-4 cnas. That means each cna has 15 patients on a normal basis. I am reading all these posts and wondering where everyone works because 6 patients sounds like heaven to me. Someone even wrote about an lpn passing meds - lpns have thier own patient load here. the hospital is just really strict about how much they are allowed to do, in the event the patient needs something the lpn cannot do (isnt allowed to because they definitely know how to do it) it becomes an extra responsibility for the rn. although those are not the rn's patients... I feel as though I am learning alot, but it really is a heavy workload. and now I am wondering if I am just at the wrong hospital.

ACRN06 · May 1, 2008

I started Med/Surg out of school even though I too always said "I'll never do Med/Surg!!"

Well... Its been the best decision I ever made! I now, 2 years later, feel totally competent in my skills, you'll never learn time management and efficiancy like you will on "the floors", and I'll know a lot more about the "big picture" of things now that I've cared for patients on the acute level, not just the emergent or critical level as is the ER and ICU.

I recommend starting in M/S... but plenty of nurses don't and get by okay as well...

I'll tell you this much though... I know tons of ER nurses that can't stand new grads coming into the ER w/o a clue as to some of the BASIC knowledge one would expect a nurse to have...

I think working M/S does just that... it lays a solid foundation on which to build.

ACRN06 · May 1, 2008

I have been on my own for 3 weeks now on med surg. Here we call it the " trenches". It's alot. Alot of patients, alot of new orders, alot of tests, labs, surgeries, hanging blood, and most people have many health problems, nit just what they are in for- just alot. Everyone is in for something different. My hospital aims for a 5 to 1 ratio, but I had 6 with an admission my last shift and no LPN to help pass meds. It's extremely busy but I do have to agree that I am learning tons. I do however doubt that I will stray in med/surg, just not my niche.

Hehe... yes... The M/S floor I work on is affectionately called the "dump floor".. "the pit".. "the ghetto".. where you are responsible for everything, and in control of nothing! Typical patient load is 7 patients on nights.. You're lucky to have a PCT to do your vitals, I&O's, and baths, and yes, as is typical for M/S floors, you've got a lot of patients w/a lot of CHRONIC disease... Its not like some floors where they come in w/one problem, you treat it, they go home... You're talking about someone who you WONT cure of their COPD, CHF, DM, Arthritis, Depression, and Glaucoma... you treat the pneumonia they came in with...or the fluid volume overload... or whatever hundreds of Dx's they might present with...and you send them back home.

It sort of is a downer after awhile... you feel like you're never really "making it better"... you're never really "healing"... you're just managing symptoms..

Lots of patients w/LOTS of co-morbidities... top it off w/some soft wrist restraints, a couple bags of TPN, and an isolation gown and you've got a Med/Surg floor!

angel75 · May 9, 2008

I feel the same way as the above poster although I have only been off orientation 2 1/2 weeks. I haven't done a bit of critical thinking. Even w/5 pts, admissions and discharges, I barely have time to look up labs after giving all meds. My preceptor gave me a nice schedule to try to follow, but for me, sometimes it doesn't work. I do feel my time management skills are improving, but I don't feel like I have a good idea of what is going on with the patient. It is rush, rush, rush for the most part. Then I want to look things up on my off time, but I am so tired...

Hello! I am a new grad and will be coming off of med-surg orientation next week. :bugeyes: I feel so overwhelmed most of the time. Not sure if this is something that I want to stick with or not. I find med-surg VERY frustrating and I have considered going into another area. You were saying that your preceptor gave you a schedule to follow. If you don't mind, I would love to have a copy of it. Thanks!!!

jessi1106, BSN, RN · May 11, 2008

I guess we all differ.

I love med/surge. Actually, I work on an acute care medicine unit (occasional surgery pt). I get 3-4 patients.

I have learned SO much! Hanging blood, insulin drips, dopamine drips, heparin drips, PCA's, G-tubes, J-tubes, NG tubes, dhts, chest tubes, nephrostomis, colostomies, TPN, decub dressing changes, trachs, nt suctioning, restraints, communication, so much more.

I am now fairly comforable with such a wide range of nursing skills. I do not know where else I would have gained such experience....I also feel that I have gained a lot in my critical thinking....I learn something new each day. Yes, most days are hectic. But each day is new and unpredicable - I like that.

Best of all I feel that I am gaining the experience, knowledge, communication/prioritization/organization skills & critical thinking abilities,to go nearly anywhere from my current job.