Top 10 things you'll see/take care of working in med-surg

MQ Edna · Nov 20, 1999

The top 10 things I have found are:

1. Patients are sicker now than 10 years ago, requiring more intense care.

2. Patients and families are paying more, therefore, demand more.

3. Nurse turnover is very high in the med/surg units, therefore, new nurses are frequently hired to this are. When this occurs, expertise is not there - they must learn to expand their clinical skills.

4. Younger nurses have different work ethics than the older nurses. I know this will get everyone's attention - Trust me, I have been a nurse for 29 years, and many of us have seen this first-hand.

5. Med/Surg units are often speciality areas. Ours in: general surgery, othopedic/ urology, oncology and respiratory disorders. Sometimes the patients are "mixed" due to bed shortage, resulting in physicians being angry.

6. Electronic documentation - the thing of this era. Some of the older nurses resist this.

7. Demanding physicians. They want to be waited on hand and foot. Lack of respect.

8. You must be organized. In school the student cares for 2-3 patients, graduated, expect to care for 5-10 patients right out of orientation.

9. Politics.

10. Varied wages from one institution to another one.

Good luck - nursing is great, all you have to have is one patient say a kind word about what you have done for them and sometimes that is enough.

mn nurse · Nov 20, 1999

Ruby,I agree. I especially agree with #4. I have only been a nurse for 10 years, but the unit I started on was staffed by VERY experienced nurses (the next youngest had been there 10 years and most averaged 20-30 years experience). It was neuro/HIV, the care was heavy, and we did primary care (i.e. all care!) for 6-7 patients. Every single patient got a bath, bed change, back rub, ambulated, ward order restored, etc. - just like they taught in school - every day shift and every PM shift. You would NEVER skip a treatment, or leave without updating the careplan and Kardex. It just didn't happen. My manager wouldn't write you up, she would kill you! The amazing thing is, everybody lived up to her expectations, and we weren't feeling abused or unhappy.

[This message has been edited by mn nurse (edited November 19, 1999).]

RN, PA · Nov 20, 1999

I agree with most of what Ruby had to say. And I want to respond to your question regarding the most frequently - occuring diseases/problems I've encountered during my 6-year-old career as a med/surg staff nurse. I just took around 5 minutes to think about the predominant types of patients I care for in a suburban community hospital, & in no particular order my "top ten" list includes: sepsis, GI bleed, cholelithiasis, renal colic (kidney stone), hip fracture, dehydration (often chemotherapy-related), change in mental status, abdominal pain (either of unknown origin on admission or often, pancreatitis), colon resctions (for CA), & last but not least, cellulitis. We also see a lot of DVT's with heparin therapy. Oh, and I almost forgot respiratory! LOTS of pneumonia & exascerbation of COPD! I'm also noticing , in the last year or so, more pancreatitis & other problems related to alcohol abuse, often in patients younger than 40 or 50 years

of age...sad. I hope this is of some help to you- warmest wishes for much success & fulfillment in your nursing career!

Sian · May 8, 2000

I don't know how relevant my views are as I have spent most of my working life as an RN in Australia,in the field of general medical nursing (we don't tend to have combined medical and surgical units. However, clinically speaking,I would like to add that with our ageing population I am seeing a lot more acute-on-chronic presentations. I suggest that it is extremely helpful to have a strong understanding of conditions like congestive heart failure, COPD, diabetes mellitus, chronic renal impairment, degenerative neurological conditions (eg Parkinson's) and peripheral vascular diseases, particularly in terms of how they impact on the client presenting with acute disease (especially sepsis in any form). In Australia I worked on a unit that specialied in the treatment of patients suffering from iatrogenic conditions (including problems of polypharmacy and adverse drug reactions), and this background really makes me aware of the need for preventitive nursing care. especially in the ageing population. I hope this is helpful.

hanging in there · Nov 21, 2006

I'm a nursing student and this past summer I was in a Med-Surg unit for clinicals. All my patients were elderly patients with hip fractures and they had ORIF surgery. It really surprised me how many elderly people have to have hip surgery. I hope that I'll be able to be a good Med-Surg nurse in the future. I just have to get through nursing school first.

General E. Speaking, RN, RN · Nov 22, 2006

On our floor:

1.Pneumonia

2.CHF

3.R/o MI (chest pain)

4.COPD exacerbation

5.R/o CVA

6.Staph infections requiring I&D's

7. AMS

8. Fx hips

9. lap appy's, lap chole's

10. Knee replacments

Organization and prioritizing a must! What bothers me is the turnover rate. Empty a bed, fill a bed, etc.

meownsmile, BSN, RN · Nov 24, 2006

My list pretty much coinsides with RN PA's list. I might add it depends on the type of surgeons you have at your facility. We used to get a lot of new trach's but now our EENT doc doesnt do many of those any more he sends them to another facility. But another doc we have has been doing some lung resections with chest wall reconstructions so we have more chest tubes than we used to have.

We dont have a lot of respiratory patients on our med/surg anymore, they go to the medical floor first and we may get a bit of their overflow if they are getting full. They dont want to fill the surgery beds with pneumonias etc that are potentially contagious.

porterwoman · Nov 26, 2006

Ditto to what you all have said, plus plenty 'o' DM out of control and a-fib with RVR. (not always both together, but then, sometimes they are!)

RNperdiem, RN · Dec 6, 2006

diabetes

COPD

dementia

obesity

pneumonia

sepsis

GI bleed

CHF

chronic renal failure