Medical vs Surgical Nursing

alibee · Sep 10, 2012

I can provide some input into surgical nursing. The majority of my patients fall into four categories: Surgical/Oncology (ie: masectomies, ostomies, thoracotomies, etc. related to cancer diagnosis), vascular surgery, bariatrics, and every other surgery is lumped into General Surgery. I also see a lot of potential problems that could escalate into surgeries (ie: partial bowel obstruction). My wound care skills are pretty awesome at this point. Med passes aren't terrible unless a patient also has high blood pressure/blood sugar issues (usually just lovenox/heparin, protonix, colace, and pain meds). You manage a lot of chest tubes, NG tubes, and drains of various types. I occasionally get people with DVTs who need a heparin drip. I don't see a lot of trachs. But for the most part, you help get your patients recovered and ready to go home, while monitoring for any potential post-op complications (Is there an infection? If they had their gall bladder taken out, is there a bile leak?).

"Ideal" day goes:

- Get there a little early and check 6am vital signs and patient summary.

- Get report

- Quickly go into each room and introduce yourself, check pain levels, and make sure your patient is breathing Let them know you'll be in soon to see them. Do blood sugar coverage as needed for breakfast.

- Check labs and orders while pharmacy restocks the omnicell between 7:30 & 8:00.

- Assess your patients and do your morning med pass. Make sure lines are patent by flushing, check your dressings, wounds, and drains.

- Discharge rounds with the MDs/NPs, home care, PT, pharmacy, and social work, where you update them on patient progress, figure out who needs consults where, and approximate discharge date.

- Chartchartchartchartchart.

- Lunch insulin coverage. Review labs, orders.

- Afternoon med pass

- Dinner insulin coverage

- ALWAYS check your patients pain levels, but be sure to do it around 6:00 pm so they're okay during change of shift. Hang new bags of fluids for night shift so they don't hate you.

In addition to this, you'll be juggling patients on the call bell needing everything from pain medications (after surgery, patients HURT!) to assistance getting up to the chair/to the bathroom/etc. A lot of patients will be very anxious and need more education/reassurance. You'll have admissions and discharges throughout the day because surgical patients usually don't stay long unless it's a major surgery or there are complications. You become a master of multitasking as a surgical nurse.

The downside? Dealing with gods--I mean, surgeons. (actually tbh, they're pretty good at my hospital--especially the residents). Hopefully someone else can come on here and give you a medical nursing perspective -- I'll get the occasional stage IV bedsore overflow onto my floor, but it's rare.

RNewbie · Sep 16, 2012

I agree with the points the previous poster pointed out. I've worked on all kinds of med/surg floors and my fav are floors that are strictly surgical. Some floors have a mix so you can end up with pts with medical probs and pts who are post op. With surgical pts you are mainly concerned with pain management and wound/surgical site assessment. Medical pts tend to have a lot of comorbidities with a lot of meds and treatments. I would choose a surgical floor over medical any day. I just enjoy it more.

misscherie · Sep 17, 2012

Thanks for your feedback! Do you have a whole range of different surgeries rather than a common one?

Any med ward people care to comment? :-)

Thanks so much again :)

aboucherrn · Sep 19, 2012

I am a medical-surgical nurse who is more comfortable with medical patients. I enjoy surgical patients for the reasons the other posters listed (I can't tell you a lot about ortho, though). I have a special place in my heart for geriatric and pulmonary patients, so medical nursing is a great place for me.

Medical patients typically have chronic conditions, unlike the acute surgical patients, which means you will be giving them a LOT more medications. You will see patients with diabetes, CHF, COPD, cellulitis, renal failure, UTI's, pneumonia, GI bleeds, dementia, etc. Sometimes one patient will have all of these problems at the same time. Ha ha.

In a large hospital you will find more specialized medical and surgical floors, but in smaller hospitals there is more of a mix depending on what units have beds available! Good luck with your choice :)

Jw1724 · Sep 26, 2012

I work on a surgical specialty floor. We don't do purely medical unless there's a good chance they'll end up surgical. But we do also take traumas with chest tubes.

I spent a day in the OR with a surgeon when I first started and he told me "you work on a sophisticated units. lots of us surgeons would rather send our sickest patients to your unit than to the ICU." And maaaan do I believe him now haha.

We specialize in urology and GI for the most part. LOTS of urology and GI. But also do plastics, trauma, vascular, etc.

I work evening shift which is busybusy because lots of postops are coming up. We range from lap appys to bladder augmentations to fempop bypasses, masectomies, prostates, bladder slings, hernias, amps etcetc. Always changing and ALWAYS interesting.

PediLove2147, BSN, RN · Sep 26, 2012

I too work on a surgical floor but we also get neuro and trauma so not strictly post-op. Our hospital has two surgical floors so our floor sees neurosurg, ENT, urology, and gyn while their floor sees vascular, bariatrics, and general surg. We hardly ever see medical patients and when we do they get transferred pretty quickly since the docs are lazy and hate coming to another floor to check on the pt! Evenings are VERY busy because like Jw1724 stated that's when everyone is coming out of the PACU. You will give a lot of narcotics, pain is usually the biggest issue post-op. Oh, and Heparin, you give a lot of it. I am so sick of drawing that stuff up! How about a Heparin pill, can that please be invented. I don't even know if it's possible but I want it!

I much prefer surgical, since like past posters have pointed out, they come in and generally leave well but I probably would have chosen a medical floor if given the chance just because I didn't have experience in anything else. I am glad I wasn't given a choice though because I think I would have hated it, haha. Have you been offered both jobs, if so can you shadow, see the kinds of patients they take care of? Did you do clinicals on either type of floor, what kind of pt did you like then? Good luck!

Willowdean, BSN · Jul 13, 2015

I'm kind of late to this thread. . . but thank you all for your insights about med and surg nursing! I was just offered a choice between a post-surg unit and an oncology unit, and I have been agonizing over trying to make up my mind. (I am graduating in August, so I don't have much experience of my own on which to base my choice). I think I will choose post-surg, based on your descriptions. If anyone has experience on both a post-surg floor and an oncology floor, I sure would appreciate to hear your thought on it as well. :)

NurseKatie08, MSN · Jul 13, 2015

I work on a transplant med/surg unit. We see everything from end stage liver disease (lactulose enemas abound!) & end stage renal disease listed for transplant to post liver and kidney transplants (both live and deceased donors), donor hepatecomy and nephrectomy, Whipple procedure for pancreatic cancer, colorectal medical patients (crohns and colitis flares) and colorectal surgical patients (new ostomies, etc), gen surg patients (appys, choles, thyroidectomies) to a smattering of standard medical patients (pneumonia, uti etc). It's a great floor to work on and always exciting.

CT Pixie, BSN, RN · Jul 13, 2015

I work a specialty surg floor but we do get medical overflow pt (if a pt needs a bed and we have one, we get it regardless of their dx.).

Give me surgical pts anyday. Main focus of my pts is pain control, pain control, pain control. :) We do a lot of surgical wound assessments making sure everything is where it should be, no profuse bleeding, neuros intact etc. Of course our surgical pts have medical issues but they are chronic, not acute. I dread weekends as our surgeons don't do any over the weekend so our census is low and we get the medical patients.

I have no real experience in oncology. I have gotten a few patients who went to the ED for whatever reason and ended up finding out they have a mass and/or cancer and they are admitted to our floor until an onc bed opens up (again..over the weekend).

RedInScrubs, ASN, RN · Jul 22, 2015

I've worked both. I actually started on a general surgical floor, though it took medical patients by nature of the need for overflow. Surgical tends to be divided into a few different specialty areas, depending on the hospital. Ours has general surgery (cholecystectomy, appendectomy, bowel resections, urology, nephrology), ortho (knee/hip replacements), neuro (spinal), cardiac (CABG, stents, vascular), and oncology.

Our specialty floors like general surgery will still take medical patients (pneumonia, electrolytes, dehydration, etc.), but if for instance we have someone with cholelithiasis come from the ER, they'll go to the general surgery floor first. And patients that are post-op from knee replacements will go to the ortho floor. Oncology takes a lot of general medical conditions, mostly it seems because if a patient has a current chemo regime at home but are there for a medical condition to be treated like pneumonia or PEG tube replacement, they will go to oncology even if it isn't for the cancer treatment specifically, because the nurses there are infusion-certified and the floor is usually better equipped to handle specific precautions geared towards cancer patients.

I've also been in float pool, and all our specialty floors that focus on specific surgical interventions also take general medical conditions if the beds are available or the need for overflow occurs, but they will prioritize beds for the specialty floor and move patients based on need for beds. A lot of our surgeons prefer the ability to just be on one or two floor for their given focus, rather than running around the entire hospital all day.

Fancypants09 · Oct 9, 2015

Reviving this thread!

I have been invited for an interview on a surgical oncology floor, and I intend on asking my interviewers about orientation for new RN graduates (I'm a new grad). If someone can shed some light on this, what is the typical orientation period on surgical units? What orientation periods have you personally had? Thank you!