New Grad Med Surg or PACU?

GHGoonette, BSN, RN · Jan 22, 2011

If I understand you correctly, you are debating which would be the best fit for you, given the fact that you are studying further. As a new grad, and I presume not having had much ward experience during your training, it might be better for you to go with the med-surge offer. That's a pity, because PACU is a really great place to work. But unless you're planning on making a career in a peri-operative setting, I think you should avoid committing yourself to a 30-month contract, especially if it's going to interfere with your studies.

djmatte, ADN, MSN, RN, NP · Jan 24, 2011

As someone who started in PACU as a new grad, I couldn't help but strongly encourage this environment. The only down side is the school issue. I would see if they would be flexible and give you 3 12s to allow you to continue on with your schooling. While most of my floor experience was gained in school and through SNA programs, hearing some of the stories from my former classmates makes me believe that PACU was definitely the right choice for me. There is a ton of faith put in your abilities, but if you are focused and able to learn a lot really fast, it is an excellent choice.

NurseVN · Jan 24, 2011

As someone who started in PACU as a new grad, I couldn't help but strongly encourage this environment. The only down side is the school issue. I would see if they would be flexible and give you 3 12s to allow you to continue on with your schooling. While most of my floor experience was gained in school and through SNA programs, hearing some of the stories from my former classmates makes me believe that PACU was definitely the right choice for me. There is a ton of faith put in your abilities, but if you are focused and able to learn a lot really fast, it is an excellent choice.

I heard it's hard to get into PACU too, that's why it's hard to decide. They can't offer me 12hr shift because everybody is 8 and the hospital wants to remain so. They're both good hospital. PACU one is a Seventh Day Adventist with the new grad versant program. The med surge one is a Trauma I center and magnet Hospital since 2000 with an intensive training program. I'm a quick leaner so I think I can work with both specialites ( I believe med Surge is a speciaty though I'm not a great fan yet). You're right about school. I have about 30 more units of school that requires clinical hours in my FNP program. So your friends did not like med Surge? Is it because of the floor or the people they work with or the hospital itself? Thanks!

GHGoonette, BSN, RN · Jan 24, 2011

Op, after 21 years in PACU, I admit I couldn't face ward work again, so you have to decide which is more important to you-to continue with your studies or go with a job which I'm 99% sure you will be very happy in.

Most nurses I know are so happy in PACU they don't want to move. The rare ones who move out usually do theater technique and go to OR.

I've had students who preferred ward work, so after their stint with us was finished, they went back to the wards, but most of them admitted that they wouldn't mind working full time in PACU. I can't recommend my specialty highly enough, but it's about what YOU feel you need to do now.

NurseVN · Jan 24, 2011

Op, after 21 years in PACU, I admit I couldn't face ward work again, so you have to decide which is more important to you-to continue with your studies or go with a job which I'm 99% sure you will be very happy in.
Most nurses I know are so happy in PACU they don't want to move. The rare ones who move out usually do theater technique and go to OR.
I've had students who preferred ward work, so after their stint with us was finished, they went back to the wards, but most of them admitted that they wouldn't mind working full time in PACU. I can't recommend my specialty highly enough, but it's about what YOU feel you need to do now.

Now I'm more in dilemma :-( Thanks for your input! My goal is to finally become a FNP, will my experience in PACU or Med Surge more valuable?

GHGoonette, BSN, RN · Jan 25, 2011

I still hold to my original statement that the position that offers you more freedom to pursue your studies is the better choice. As the other posters and I myself have said, PACU is an amazing place to work, but with the work hours you describe and the 30 month commitment, you have to decide whether you can afford to take that amount of "time out" from the course you are doing. Alternatively, you will find yourself doing all your studying at night and on weekends.

djmatte, ADN, MSN, RN, NP · Jan 28, 2011

I heard it's hard to get into PACU too, that's why it's hard to decide. They can't offer me 12hr shift because everybody is 8 and the hospital wants to remain so. They're both good hospital. PACU one is a Seventh Day Adventist with the new grad versant program. The med surge one is a Trauma I center and magnet Hospital since 2000 with an intensive training program. I'm a quick leaner so I think I can work with both specialites ( I believe med Surge is a speciaty though I'm not a great fan yet). You're right about school. I have about 30 more units of school that requires clinical hours in my FNP program. So your friends did not like med Surge? Is it because of the floor or the people they work with or the hospital itself? Thanks!

Some of the people I know in our hospital end up with patient loads upwards of 10+ patients on floors that are severely understaffed. IMO this doesn't constitute safe nursing and at that load, you are no longer a nurse and just there to check ID tags as you play catch up with medications. I do have another friend in particular who was working the floor at a different hospital and really didn't like it. Swapped hospitals and shes now working in PACU and couldn't imagine working anywhere else.

As for which you should choose regarding becoming an FNP...You will probably be best off on a regular floor given your circumstances. You have the flexibility for school, you will develop some good round-the clock assessment abilities, and participate in wound care and other patient care needs regarding a multitude of problems they may have. In PACU your general focus is a through (yet fast) head to toe assessment with a huge focus on the surgical site, but not on the long-term goals or care that the person needs. You won't have a lot of time to educate these patients on things they could do in their life to make corrections to stay healthy. You basically treat to the best of your ability to put the patient in a stable spot, but alot of the time its viewed if "the patient was like this preop...thats their baseline".

As an FNP, you'll want exposure to a multitude of meds that treat lots of different conditions, not just the pain meds, breathing treatments, and what you need to sedate a patient. Hate to dissuade someone from this area...but ya know what you want for the long term and should stay focused on it.

meandragonbrett · Jan 29, 2011

The medSurg background I would say would be most helpful to you when it comes to Advanced Practice Nursing.

PACU tends to be extremely fast paced. It's treat `em and street `em on speed. 45 minutes max. It's a revolving door. We often times tend to get tunnel vision and only focus on what's important for that patient at that very minute. We don't treat long term chronic health problems....we treat what is an immediate threat to life or limb and move on.

NurseVN · Feb 3, 2011

Thanks Everyone!!! I have decided to go with Med Surge option because of my long term career goal. It was an extremely difficult decision but I am thankful to have the support from my family, friends and people on this site who are so kind to open my eyes with options! Good luck to those who are job searching and if I can be of any help, read my old posts or contact me :-)

katkonk, BSN, RN · Feb 6, 2011

I think you clearly made the right choice. Med/Surg will definitely help you in graduate studies more. You don't have to do it forever, just long enough to get through school. PACU is very narrowly focused, and you don't get into the medical issues with the patients. You stabilize and move as quickly as possible if going to ICU or the floor, or d/c them as quickly as possible if they are outpatient. There is no doubt you will know you made the right choice on the MS floor. Plus, it will allow you to get to the NP status more quickly as well. Good luck!