Please Help Me Survive Med-Surg

[Nursemeg89]

Okay, so here's my story. I am in my early twenties, and this past November I landed my first hospital job at a small community hospital. I was hired on the hospital's medical surgical floor and have been faced with countless struggles. Please, all those who have experience with med-surg, help me see the light at the end of the tunnel! My floor is chaotic and highly unpredictable. As nurses we are expected to care for up to seven patients at a time and never ever have a night without an ER admission. The patients who are admitted from the ER often come up soiled, with non-functioning IVs, and having major orders "skipped accidentally." The last two nights I've worked I've had to drop NG tubes on patients when they were ordered hours prior in the ER. Under strict budget restrictions, we rarely have a nurses assistant and are left to fend for ourselves. I am working hard to build my skills but feel that there are not enough resources for me to do so. Our charge nurses are forced to take full patient loads and are struggling to get their own work done. I can say that I have learned a lot in past five months, but I am under a tremendous amount of pressure. I often spend most of my days off worrying about my patients. Please- give me some advice to get me through this time in med-surg that most have told me will be "the foundation of my nursing career."

[tokmom, BSN, RN]

First of all, and I have to say this... Med/Surg is more than a foundation. It is a specialty field. I wish more people would recognize this.

With that being said, your ED is passing along garbage care. Are they that busy, that they can't do the NG's etc..prior to coming up to the floor? Do you have a way of seeing the ED orders prior to the pt coming to the floor? Can you write them up for missed orders? Do you have backing from your management team? Something is really wrong with your ED to Med/Surg flow. Until that is fixed, you are going to have really bad shifts.

Where I work, we had a redesign of the ED to Med/Surg flow. Our motto: No passing garbage. If a pt is soiled, abnormal vitals, needing tubes, etc.. it's supposed to be started or fixed in ED. If not, then we have the right to say No to the pt coming to the floor. If a nurse brings the pt up anyway, it gets reported to their manager.

On top of your high pt load, no wonder you have such crap shifts. You and your team need to speak up or you will be miserable until you either leave or it's fixed.

BTW, Med/Surg doesn't have to be an awful place to work.

[Awesomepossum]

My floor is like that too only usually we have 40-46 patients, but only budget for 36 surgical so we end up with 5 nurses on days and 4 at night with 2 aids on days and 1 (if we're lucky) at night. Do the math...very dangerous patient ratios! Everybody is miserable and nurses drop like flies. I"ve been here 3 months and we've lost 5.

I wish somebody would tell me a way to make med/surg not hell but I think it's just the worse speciality! I actually like the surgical patients, y'know the people with problems you can fix, not the chronic med cases. Hate 'em. If I have all surg people I have an ok night shift.

As things are now tho I hear your pain, I hate my job to the point where I have daily panic attacks and actually cry in the car to (And from) work every day. Does it ever end?!

And no I can't get another job in my city. The mega corp I work for owns ever hospital in town but one and won't let you transfer or get rehired with them without a year of exp, only good union hospital doesn't hire new nurses and since it's the only decent place to work nobody quits. They've only posted 2 nurse jobs in a year.

[ICU_JOSIE, MSN, RN]

I feel you. I used to work in a place like that and it's very unsafe. I am based here in California and AB394 mandates 1:5 ratio for Gen MS and 1:2 for ICU. At one point, I had 4 patients in ICU (w/ 1 LVN), the 2nd RN was a no-show and the supervisor just told me to call her when I need help. Luckily 1 fellow RN agreed to come in and do extra. I had all 4 patients for almost 8 hours!

[tokmom, BSN, RN]

Any updates OP?

I hope something better came along and you were able to quit. Seriously, as someone who has worked in a variety of hospitals over the years, med/surg does NOT have to be horrible! You won't believe me until you are able to move on and see for yourself.

[Anna Flaxis, BSN, RN]

Maybe the ED nurses are drowning, too. Maybe they are left to fend for themselves with no or not enough techs. Maybe they are trying to do their best with inadequate resources. Don't let the policies of the PTB pit nurses against each other. I'll bet, if you were to investigate, it's like that all over the hospital, as hospital CEOs try to cut costs to the detriment of patient care, while still receiving their multi-million dollar bonuses.

Don't take it on like the problem is you. It's not.

I see it happening all over the place, and I think it's going to get worse before it gets better. When there is a sentinel event and the hospital is sued by a grieving family for wrongful death, they will up their staffing levels and make corrections so they look like they're being responsive. But eventually, the pendulum will swing the other way once more.

This is what I hate about hospital nursing.