Profession for some...attempted by many..

[jdruds]

The number of new grads who are already contemplating leaving the profession is something that has blown my mind on these threads. Going into nursing school we had fair warning about how difficult of a career it was going to be; the patients who are so thankful for bringing everything when they demand it, the pleasures of dealing with stubborn doctors, the glorious hours, the emotional stress of seeing what we do on a daily basis, the coworkers who always go out of their way to help us. Do people think that we are kidding or that the professors are trying to scare you”? They aren't. Nursing is challenging in every way which is why it is so rewarding. If you have never been challenged in your life, then this will be the most challenging step of your life. But persevere. Stretch yourself. Be patient. And be willing to grow.

Going into the first job we had been prepared (as a BSN student) that finding a job was not a cake walk. Only applying to the L&D jobs or OR jobs is no realistic and I do not understand where these ideas are coming from? Med-surg experience is indispensable regardless of the career path you are on. Prior to applying to my first RN job I got my ACLS and PALS to be marketable and because I am a firm believer in knowing more than you may need for your job description. Though my dream job may be ER nursing one day, I knew that my ideal out of school was med-surg.

I started working on a med-surg floor that is the dreaded unit of the hospital.” Float nurses come to the morning huddle already defeated and frustrated. We have patients in full-blown sepsis, suicides, behavioral health, post-surgical overflow, and everything in between. Just the other day I had a thrombocytopenic patient on the verge of DIC bleeding from every orifice. We do insulin drips, IGA infusions, chemo meds, CIWA protocols, sepsis management, you name it. This is NOT to say that I have it harder than anyone else and you all should be ashamed of yourself.” This IS to say that you can do it and should build your knowledge base. At least for 2 years. You will have a competent base to make a solid decision about furthering your career path and figuring out where you truly want to end up.

NP your calling? Great, how many patients did you actually spend time caring for? CRNA? Awesome, but do you know what happens after they come off of the anesthesia that you administer and pass onto the floor? 6 months is not enough time to be competent in your skills or communication abilities. If you are reading this and want to go to nursing school, do it!! But be realistic and know that it is a JOB. You get paid to deal with literal and figurative poop; from people and coworkers. If you think that nursing is where you can make people feel good all the time, you can't. You are going to be wrong, you are going to handle more than one situation wrong and wish you could have done it differently, you are going to be reprimanded for not calling out report before transferring a patient or not introducing yourself to the patient with your first, middle, and last name....the list goes on and on. You have to find a way to LEAVE IT AT WORK. The emotions you'll take home on some days but find a support system or an outlet. Realize that life is life. We have a huge responsibility of managing people's lives. If that gives you anxiety reading that maybe this isn't the career for you. Not harsh, just honest.

You have to have a backbone, you have to compartmentalize, and you have to realize that it is a job; you have a salary, some sort of insurance (though every healthcare worker has some complaint about their coverage), and you are helping people whether it is appreciated or not. If someone talked you up telling you that you have the personality of a nurse.” That is not good enough. Not everyone can do this profession. Not everyone was built to be a nurse. The nicey nice people pleaser is not going to make it at bedside nursing (Let me tell you, you can be nice, but if you don't have the skill to manage my dropping BP as your patient or recognize changes in cognition level, I sure as heck don't want you as my nurse. We can be friends outside of the hospital.) Covering up incompetence with being overly polite does nothing for your patients. I have seen nurses burn out because of that stubborn old man with CHF who cuses her out. It's ok to have sarcasm with patients and to reinforce the facts of their diagnosis. Our job is to get them better, not become their best friends….Rant over.

Please please please reevaluate how much stress you have been able to handle and how easily your feelings are hurt. Otherwise you will become another statistic in the first 6 months of your nursing career; sad but a cold hard fact. Nursing is a respected profession that many seek out. However, the reality is that only some have the personality and realistic perspective to make it a career. Those blunt, honest, and knowledgeable nurses are the ones that I would want if I had to be hospitalized. Not the nurse who wants to befriend me while dodging questions as to whether my test results came back and the risks of the new medications I am starting. Buyer beware. I love nursing because I was not jaded when I came out of school in the least. I knew exactly what I signed up for….Nursing students, do your research on what you are going into. If you have been reading many of the threads and they are scaring you, this is NOT the career for you. As crazy as they sound, they are accurate :)

[ThePrincessBride, MSN, RN, NP]

I agree with most of your post. However....

Going into nursing school we had fair warning about how difficult of a career it was going to be

;

Until one starts working as a nurse, he/she can't fully comprehend or experience how difficult nursing is...that is why I get a chuckle out of all these nursing students who try to nurses how it is or should be.

Going into the first job we had been prepared (as a BSN student) that finding a job was not a cake walk. Only applying to the L&D jobs or OR jobs is no realistic and I do not understand where these ideas are coming from? Med-surg experience is indispensable regardless of the career path you are on. Prior to applying to my first RN job I got my ACLS and PALS to be marketable and because I am a firm believer in knowing more than you may need for your job description. Though my dream job may be ER nursing one day, I knew that my ideal out of school was med-surg.

I am going to go against the grain and say that med-surg experience is completely overrated. You can get all the basics down and so much more in other areas of nursing. Med-surg isn't the end to be all. In fact, I encourage all new grads who KNOW what they want to do to pursue. Life is far to short to be in misery.

And in some specialties, med-surg experience doesn't translate well at all. I want to work with neonates...NICU is its own world...med/surg has been a hinderance and I am looking to get STAT.

I started working on a med-surg floor that is the dreaded unit of the hospital.” Float nurses come to the morning huddle already defeated and frustrated. This IS to say that you can do it and should build your knowledge base. At least for 2 years. You will have a competent base to make a solid decision about furthering your career path and figuring out where you truly want to end up.

Med-surg units are known for being the dumping ground in many areas of nursing and for good reason. My unit in particular gets the least desirable, most difficult and noncompliant patients in the system. After awhile, it gets tiring having to deal with adults who behave worse than toddlers.

Two years of this crap? No thanks. If one can make it a year, good for the them. But I encourage people to pursue their goals and dreams. A wise man once said that the person who finds something he or she loves and it pays well, that person will never work a day in their life again.

Granted, not everyone will find something they LOVE or even like, but some fields are much better than others...

As for the rest of your post, I agree with it. Though at seven months, I am ready to jump ship. I hope to be out of med/surg by my one year anniversary and into dream specialty.

[RNperdiem, RN]

The trade-off nursing made when it moved from an apprenticeship/hospital based system to an academic world is the reality shock of new grads.

[Horseshoe, BSN, RN]

NP your calling? Great, how many patients did you actually spend time caring for? CRNA? Awesome, but do you know what happens after they come off of the anesthesia that you administer and pass onto the floor? 6 months is not enough time to be competent in your skills or communication abilities.

Unless something has really changed recently, this isn't even an issue for a CRNA. Most schools require one year of ICU at minimum (many require at least 2), and every CRNA I work with (and I work with a lot) spent well over 2 or 3 years in ICU before even applying for CRNA school. Given that most new grads don't go straight into ICU from nursing school, many CRNA students have years of experience under their belts before they even set foot in CRNA school. I think they have a pretty good idea of how patients do once they are out of the OR or other procedure.

[jdruds]

Unless something has really changed recently, this isn't even an issue for a CRNA. Most schools require one year of ICU at minimum (many require at least 2), and every CRNA I work with (and I work with a lot) spent well over 2 or 3 years in ICU before even applying for CRNA school. Given that most new grads don't go straight into ICU from nursing school, many CRNA students have years of experience under their belts before they even set foot in CRNA school. I think they have a pretty good idea of how patients do once they are out of the OR or other procedure.

That is great to hear. Just an advocate of knowing the entire POC and how each profession ties into the next. Like who the patient is after they're off intubation and transferred out of the ICU.

[applesxoranges, BSN, RN]

If the patients are in full-blown sepsis, then they are not appropriate for a med-surg. If they are septic per some piece of sheet, then that is a different story. We have "septic" patients that are septic per protocol but not what we would consider septic traditionally. Per the new protocol sheet we have, about 80% of the patients we see are septic but we are not going to do a full sepsis work up on them (nursing home patient is one criteria per the sheet).

Suicides/behavioral health? Those can differ greatly in terms of what they are. Insulin drips generally should not be going to med-surg and should go to a stepdown just due to how often the protocol needs to be done. Chemo meds should be done by a chemo certified nurse. CIWA protocols are generally done initially on every patient and that one seems easy.

One concern is that either your floor is a dumping ground or they could potentially be sending you inappropriate patients. One good thing is when a nurse knows not to play heroics and knows when to ask for help or when to transfer a patient. If the patient is not appropriate for med-surg, then the nurse needs to be able to able to get the patient transferred to a higher level if necessary.

[Everline]

Two years of med-surg? Hey, if you like it, I love it. Only not for me. I'm in my seventh month and I am saying goodbye to go do the type of nursing I went to school to do. I say if med-surg is going to help you get to your goals or it's the specialty of your dreams, then go for it. But I don't believe everyone has to start there or that everyone would benefit from starting there, let alone enduring it for two years when their heart is somewhere else. I think it's important to know where you want to go and take the steps to get there. The steps will not be the same for everyone.

[Steve_e]

Haha this is kind of an interesting post. I more or less agree with the OP. Med/Surg is really the most well rounded "see all you can" area to really get a good, extensive knowledge base. The people who have been on a med/surg floor for under a year and are ready to move on are kind of interesting. When I started on the med surg floor I work on now out of my ADRN program I literally dreaded it every day. Not because I didn't like it but because I was scared, and there is SO Much to learn! You feel like everything is falling or collapsing around you yet you don't wanna look weak and call uncle so you just muster it up and figure it out! But, that is just me. I wasn't "anxiety free" going to work til I would say about 18 months on the floor. Even now 4 years later, do I know everything, HELL NO! But I know who to go to, who to call, if sh*t does start going down, and much of what I feared when I started I have learned to handle myself. Handling things yourself and becoming competent is what med/surg does for you. I went on for my RN,BS, and now I am in NP school. To the OP, any NP school that is taking people w/ 6 months of med/surg or ANY experience is kind of silly. My program required 3500 hours to even apply, which works out to around 2 years.

Steve E, RN,BS

[joanna73, BSN, RN]

I had valuable med surg experiences all through 4 years of nursing school. I'm glad I had the rotations, but there is no way I would have lasted 2 years. No thank you.

Instead, I worked LTC and palliative in various roles. I've enjoyed my work and I know I would have detested med surg for any length of time. Everyone is different.

[RescueNinjaKy]

There are too many people who go into nursing for no other reason than just because. Many think it's a cushy job with great stability and excellent pay. Well, now they know it's not and they're getting out so I say good riddance. Just like how nursing school was designed to herd out people, the first new grad year is also. Some people persevered and go on and some don't.

Personally I went straight to a cardiac step down floor and I really liked it. I knew from the start that med surg was not my desired unit and I was willing to take whatever but hey if I can get what I want from the start, I'm gonna go there for sure.

[nutella, MSN, RN]

I think there need to be different path for new graduates to accommodate different personalities and learning styles. I agree that the hospital based program provided more hands on experience with a different focus on real life nursing. But since nursing is now usually tied to an academic program for RN the profession needs to find out how to transition nurses into practice after they graduate. I like residency programs that are getting more common now but the fact that some of them do not pay enough to enable new nurses to pay off their loans is a problem. While med/surg is great for some nurses and they benefit from getting the experience, it is not the ultimate experience one needs. If you work on med/surg in a large busy teaching hospital of course your level of business and acuity is different from a med/surg floor in a small community hospital. I have seen nurses start in long term or acute long term care after they graduate and later transition to a different position - they were well prepared as well. There is no one size fits all. Perhaps some career counseling for nursing students would be great so they can explore their personality type, what their goal is and how to find an initial setting that encourages them instead of making them want to drop out after a short time. If somebody is 100% sure that psych nursing is what they want to do why drag them through med/surg is that is not their goal anyways? Just because it used to be the "gold standard" of getting initiated into the nursing profession does not mean it has to stay this way....

I agree though that if you tend to be very sensitive and take things personal easily, nursing may be difficult.

[nynursey_]

I'd like to kindly remind everyone that Medical-Surgical Nursing *is* a specialty. And there are those of us that choose to continue to specialize in it.