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 :)
Don't get me wrong - having vents on a "med-surg" unit is pretty crazy - but there's a HUGE difference between a wean/failure to wean with a trach and someone with an ETT with huge FI02, huge PEEP, and completely dependent on control modes.
As for the "septic" patients, these patients may have SIRS, but I assure all of you a patient in true septic shock isn't going to fly on the floor.
Right. First it was m/s doesn't have vents, now it's vents are okay as long as the FiO2 is below a certain level. This illustrates perfectly how the acuity level in m/s is creeping up. The frog will be boiling shortly, but as long as ICU nurses can still feel superior to m/s, why not.
As far as real sepsis vs not - real sepsis, I'll try to remember that it's all not real when the admitting and attending physicians put "x in the setting of sepsis" as the working diagnosis. As one could note, I DID say that if they require pressors or develop anything near ARDS they're gone.
Amazing how many nurses work to downplay the acuity and complexity of m/s.
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.
If only it was possible to transfer some of these patients, but we are able to effectively manage and handle them on the floor. We are typically on divert with ER full and ICU slammed. Insulin drips do have policy and protocols but are manageable on the floor. Full blown sepsis based on acuity would get transferred if need be. And I don't know what CIWA patients you have had but scores of 45 and up are not exactly easy. All depends on the hospital and what you are trained and certified for. Different perspectives make for diversity in nursing which is great.
"not appropriate for med/surg" is very vague. It depends on a lot of different factors and it is largely facility dependent. At my first hospital, IV chemotherapy, insulin drips, CAPD, and CBI were totally floor appropriate. At my current facility? Not so much. However, what is appropriate is anything not intubated or sedated or on a cardiac, insulin, or diuretic drip. Everything else is fair game. I held a patient on our unit (who was a recent MICU transfer) for a full week when she was rapid responded up to twice a day simply because "ICU will not do anything differently for her than you will do here." The nurse-to-patient ratio and hours of care required by the patient means absolutely nothing in the grand scheme of deciding if someone needs the ICU or not. And sometimes, "stable" is debatable depending upon who you talk to. This is why each floor needs a set of standards of the types of patients they are and are not capable of taking care of.
That is exactly how our hospital works. W capable of and expected to care for these patients. At my past hospital it was completely unheard of and unimaginable. A patient with sepsis or even suspected sepsis was off to the unit. With a high volume high traffic hospital the bed needs to stay empty for a more critical pt. Different hospitals have different expectations for sure.
Great thread, but appears to be digressing from OP's original thesis.... the reality of nursing versus the idealized perception of many students. I really enjoy the input from experienced MedSurg nurses.... a definite specialty.
Hope everyone realizes that in 10 years time, nurses will be referring to this as "the good old days".
You should come talk to our house manager then. I'm on a M/S floor. We take vents, insulin gtts, Cardizem gtts, heparin gtts, full blown septics, suicidals, Lasix gtts, tele pts, post surgicals, post transplants POD 2 and on. Dialysis pts, bipaps, etc. M/S may have been less acute before, but it is ratcheting up fast. This *is* my specialty. I initially thought I wanted critical care, but I am slowly and surely coming to appreciate the complexity and opportunity from my floor.
I don't think it's the acuity. It's the ratio.
Sounds familiar. We start taking Tele patients next year and already have the drips as well. You'll never stop learning on medsurg these days
Right. First it was m/s doesn't have vents, now it's vents are okay as long as the FiO2 is below a certain level. This illustrates perfectly how the acuity level in m/s is creeping up. The frog will be boiling shortly, but as long as ICU nurses can still feel superior to m/s, why not.
As far as real sepsis vs not - real sepsis, I'll try to remember that it's all not real when the admitting and attending physicians put "x in the setting of sepsis" as the working diagnosis. As one could note, I DID say that if they require pressors or develop anything near ARDS they're gone.
Amazing how many nurses work to downplay the acuity and complexity of m/s.
If they're not requiring pressors, then they most likely aren't in septic shock. Anyone who has dealt with the true hot mess that is sepsis understands the distinction between SIRS on the floor that may be labelled sepsis and actual septic shock.
I never said only ICUs have vents. I have never heard of a true med-surg floor taking vents, but I have seen PCUs with 4 or 5 to 1 ratios take stable vents. Just because your facility does something doesn't make it appropriate for med-surg, safe, or the norm in med-surg units generally.
I never said only ICUs have vents. I have never heard of a true med-surg floor taking vents, but I have seen PCUs with 4 or 5 to 1 ratios take stable vents. Just because your facility does something doesn't make it appropriate for med-surg, safe, or the norm in med-surg units generally.
Ah, well that makes it all better, doesn't it? I'm either not a safe nurse (because I won't refuse what you consider an unsafe assignment), or my floor isn't a "true" med-surg floor.
Look, I'm not going to continue arguing with you over whether or not M/S nurses can "handle" vents, sepsis, yadda-yadda. I'm reporting what we have on floor. My name tag says "Med-Surg" right on it.
As a recent new grad, I was shocked and confused about a lot of things, including lack of support from management about pt ratios, the common dream that 6 weeks is enough training time, that we are all just one big professional team. No, not all doctors think nurses are an integral part of the care team.
The one issue that has been the hardest for be to adapt to: I am responsible for 99% of a pt's care. Lab screws up? My problem. Dietary loses a tray/gives wrong diet/late with food? My problem. Coordinating with CT/MRI/XRAY/IR? My problem, and if they're screwing my pt around with imaging or times or contrast it's my problem, and if the doctor(s) get wind it's my problem x2. I never realized in nursing school that I'm the last stop, I'm at the bottom of the hill, and it all rolls down. No one warned me about HOW MUCH rolls downhill!
Ah, well that makes it all better, doesn't it? I'm either not a safe nurse (because I won't refuse what you consider an unsafe assignment), or my floor isn't a "true" med-surg floor.
Look, I'm not going to continue arguing with you over whether or not M/S nurses can "handle" vents, sepsis, yadda-yadda. I'm reporting what we have on floor. My name tag says "Med-Surg" right on it.
As a recent new grad, I was shocked and confused about a lot of things, including lack of support from management about pt ratios, the common dream that 6 weeks is enough training time, that we are all just one big professional team. No, not all doctors think nurses are an integral part of the care team.
The one issue that has been the hardest for be to adapt to: I am responsible for 99% of a pt's care. Lab screws up? My problem. Dietary loses a tray/gives wrong diet/late with food? My problem. Coordinating with CT/MRI/XRAY/IR? My problem, and if they're screwing my pt around with imaging or times or contrast it's my problem, and if the doctor(s) get wind it's my problem x2. I never realized in nursing school that I'm the last stop, I'm at the bottom of the hill, and it all rolls down. No one warned me about HOW MUCH rolls downhill!
Frankly, I won't argue with you because you don't know what you're talking about, and I'm not even sure I actually believe you.
Frankly, I won't argue with you because you don't know what you're talking about, and I'm not even sure I actually believe you.
I assure you on many a MedSurg unit, this exact thing is happening.
My former sister unit has 2 vent beds available. As a result, all nurses must now attend vent training, and subsequently be responsible for all the other MedSurg nonsense.
CountryMomma, ASN, RN
589 Posts
Right. First it was m/s doesn't have vents, now it's vents are okay as long as the FiO2 is below a certain level. This illustrates perfectly how the acuity level in m/s is creeping up. The frog will be boiling shortly, but as long as ICU nurses can still feel superior to m/s, why not.
As far as real sepsis vs not - real sepsis, I'll try to remember that it's all not real when the admitting and attending physicians put "x in the setting of sepsis" as the working diagnosis. As one could note, I DID say that if they require pressors or develop anything near ARDS they're gone.
Amazing how many nurses work to downplay the acuity and complexity of m/s.