Soon-to-be New Grad : I Don't Want to Settle for Med-Surg

[Nurse Beth, MSN]

Hi Nurse Beth,

I am a nursing student getting ready to graduate soon with my BSN. I have been an LPN for 6 years. I am starting to apply for GN residency/job opportunities. I know that I like the ICU and hope in 5 years to graduate to an ICU trauma unit eventually. However, I have a lot of nurses tell me to get a medical surgical background. The only thing is I know I do not like having a large patient load of 6-8 patients. The small patient to nurse ratio is of the reasons ICU appeals to me, I feel like I can give better patient centered care.

My question is - I do not want to pass up opportunities, but I also do not want to accept a position as a med surg nurse when I already know I do not like the patient to nurse ratio. In an interview I am afraid this will make me sound like I can't handle it, or am unorganized or have time management issues. How do I make this sound like a positive attribute?

Basically I do not want to settle.

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Dear Don't Want to Settle,

Don't worry about what the other nurses are telling you. You will find strong opinions either way on the "start in Med-Surg or not" debate. Just nod and thank them for their input.

Hiring managers will not judge you for applying to and preferring ICU over Med-Surg. It's very common and everyone has a preference.

The question is, what will you do if you are not offered an ICU position? I would take a hospital position in Med-Surg over no job. You always want a backup strategy, and you can transfer later.

Best wishes,

Nurse Beth

[llg, PhD, RN]

... and in an interview, don't say that the reason you don't want M/S is because of the ratios -- or you want ICU because of the lower ratio. That usually comes out sounding bad no matter how you say it.

You can think it. Just don't say it out loud.

[kbrn2002, ADN, RN]

Nothing wrong with knowing where you don't want to be, just as there is nothing wrong with setting a goal for where you do want to be. Simplest solution is to not apply for any med-surg positions. If you don't apply you will never be put in the position of explaining why you really don't want the job.

Of course there is that possibility that you are not offered a position on any of your preferred units. If that happens would you be willing to apply to med-surg in the hopes of getting your foot in the door? Unit to unit transfers are often easier than getting hired into a coveted unit from outside. If that does happen though, be prepared to work med-surg for whatever the minimum time required before a transfer will be considered. That time will vary depending on hospital policy. You should question what the policy is discretely, maybe ask another nurse you know that works there. Because sure as heck if you ask in an interview how soon you can transfer off the unit your chances of being offered the position just plummeted.

[Mavrick, BSN, RN]

You might want to keep that business about "I do not want to settle" to yourself also. No hiring manager wants to hear some smug new-grad be so dismissive about a perfectly good job. State your preference and eagerness to take on critical assignments and hope they hear your enthusiasm. You will have plenty of time to ***** about other people's jobs when you have one of your own.

I absolutely agree with your preference though. I fell for the sage advice to work Med/Surg first. Though I had worked in the ICU as a tech in Nursing School and was pretty dang sure I wanted a critical care career I did 6 months of Team Leading on an Ortho/Neuro floor. Ick, ick and ick. Quit and never looked back. I did learn to appreciate the advanced organizational skills of a crack Med/Surg nurse though. I never learned to manage 6-8 patients, admissions, discharges, phone calls, docs, aides, visitors, management, etc, etc, etc.

[AngelNeuroICUBSNRN]

I definitely do not think that there is anything wrong with preferring an ICU setting out of school and skipping the "MedSurg foundation". I did a year in Med Surg before getting an ICU job & I feel as though I wasted a year not doing what I truly am passionate about. Kati Kleber is a Neuro ICU RN and on her blog she had someone who wrote a three part series about new grads in the ICU. Definitely try, just keep the Med Surg or Stepdown possibilities in your back pocket if you don't come across that perfect ICU position.

Tips for New Grads in the ICU, ICU Nurse Characteristics. — FRESHRN

[EaglesWings21, ASN, RN]

I have worked Med Surg for 3 years now. My patient load is typically 4 patients with a tech. I have experienced and learned so many new things, I enjoy my job, and even though it is hectic I am thankful for the experiences I have had. I work with patients with countless medical conditions from the age of 18 to 100+. I work with experienced nurses and doctors and ones that are fresh out of school. Eventually I want to do something different, but right now I enjoy what I do.

[LessValuableNinja]

In my area, you could potentially apply for 30+ ICU residencies at 10+ hospital systems and 30+ hospitals. There's nothing wrong with applying to every ICU residency in your area. I know plenty of people who only applied to ICU residencies and now work in the ICU.

[TheGerb, MSN]

It sounds like it isn't necessarily the patient type or tasks of the ICU that appeal to the original poster but rather appropriate staffing levels. There are med surg units that staff appropriately (no more than 4 patients during days/evenings). Apply to a number of different environments, but just say no to hospitals that staff with a larger patient:nurse ratio than you feel comfortable with. I know of worst case scenarios with friends where they ended up carrying a load of 10 in an ICU. Bad staffing happens everywhere.

[LessValuableNinja]

It sounds like it isn't necessarily the patient type or tasks of the ICU that appeal to the original poster but rather appropriate staffing levels. There are med surg units that staff appropriately (no more than 4 patients during days/evenings). Apply to a number of different environments, but just say no to hospitals that staff with a larger patient:nurse ratio than you feel comfortable with. I know of worst case scenarios with friends where they ended up carrying a load of 10 in an ICU. Bad staffing happens everywhere.

I've found 6:1 an appropriate level in med surg. Depends on the unit.

[MomInMotion]

That's one of the great aspects of nursing, something for everyone! I am a new grad and work on a busy med-surg floor and I love it! I felt it was a great place to work on my skills, assessments, documentation, and of course the difficult to grasp prioritization and time management skills! I have been on my own now for just 2 months and am learning so much. It is challenging, stressful, and very demanding. I'm trying to remind myself to embrace the discomfort as it means I am growing. I wish you luck in landing your dream ICU position. Everyone should be happy and enjoy their job. Please try and keep an open mind though when thinking med-surg nursing is settling, it's just different.

Best wishes!

[TheGerb, MSN]

I've found 6:1 an appropriate level in med surg. Depends on the unit.

I normally carry a load of 5-6 on telemetry "successfully," (in quotes because I meet all their immediate needs but rarely have time to do additional education or ambulation for high fall risk patients, more time intensive things that no one will call you out on if you skip but are important at the heart of nursing, etc.) but research does show that every patient over four leads to increased morbidity/mortality even in med-surg.

[vt prn]

You need a better reason than assignment size to focus on when choosing a specialty. While no nurse in any area wants a larger assignment than can be safely managed, calling med/surg "settling" comes across in a negative way both to nurses who work there and the patients that need care on these units.