Starting Out on a Medical-Surgical Floor

My personal journey as a nurse starting out as a medical surgical nurse has opened my eyes to reasons as to why nursing teachers always advise students to start out on a medical surgical floor. I'm here to offer some insight into the good and the bad about starting out on this unit.

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Starting Out on a Medical-Surgical Floor

As someone who went through nursing school never wanting to work on a medical-surgical floor, that's exactly where I ended up. Throughout nursing school, I heard every teacher advise everyone to start out on a medical-surgical floor, and I heard almost every student say they never want to work on a medical-surgical floor. I too found it ridiculous, especially since they heard so many voice their opinions against it. Yet I ended up on a medical-surgical floor, and so I have the perspective of someone who both didn't want to originally, did, and wouldn't trade the experience.

I was very lucky to have some amazing people to work with during the year I was on a medical-surgical floor. Most everyone was supportive, helpful, and worked well together, and this really made each shift more enjoyable, even during the hard times. Not every place has this, but I was super grateful and thankful for the people I worked with.

The good, the bad, and the ugly happens on the medical-surgical floor.  With anywhere from 3 to 6 patients a shift, some patients more critical than others, and some patients more time-consuming than others, one never knows what kind of shift they're going to have. It's imperative to have a good CNA when the patient-to-nurse ratio gets high, but unfortunately, that doesn't always happen.  Those shifts were the worst. One had to rely on time management and prioritization to make it through these shifts. It for sure was not a lie that medical surgical floors improve time management and prioritization in new nurses. Though this could easily be learned in other units as well, there is something about medical surgical floor time management skills that are respected across the hospital.

On medical-surgical floors, nurses often have to think for themselves. Often, medical-surgical nurses aren't listened to by doctors and don't often have support systems outside their unit. These nurses are questioned and sometimes even ignored despite their knowledge. I was lucky on my unit to typically have decent doctors, but even still, we struggled with getting what we needed for our patients. We had to learn how to navigate doctors and patients and communicate well.

Medical-surgical floors are not for the weak. The nurses that stick around on these floors become experts in their field. Many other units could not do what medical-surgical floor nurses do, and this is due to harsh conditions, unsafe nurse-to-patient ratios sometimes, lack of CNAs, meaning total care for patients, and a wide range of patients with different needs and different levels of care required. While they aren't always respected, medical-surgical floor nurses are often the backbone of nursing. I believe this is why teachers advise nurses to start out on these floors.

Every hospital has its own set of problems depending on the people and the way they are run. It's important to scope out some of these problems during the interview process and determine what they are willing to deal with and what they aren't. This applies no matter what unit a nurse plans to work at.

Not everyone needs to start out on a medical-surgical floor. Many units are so different from medical-surgical floors, and not every nurse would do well on a medical-surgical floor. I was lucky enough to have such a wonderful team by my side that I was able to learn so much through my experience. I'm glad to have started out on a medical-surgical floor, and I think it's important for nursing students to have an open mind about starting out on a medical-surgical floor.

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Jessica Carter

About Jessica Carter

I have been a nurse for just over a year. I have recently switched from being a medical surgical floor nurse to an ICU nurse. While I am happy to now be in a unit that I wanted, I look back fondly on my medical surgical experience.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

My first hospital experience was a med-surg floor (after I worked in long-term care). I think it was the perfect place for me to start my hospital experiencefor many of the reasons you mention. I am still and always will be in awe of a few of the 25+ year nurses on the floor that just seemed to glide through their day. With patients that were always clean and up in the chairs, they seemed to be able to attend to every need or request and still manage charge and supporting other nurses. They are truly amazing!

With the variety of patients and conditions on the floor I became familiar with the tests, medications and treatments for many conditions. It's a great place to meet the other team members because so many people are involved in care. And learning how to juggle a 5-8 patient assignment (on night shift), definitely taught me time management and prioritization. I have fond memories of my time working there and my coworkers. I picked up per diem for a few years after I transferred to the ICU. And I still get floated on occasion and will always volunteer to see my friends on the med-surg floor. 

It gets a bad rap, but there can be so much to learn, I think it's a great place for nurses to start, and maybe stay. We need nurses there as much as anywhere. 

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Specializes in CRNA, Finally retired.
On 12/13/2022 at 7:06 AM, Jessica Carter said:
As someone who went through nursing school never wanting to work on a medical-surgical floor, that’s exactly where I ended up. Throughout nursing school, I heard every teacher advise everyone to start out on a medical-surgical floor, and I heard almost every student say they never want to work on a medical-surgical floor. I too found it ridiculous, especially since they heard so many voice their opinions against it. Yet I ended up on a medical-surgical floor, and so I have the perspective of someone who both didn’t want to originally, did, and wouldn’t trade the experience.

I am now retired but was always grateful for my med surg background in the beginning. It really is a foundation for any specialty and deserves more credit for the intellectual rigor it requires.

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Specializes in School Nursing.
On 12/13/2022 at 7:06 AM, Jessica Carter said:

The good, the bad, and the ugly happens on the medical-surgical floor.  With anywhere from 3 to 6 patients a shift, some patients more critical than others, and some patients more time-consuming than others, one never knows what kind of shift they're going to have. It’s imperative to have a good CNA when the patient-to-nurse ratio gets high, but unfortunately, that doesn’t always happen.  Those shifts were the worst. One had to rely on time management and prioritization to make it through these shifts. It for sure was not a lie that medical surgical floors improve time management and prioritization in new nurses. Though this could easily be learned in other units as well, there is something about medical surgical floor time management skills that are respected across the hospital.

I totally agree with this. I also think that going to a med-surg floor first allows nurses to hone their critical thinking and assessment skills. You see everything and anything on these floors, and will learn so much. I always recommend a good couple of years of med-surg experience to new grads for these and the above reasons.  I believe once you have this experience under your belt, you are prepared to go anywhere and do anything. 

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I am glad you mentioned one factor that is overlooked in success and survival on med-surg floors: the CNA. On days I had a strong, compassionate, hard working CNA assisting with patient care, my job became so much better. The patient population we had on my floor made caring for 6 patients with mobility issues who were not independent in ADLs, pretty much impossible to care for without the CNA.

I might have stayed longer in med-surg if I consistently had that level of support. Unfortunately, CNAs are often pulled for staffing, pulled for sitter cases, hiding out somewhere, out on perpetual smoke break or otherwise unavailable. 

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Specializes in CRNA, Finally retired.
2 hours ago, RNperdiem said:

I am glad you mentioned one factor that is overlooked in success and survival on med-surg floors: the CNA. On days I had a strong, compassionate, hard working CNA assisting with patient care, my job became so much better. The patient population we had on my floor made caring for 6 patients with mobility issues who were not independent in ADLs, pretty much impossible to care for without the CNA.

I might have stayed longer in med-surg if I consistently had that level of support. Unfortunately, CNAs are often pulled for staffing, pulled for sitter cases, hiding out somewhere, out on perpetual smoke break or otherwise unavailable. 

That's just bad management at work when ancillary help is unavailable.  It would be wonderful if CNA's could exclusively be harvested from nursing students!

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When nurses at the hospital I was doing clinicals at last year started telling me that 8 patients was the new norm with mandating every week, I instantly said "not for me." No, and hell no. I’m too physically disabled and old to wreck what is left of my body and risk my license over the penny pinchers in charge of hospitals squeezing every last cent they can out of nursing staff willing to be abused by unsafe staffing practices. 

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Specializes in OR 35 years; crosstrained ER/ICU/PACU.

I knew during my 6 weeks OR rotation in college (not just 1 day observing, as is common now)that I wanted to be an OR nurse.  However, starting out as a new GN at a community hospital, I took the job I could, just to get my foot in the door.  It was on a surgical floor, 3-11 shift.  It was great as far as getting to know the surgeons (& they got to know me) for the 1st 5 years of my 40+ year career.  Inpatient surgical care in the 70’s & 80’s was different, as patients were admitted the night before surgery for pre-op care & preps, & stayed several days post-op.  Same day outpatient surgery wasn’t a thing yet.  My 5 years were full of many challenges, all types of specialties, & many emergencies.  My skills were well-honed, I was able to prioritize & organize quickly.  I had a great rapport with our docs: they knew if I called, it was for good reason, & they listened to my thoughts & suggestions.  I was ACLS certified & could run a code with the best ET or ICU nurse.  When I switched to the OR, all of those skills still came into play, especially still working the 3-11 shift, with fewer staff available for help on a bad trauma, ruptured aneurysm, brain bleed, etc. Those basic skills that I built upon starting on a surgical floor stayed with me iver 35 years of OR nursing.  Technology changes, but fundamental tenets don’t.  Getting some basic principles & training on a med-surg unit will give you a good foundation on which to improve your nursing practice.

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