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The Case Against Med-Surg!

Students Article   (36,187 Views 56 Replies 736 Words)
by jb2u jb2u, ASN, RN (Member) Member Nurse

jb2u has 5 years experience as a ASN, RN and specializes in ICU, ER, Hemodialysis.

1 Article; 10,980 Profile Views; 862 Posts

Imagine finally graduating from nursing school and being miserable for a whole year. Everyone should spend their first year in Med-Surg, or should they? This article attempts to offer an alternative to the belief that new nursing graduates should spend one year in Med-Surg before going on to something else. You are reading page 3 of The Case Against Med-Surg!. If you want to start from the beginning Go to First Page.

babyNP. has 11 years experience as a APRN and specializes in NICU.

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No one would debate that a year of ICU experience, rather than a year of med-surg experience, somehow doesn't prepare you for a future in another specialty. Just my 40 years of observation, but a year of OB does not prepare you to care for the patient that happens to bleed out or code on the OB floor (yes, death does happen in OB:(). That year of dealing with all of human's common medical conditions prepares you for any other specialty- especially how to handle a crisis in a specialty where crisis rarely happens. You learn the common meds, lab values, how to separate the zebras from the horses. You can take that experience with you forever because you'll always use those skills. However, I do understand that in this economy, people with debts need a job. While that's not a justification to avoid that med-surg experience, I understand that it is a reality...but it is the nurse's loss.

I started NICU as a new grad (large level IIIC with ECMO/nitric/pre/post-ops/HFOV, etc etc) and I don't think med-surg would have helped me out very much; babies are outer space compared to adults, even basic things like oxygen sats. We have lots of cardiac kids that sit in the 70s as their norm and I don't jump right away if a "normal" baby drops her sats to the 70s because I know that she will likely bounce right back up before I have a chance to think about turning up the FiO2 (which in adults is usually only 100% and we *only* use 100% in the sickest).

In fact when we train nurses who worked on adult floors, they often need a little bit longer orientation because we have to get them to re-think everything they've been taught...even while I was in our central nursing orientation with just other peds nurses, it seemed like every other sentence was, "This doesn't apply to NICU..."

By the way, I hope to never leave NICU. I love it so much and know I would be so miserable if I went elsewhere. We have many nurses who have been on this same floor for 30+ years, so many NICU RNs are very self-selected.

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jb2u has 5 years experience as a ASN, RN and specializes in ICU, ER, Hemodialysis.

1 Article; 862 Posts; 10,980 Profile Views

@subee

I understand what you are saying, but I would think that a bleed postpartum would be something taught to a new grad in OB(s/s of bleed, what to do, etc). As far as codes, they really are not that big of a deal. I'm not sure about OB, but most floors do not even require ACLS for their nurses; so, that nurse's job would be to call a code and follow ABCs until the code team gets there. Right? Any nurse should be able to do that.

Again, I'm not saying that there is zero value in med/surg experience. I just don't think a new grad needs to be miserable their first year just to get these "skills." I agree some new grads would never make it going straight to the ICU; however, there are nurses that could not do ICU even if they spent 15 years in med/surg. There are some nurses that can't do med/surg.

People do not say, "spend a year in med/surg" because it is easy, do they? No! They say spend a year in med/surg because of the broad spectrum of what you will see and do, and the organizational skills that you will learn. What if I have great organizational skills and I do not need to learn a broad spectrum of nursing skills?

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rcmageeRN has 2 years experience and specializes in ICU.

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I think going into the specialty you want right out is nursing school is wishful thinking for a lot of us new grads. Sure, I would have loved to start off directly in ICU - but I couldn't get a recruiter to give me the time of day regarding any of those positions. I applied for 100+ jobs as a new grad and FINALLY got one.. on a med-surg/tele floor at a hospital 40 minutes away from where I live (there are 3 hospitals in a 10 mile radius from my home). I lived and went to nursing school out of state and had basically no connections here so I think I am lucky. I will happily learn as much as I can in med-surg and hopefully make the move to ICU in a year or so. In the meantime, I am going to work my butt off and make myself marketable (certifications, etc). Starting off in your desired specialty is easier said than done!

Good article. I don't think med-surg is required to succeed in any other specialty but it may be necessary to get your foot in the door!

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Understand three things...

I know that the economy is tough now, but there are jobs. And, with this tough economy, nursing schools are cutting back as well. What does that mean? That means less nurses are being produced every year. Fewer nurses equal higher demand.

Nursing schools are graduating less nurses??? Seems to me they are capitalizing on the "nursing shortage" myth all the more with the tough economy. They LOVE the myth that many nursing students buy into - that a new grad RN will "never have trouble finding a job." The school I graduated from increased the size of their incoming classes by 40% for each semester during the past year!

I do agree with the OP overall. I am a new grad on a Tele/stepdown unit and couldn't be happier. I love having 3 patients. It's the perfect balance for me - I get to spend lots of time with each patient focusing more in depth on their disease process, but I think ICU would be a bit overwhelming for me as a new grad. The time I spent teching on a Med-Surg floor was more than enough for me to realize I wouldn't enjoy running around in a 12-hour panic attack.

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"

so, why would the year be lost? let's say you really wanted to go into icu nursing. if you go straight into icu, you now have one year of icu experience"

"

i went straight into icu."

lol.

students we have the answer!! just pick your specialty and start there. you don't need no med surg experience, just graduate, pick your specialty and show up.

that's why a lot of hospitals are developing nursing internships for new grads. the hospital i work at as a pca and the hospital i plan to work at as a rn does that. we have them in critical care, er, neurology, infectious disease, gi, gu, trauma, peripheral vascular, surgical, pulmonary, corrections, ortho, bariatric, women & infants, or, rehab, cardiothoracic, oncology, and psych. as a new grad nurse, you have the whole world of specialties open to you. the internship track lasts 1 year and does a great job of preparing nurses to work in what they want without being forced into something else first to get experience. i think it is wonderful. i used to be a pca in med/surg. no way - not for me. i am now a pca in psych and a cardiac icu. i have done clinicals in many areas. i absolutely love the cvicu and have already started talking to the nurse managers about getting into the nursing internship track when i graduate there. why do you find this concept so awful?

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49 Posts; 1,835 Profile Views

I think there are a lot of good things about med surg. I was a PCA for two years on a busy med surg floor and wow, did I learn a lot. I feel like my exposure gives me an edge starting as a new RN on my dream floor, OB/GYN/couplet. That said, I totally agree with the article in the sense that the year in med surg isn't necessary for every pathway. I think there are certain pathways where the experience is more helpful, but there are others where it isn't. I think if you are a new grad and you can get a position in the area you want with a strong residency or internship, you'd be crazy to turn that down or worse not try for it at all, just because you think its necessary to do med surg.I also think its misleading to say that nursing students only want certain units or that hospitals don't hire new grads. It might seem that way externally, but its just not true. I know so many people who aspire to work in oncology, dialysis, school nursing, womens health, geriatrics, psych, surgical, etc. ICU and L&D are popular units, but they are broad areas too. There are many specialties within those areas, especially if you live near a major hospital system.As for the job market for new grads, its limited but not closed. If you build your resume from the beginning of school by getting involved in school associations, keeping your gpa competitive, volunteering, and working in or near the setting you are trying to get into, you won't have a problem. If you don't do anything to stand out from everyone you are competing against, you might have to consider med surg to get started. its not a bad thing tho, its experience you can really sell when you interview for the dream spot!

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Perhaps the person who wrote this article graduated at a time when you could choose a specialty and there would be a job available. When I hear of new grads looking for their first job for months to a year or more, I would suggest that you take what you can get.

A lost year is one waiting for the dream job to appear while you could have been gaining experience!

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jb2u has 5 years experience as a ASN, RN and specializes in ICU, ER, Hemodialysis.

1 Article; 862 Posts; 10,980 Profile Views

Perhaps the person who wrote this article graduated at a time when you could choose a specialty and there would be a job available. When I hear of new grads looking for their first job for months to a year or more, I would suggest that you take what you can get.

A lost year is one waiting for the dream job to appear while you could have been gaining experience!

Not everyone can just choose their job/position. And yes, if you can only work in job "X" then you better take it. I would not say specialty jobs were "plentiful" when I graduated, but I didn't just do as my Director said and do a year in med/surg first. Had there been no other options for me, then yes, I would have taken a med/surg position, if that is what was available. That is my point.The general thought is that EVERYONE should do a year in med/surg as a new grad. The point of this article is to refute that point of view.

Has anyone ever considered that maybe med/surg jobs are so plentiful because of the huge turn over caused by people just doing their year as advised?

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Jackfackmasta is a ASN, RN and specializes in Adult ICU.

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I enjoyed reading this post.

I graduate this May. Yay!!!! and want to go into the ICU. I work as a ED technician in the crash area and deal with critically ill patients and code situations frequently and this is where I developed my passion.

I have taken some critical care classes through my hospital and have loved it. I do believe that tech experience can make a big difference in making that transition from new grad to ICU nurse. I have developed more confidence, knowledge and strengthen my basic nursing skills as a tech whereas on the first day when I had back to back codes in 5 minutes I was stunned and through experience/hands on I do not even have to think about what I need to do now. It comes naturally.

I am not cut out for med surg. I like ICU patients, monitoring devices and critically thinking. I can see both people's side about med surg and at the end of the day follow your heart.

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hecallsmeDuchess has 6 years experience and specializes in LTC, Acute care.

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Has anyone ever considered that maybe med/surg jobs are so plentiful because of the huge turn over caused by people just doing their year as advised?

I do think this is exactly why there is such a huge turnover because people serve their year sentence and flee to the mountains. On my floor, everyone that was there when I started some 18 months or so ago is gone which means that nurses hired when I was, straight out of school with no experience are now having to mentor new grads. We have just barely learned to stand on our two feet but we are now preceptors to newer newbies, med/surg sure makes you grow up fast...

I definitely agree that students should be aware that other specialties besides med/surg exist and nurses can also hone skills there. I also wish more hospitals will develop residency programs for different specialties as that would definitely help new grads transition easier from students to professional nurses.

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Rose_Queen is a BSN, MSN, RN and specializes in OR, education.

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I don't get why med/surg is considered a requirement by some hospitals. There was one I applied to when I graduated who required every new grad to do a year of med/surg before they were allowed to specialize. If you ask me, med/surg is its own speciality and should be treated as such!

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anne_marie_oregon has 6 years experience and specializes in Nursing.

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AGREE! I would like to spend my first year in ER. I have "paid my dues" as a CNA and a Unit Coordinator - so I am ready to learn about ER nursing!

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