What to expect on Surgical floor?

Up2nogood RN, RN · Dec 4, 2010

Congratulations! I love my surgical floor!

You'll experience lots of different types of drains depending on the surgery.

You'll gain exposure to a variety of patients of all ages. You'll have to learn to be a stickler about post op ambulation and IS use. Neither of these the patients will willlingly do on their own and you'll hear every excuse under the sun why they can't do it. You'll give a buttload of IV narcotics, antibiotics, and occasional blood products. I see a lot of nausea, retching and emesis too, blech.

It will get easier as you gain experience and you see the same types of patient over and over again. And you may find that the hardest patients to care for have had the most minor surgeries.

Good luck in your new adventure!

carolmaccas66, BSN, RN · Dec 4, 2010

You will be busier than u ever have been in ur whole life. Get a cheat sheet, work out a plan of care b4 u start caring for ur patients and stick to it. Good time management is the key on a surgical floor. You will do tons of normal obs, neurovascular obs, bladder scans, use heaps of narcotic/IV fluid pumps, give many anti-emetic meds, check drains, remove drains, teach re deep breathing & coughing, observe/change dressings, deal with pain and discomfort issues & put up with cranky patients who refuse to move after surgery. U will get patients who can deteriorate very quickly and those who breeze thru their ops. U will also do a lot of skin care, and post op washes, which ur patients will be very grateful for.

It's hard work but u gain a lot of exposure and good general nursing skills and knowledge. Ur feet will probably be throbbing by the end of a busy 10 hour shift where u get no break, & haven't even had time to really talk to ur patients, but it can be satisfying.

But it's hard work running around when u get older!

MntnGirl · Dec 5, 2010

I started on a Surgical floor about a year ago and am still there - overwhelming at first but the more time I put in the more comfortable I get. Pain, pain, and more pain you will deal with most every patient.I found this to be my most difficult aspect of my job, many patient's expect to have no post-op pain (it seems that the alot of the younger patients have this attitude of "no pain" whereas many of my older patients are more tolerant of pain). Ambulation is very important with all your patients and can be more difficult than expected due to ortho surgeries, age of patients, quick deteroration due to laying around in bed, patient motivation - getting a patient to walk to bed, bathroom, to the door, many times requires more than 1 person assist and can take alot longer than expected, try to plan this into your schedule. Surgical floors are much different than a medical floor - I find the patients on surgical floor require more time due to pain issues, ambulation time, and endless post-op complications not covered here. We also get to deal with medical issues that the patient has (COPD, diabetes, Crohns - you name it) ALONG with their surgical procedure. If you live in an area that gets cold/icy in the winter be prepared for increase of patients' due to falls which can lead to broken bones/hips - especially in the elderly population. We also get all Trauma patients (if they don't go to ICU) due to potential (if they haven't already had) surgery. We get all kinds of surgical patients and depending on the surgery and doctor there are certain things we need to look for with our patients - for instance our gynelogical patients must have their I&O closely watched in the initial post-op period, we have to keep every 2 hour tracking of I&O and call the doctor's right away if parameters aren't met. Try to keep "cheat sheets" on doctors so you know what they are looking for with their patients. We keep VERY busy on our surgical floor, invest in a good pair of shoes, be prepared to have numerous doctors' on for one patient, and study up on dealing with post-operative pain. Good luck and try to keep in the back of your head that with time and experience your competence will increase (I don't think it gets easier but competence and comfortableness do increase).

Sarah010101 · Dec 5, 2010

I am in my 3rd year of nursing school now, but I just finished a 12 week rotation on a surgical floor. If I were to say the things I least expected... they would be,

1. Usually I would expect mornings to be busy, and they are (with new dr. orders etc), but, the new post-op patients start pouring in around 1-2 pm... and then you get REALLY busy.

2. When you know what kind of patients you are going to be recieving, its always a good thing to figure out what you are dealing with (ex- if its a Total Hip arthroplasty,.. you know physio will be coming by, usually they have a JP or hemovac, usually you will not be doing a drsg change unless you have dr orders, they will be in pain and not want to ambulate etc etc)

3. CREATE A SYSTEM!!! Figure out a way that is best for you to go in and do your assessment. Will you focus chart in the room? Will you see all your pts and then chart? Are you going to go in and remove that drain, do that dressing, and hang that med all at once? Are you going to teach about DB&C and incentive spirometers at the time?

4. Learn how to manage pain... if I took anything away from this rotation it was a very good knowledge of narcotics and how to use them for certain types of pain. Never underestimate Ketoralac... that stuff is AMAZING!

5. Follow the pre printed orders... this was a hard one. Patients who had epimorph or patients with a running epidural may have tons and tons of medications to choose from that the dr ordered.. BUT you have to go by what the anesthetist orders only. (This was a BIG mistake on my part) OH, and know how to do a good dermatome check :)

6. If they have a fever... usually the culprit is the build up in the lungs... deep breathing and coughing and use of the incentive spirometer works WONDERS :)

Wow, good luck on your job, you will do great :) I cannot wait to grad and work on a med-surg floor :)

Fiona59 · Dec 5, 2010

How big is your hospital and what type of surgical floor are you going to?

My hospital is a regional one, so Surgical Services is broken down into General Surgery (bowels, appi, gallbladder, etc), Urology, Thoracic, Ortho, Gynie.

If a unit is specific, expect your orientation to include coverage of how that unit deals with issues specific to those surgeries. Our Gynie unit does a fantastic orientation outlining specific surgeries and what to expect, as does our Thoracic and Ortho units.

Usually the unit will have a routine to follow. Pumps and drains are cleared at a set time during shifts (yes, you empty drains before hand if they are full but a tally is kept). Dressings are expected to be done in a set time frame (ie: bid should have the first one done before 1100).

The good thing is usually the patients go home within the week barring the ever popular trainwrecks. Teaching is a big part of the job.

Your buddy during orientations should cover admissions, discharges, and teaching materials.

I'm a surgical nurse, it's my niche, and I love it most of the time.

AARNBSN · Dec 5, 2010

thanks everyone for all of your input =) i'm so incredibly excited/nervous/anxious.

i guess the biggest things i should try to learn as much as possible about is: pain meds, post-op main & interventions/education about it, && various types of drainages i will come across. .. as well as to be big on postop education & the importance of it.

during my interview the NM said the turnover rate on the floor avg is like 3-4 days. is that normal?

Fiona59 · Dec 5, 2010

On my units 3-4 days is normal. Lap Appis and Choli's can go home the same day. Open may stay up to 72 hours. We won't discuss bowel resections, colostomies and Whipples...

K+MgSO4, BSN · Dec 5, 2010

or oesphagectomy or the AP resections! 10 days more likely! What about trying to place them after emergency surgery and they cannot go home?

there is a huge emphasis on early discharge planning. You NM will be getting pushed to get pts out to so that the elective lists can be done so you need to know the pt home circumstances and if they are going to need rehab or placement or go to a family member on discharge etc. A good admission assessment is essential to ask these questions to start to plan for home.

But yeah everything that the PP said as well. good shoes and a good sense of hummor cause I have had some evil shifts and some awesome ones!

carolmaccas66, BSN, RN · Dec 5, 2010

Yes I 4got re early discharge planning. Karenmaire is right. Start disccarge planning as soon as the patient comes back from OT (this sounds too early I know). It gives u time 2 get organised for d/c, say if patient needs equipment ordered, private scripts written, community nursing care organised, transport (if no family can pick them up), etc. I always ask the patient these questions and others, when I first meet them, and it's a good strategy cos it gives u a heads up re their living situation (and any other situation they need help with).

yourheartfeels · Feb 16, 2011

Bringing this thread back. Man, surgical floor kicks my butt. Try to create a "cheat sheet", but it just gets lost in the stacks and stacks of paper work we have to fill out and keep track of. Feel like I plan things, but the plan always fails and I end up with my ass handed to me at the end of the shift. Can't wait til things get easier...if that day ever comes.

blue heeler · Feb 16, 2011

we get all surgeries except hearts

pain pain pain

nausea vomiting

post surg precautions (like total hip)

IS, deep breathe and cough

braces, cpms and immobilizers

various drains including blood reinfusion

blood transfusion

ng tubes/feeding tubes

pca's, epidurals and nerve blocks

discharge planning or getting them ready for surgery

good luck!