What is Med Surg Observation?

westieluv · Aug 10, 2012

I work on a Med/Surg Observation unit. The basic concept is that patients who are borderline on whether or not they should be admitted as regular inpatients are admitted to an observation unit for just that-an observation period after which they are either discharged or admitted as an inpatient. I haven't worked on this unit for long, so I am still learning the details, but my experience has been that a lot of people who are supposed to be moved off of our unit after their obs period is up remain on our unit anyway, which is kind of annoying but probably not the case in all hospitals. Also, some of my co-workers have told me that at least some Medicare patients are now required to be admitted as an observation patient first before being admitted as a regular inpatient, which means that we get some patients that really aren't appropriate for an observation unit (although not unsafe, if they have anything acutely critical going on we send them to CCU or ICU). Typical Obs patients would be acute chest pain that was managed in the ER and we are just keeping them and monitoring their symptoms and cardiac enzymes, acute abdominal pain of unknown origin, acute nausea and vomiting, and acute headache. However, we seem to get the gamut. One day last week I came in to find a patient who had broken her neck, was wearing a neck immobilizer, and had over 30 staples in the back of her head. She ended up getting moved to a post-op inpatient unit, but still...it must have been a Medicare thing, because this woman was obviously more than just an obs patient. That's the government for you, though....(rolls eyes)

In general, an obs unit is not quite as intense as a regular Med/Surg floor because the patients usually go home or go to another floor within a day or two. Lots of patient turnover, though, so you will become expert at doing admissions!

C-lion · Aug 10, 2012

Hmmm...so it sounds like I could get some acute care experience, but not too much. I know it will be different everywhere, but what is your typical nurse/pt. ratio?

westieluv · Aug 10, 2012

Not enough/Too many!!!

LOL, just kidding, but we have been short staffed lately. Normally we get about five patients apiece, both on days and nights. That probably doesn't sound like a lot, but being the obs unit means that we get a lot of admissions at all hours of the day and night, and our ER always seems to be extremely busy, so we get interrupted a lot with new admissions, and an admission takes a while to process. Also, I guess because we're the obs floor so the perception (misconception?) seems to be that we're not as busy as everyone else, our aide gets taken away quite often to work on other floors, meaning that we have to do her job as well as ours.

I don't mean to sound negative. This is only my experience on my unit. When staffed properly, working on an obs floor is not bad, and generally better than working on a busy post-op or stepdown unit. And yes, you will get acute care experience. We give blood, start IVs (a lot!), give a lot of IV meds, access port-a-caths to both give meds and draw blood, do dressing changes, and a host of other acute care tasks. To be admitted to the hospital in this day and age of healthcare means that even obs patients have to be pretty needy to be in the hospital and not discharged home.

C-lion · Aug 10, 2012

This sounds good. Plus, the hospital where I am interviewing is really nice, and I think they would give me a day shift, which is a must. Thank you for your reply:)

GirlOnPfizer, BSN, RN · Aug 12, 2012

She gave a pretty good description of an observation unit. The one I work at is a 4:1 ratio with no aide.

BluegrassRN · Aug 12, 2012

We've been trying to get an observation unit in our hospital for years, and I would jump at the chance. I work medical floor, and while I like it, I think I would like the quick pace and turn around. I think you'll get quite a bit of acute care experience, but it depends upon the hospital.

turnforthenurse, MSN, NP · Aug 12, 2012

We do not have an observation unit in my hospital but we will get patients admitted for observation. You will still get acute care experience! There can be a high turnover but at the same time there are patients there for observation who end up being admitted for several days.