Why is Med-Surg so hated?

[Nola009]

Whenever I have told a fellow newer grad that I want to work in a hospital, they ask 'where?' And I say 'probably Med-Surg' and then they crinkle their nose. I just want to get my start in acute care and heard that's a good place to start. One of this area's hospital groups seems to have such a hard time hanging on to RNs willing to work in Med-Surg, that they will pay *experienced* RNs several dollars more per hour than in more sought after specialties. Is Med -Surg really so terrible or different from other acute care floors?

[Karou]

I love med-surg!

I like it that every day on my unit is very different from the previous. My patients are so diverse that I am constantly learning something new. I love the mix between medical and surgical. I have to organize and prioritize my care constantly, which keeps me busy.

I enjoy being busy. I don't like being overwhelmed, but I don't like too much downtime either. It's important to me to be able to talk with my patients and get to know them, this is one of the things that I really enjoy about nursing. On med-surg I am able to do this. In other areas (ICU, ED) you may not have that length of time with your patient or they may not be alert enough to form that bond with.

Med-surg nursing doesn't always have the glamour of other more acute or specialized areas. Some view med-surg nurses as beneath other specialities, less of a "real nurse".

I just shrug at that. I am grateful that there are nurses passionate about ED, L&D, ICU, ect... Because patients in those areas deserve nurses interested in their speciality who enjoy what they do. I happen to be passionate about med-surg and at this particular point do not want to go to a different area.

[PacoUSA, BSN, RN]

My PERSONAL experience is that med-surg nursing is perceived as a dumping ground, and (except for California) a higher than normal patient load is the norm and nurses are expected to deal with it. There is very little time to spend with patients and an exorbitant number of tasks to complete. Too much babysitting and not enough time to critically think. It is viewed as the place where you start out your nursing career and then move on to critical care or more lucrative specialties after you have the requisite experience under your belt. I've even heard others comment that some excellent nurses are "too smart" a nurse to stay on a med-surg unit, and that critical care nurses are more astute clinicians. Med-surg nurses have to move their patients to higher level of care when they decompensate enough and they have restrictions on what they can or cannot push or what interventions they can or cannot allow (i.e., no continuous pulse ox monitoring or continuous nonrebreather use on a med surg floor). In this sense, the critical care nurse is viewed as a better or more qualified nurse. In this day and age, few newer nurses seem to tolerate the idea that they have limitations on the care they can provide to their patients.

I'm not saying this is the truth for EVERY med-surg unit, just saying that this is the perception from where I stand and live, and why someone here too would crinkle their nose at the idea of going into med-surg. It's no wonder many new grads are killing puppies at the chance to start out in ICU or other critical care. Charting on 2 patients is viewed as a hell of a lot less onerous than charting on 6.

And btw, the concept of starting out in med surg for a year and transferring out to another specialty seems to be slowly dying. Many specialty RN job listings are beginning to specify experience in the specialty as the preferred qualification for the opening (i.e., 2 years critical care or ER experience for ER or ICU) and med-surg is no longer enough. Maybe this is a result of oversaturation of qualified candidates in the job market and employers can be more choosy. So the idea of starting out in med-surg and being stuck there seems to be a growing concern. It's harder now to change to a specialty after med surg. Also, this could be a regional thing, but again, that's how things are perceived around here.

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[amzyRN]

I don't mind med/surg just as long as I have CNAs to help since the ratios are usually higher. Their vitals might be stable but that doesn't mean they don't require a ton of time. I don't dislike med/surg at all. I think it gives a great variety of patients and I think it's good to start in med/surg or tele before going on to other specialties (just my opinion). Med/surg can be tough and a lot of work and I think maybe that's why some people don't like it. It does seem to be very task oriented, in my opinion. I would just run around trying to get things done so fast I didn't have enough time to dig into the chart.

[tokmom, BSN, RN]

Paco-RN said:

My PERSONAL experience is that med-surg nursing is perceived as a dumping ground, and (except for California) a higher than normal patient load is the norm and nurses are expected to deal with it. There is very little time to spend with patients and an exorbitant number of tasks to complete. Too much babysitting and not enough time to critically think. It is viewed as the place where you start out your nursing career and then move on to critical care or more lucrative specialties after you have the requisite experience under your belt. I've even heard others comment that some excellent nurses are "too smart" a nurse to stay on a med-surg unit, and that critical care nurses are more astute clinicians. Med-surg nurses have to move their patients to higher level of care when they decompensate enough and they have restrictions on what they can or cannot push or what interventions they can or cannot allow (i.e., no continuous pulse ox monitoring or continuous nonrebreather use on a med surg floor). In this sense, the critical care nurse is viewed as a better or more qualified nurse. In this day and age, few newer nurses seem to tolerate the idea that they have limitations on the care they can provide to their patients.

I'm not saying this is the truth for EVERY med-surg unit, just saying that this is the perception from where I stand and live, and why someone here too would crinkle their nose at the idea of going into med-surg. It's no wonder many new grads are killing puppies at the chance to start out in ICU or other critical care. Charting on 2 patients is viewed as a hell of a lot less onerous than charting on 6.

And btw, the concept of starting out in med surg for a year and transferring out to another specialty seems to be slowly dying. Many specialty RN job listings are beginning to specify experience in the specialty as the preferred qualification for the opening (i.e., 2 years critical care or ER experience for ER or ICU) and med-surg is no longer enough. Maybe this is a result of oversaturation of qualified candidates in the job market and employers can be more choosy. So the idea of starting out in med-surg and being stuck there seems to be a growing concern. It's harder now to change to a specialty after med surg. Also, this could be a regional thing, but again, that's how things are perceived around here.

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No continuous pulse ox on your floor? Holy cow, that is dumbing down nurses. Heck, I have worked med/surg where I did conscious sedation, and injected epidurals.

[tokmom, BSN, RN]

Op, excellent question. I have no idea where the idea of med/surg being a sucky place to work ever started. We probably will never know. Nurses who work on med/surg are viewed as "less than," and not a true specialty. We are ONLY med-surg nurses (rolling eyes). It boggles my mind that a bunch of grown woman (because nursing is primarily women) LOVE to bash other specialties and consider them less than. It's so freaking childish. We will never EVER move forward and have the respect of society and other health care professionals until we start liking each other!

I enjoy med/surg and will never leave unless I leave bedside altogether. It rankles my hide to hear new grads say they are being tortured having to work med/surg and can't wait to leave. Constant turn-over is bad for moral and many never give it a chance.

I enjoy the challenge of the patients and family. I see people become well and go home and I'm proud to be a part of the process.

I have worked a variety of departments and I kept going back to med/surg. I always found something "wrong" with the other department such as not using my critical thinking skills or monotonous/assembly line care. One day I realized that I'm a true blue med/surg nurse. :) I'm certified in med/surgical and very proud of my RN-C.

[Karou]

tokmom said:

No continuous pulse ox on your floor? Holy cow, that is dumbing down nurses. Heck, I have worked med/surg where I did conscious sedation, and injected epidurals.

I didn't realized just how different "med surg" nursing is at different facilities. On my unit many patients are on continuous pulse oximeter monitoring. Anyone on a PCA should be (or IV narcotics in general), anyone with respiratory issues, receiving blood, GI bleed, DVT, ect... I really thought that was basic? Even if a med surg unit does not have cont pulse oximeter in all of the rooms (mine does) then can't they get one ordered, if needed? We do that sometimes if having issues with a machine.

Patients requiring non rebreather masks may stay on the unit. Depends on the whole patient picture. Same for BIPAP or high flow NC.

The more I read on allnurses, the better I feel about where I work. Night shift RN's have 5-6 patients max, Each tech has 10-12 patients. We staff based on acuity so the ratio may be even better at times. Charge nurse does not take patients. We have a good team and there is a lot of support.

[PacoUSA, BSN, RN]

tokmom said:

No continuous pulse ox on your floor? Holy cow, that is dumbing down nurses. Heck, I have worked med/surg where I did conscious sedation, and injected epidurals.

I agree, dumbing down is how we feel many times. Our turnover rate is so high that morale is constantly in the toilet and working short-staffed has become the norm. I sometimes think we are made to feel like we cant be trusted with higher level skills like that. We rarely learn anything new, and repeated inservices on the same topics gets old really fast. I mean, I know repetition is key to keep skills from getting stale (i.e., code cart review) but learning something new seems to be an annual thing. That's not enough to keep our interest on staying put.

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[tokmom, BSN, RN]

Karou said:

I didn't realized just how different "med surg" nursing is at different facilities. On my unit many patients are on continuous pulse oximeter monitoring. Anyone on a PCA should be (or IV narcotics in general), anyone with respiratory issues, receiving blood, GI bleed, DVT, ect... I really thought that was basic? Even if a med surg unit does not have cont pulse oximeter in all of the rooms (mine does) then can't they get one ordered, if needed? We do that sometimes if having issues with a machine.

Patients requiring non rebreather masks may stay on the unit. Depends on the whole patient picture. Same for BIPAP or high flow NC.

The more I read on allnurses, the better I feel about where I work. Night shift RN's have 5-6 patients max, Each tech has 10-12 patients. We staff based on acuity so the ratio may be even better at times. Charge nurse does not take patients. We have a good team and there is a lot of support.

Yep, same here. We do non re-breathers in my region and bi-pap as well. Our ratio is very good and we have CNA's. I have worked with much higher ratios and it burned me completely out on nursing. I switched hospitals, but not specialties.

[tokmom, BSN, RN]

Paco-RN said:

I agree, dumbing down is how we feel many times. Our turnover rate is so high that morale is constantly in the toilet and working short-staffed has become the norm. I sometimes think we are made to feel like we cant be trusted with higher level skills like that. We rarely learn anything new, and repeated inservices on the same topics gets old really fast. I mean, I know repetition is key to keep skills from getting stale (i.e., code cart review) but learning something new seems to be an annual thing. That's not enough to keep our interest on staying put.

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That is poor management. BTDT. We were offered no education and were treated like left over gum on the bottom of a shoe. The hospital I'm at now staffs in a fair manner and is an excellent place to work.

[Mr. Murse]

Obviously, it is 100% a matter of opinion. I love med/surg bedside nursing. I think at some point in my career I will be ready to move on from it, but nearly 3 years in (4 counting my tech time) and I still love working med/surg.

But some people hate it, obviously. So you'll have to find out for yourself. If you like being busy and working autonomously and don't mind the physical demands of it, you may love med/surg like I do. If you're looking to sit around and gossip all night and not be bothered by those pesky sick people, or you prefer patients that are a little closer to the edge between life and death, then you may hate it.

good luck.

[dudette10, MSN, RN]

I am a floor nurse at heart. I've dabbled with the idea of moving to a different specialty, but it just never seems right.

I will be a floor nurse in acute care for my entire career, if they'll have me. Once I have a teaching position, I'll still do floor nursing PRN. I LOVE having everything tied up in a neat little bow by the end of my shift, if I can. Patients stable, pain managed, everyone is clean, lines labeled, full bags on the poles, dressings done and timed/dated, all orders complete. NO LOOSE ENDS.

I'm a bit obsessed by it.

[applewhitern, BSN, RN]

Work wherever you can get hired (or a job you want) and ignore the naysayers. I work ICU, but have been pulled to the medical-surgical floor enough to know well what it is like. I love bedside nursing; any job that involves taking care of an actual human being is delightful to me. That is why I am a nurse, and I love being a nurse. Don't let anyone bring you down or diminish you just because you might work "the floor." Yes, every hospital is different, they all have their own policies and their own culture. Hopefully you will wind up in one that has a decent "nurse to patient" ratio. Good luck.