Happy Thursday! I am especially happy today because yesterday was my last final for the semester, so I’m officially done with my third semester of my nurse anesthesia program. All grades are posted and I’m feeling good. Well, I did wake up this morning thinking, “I think I’m hungover from the semester.” (Not from celebrating, mind you.) We get a few days off before starting clinical next week, so I won’t be getting too comfortable, but it’s nice to turn the page to a new chapter.
We shall continue Nurse’s Week with some chat about a topic that I find particularly interesting. Jenny asked me about whether I think new graduate nurses (what you’re called for about the first year out of nursing school) should start out working on a medical/surgical unit, or if it’s okay to go immediately to a speciality unit.
Quick background on me: I loved critical care in nursing school, but (having graduated two weeks after the financial crisis started in 2008…), my options were quite limited and I ended up getting a job on a medical/surgical/oncology/hospice unit at a small community hospital. It was far from the intensive care unit in an academic medical center that my little new grad heart dreamed of. I worked there for 15 months before moving on to the burn unit where I worked for a little over six years.
Medical/surgical units, for those not familiar with the term, are low acuity units (although “low acuity” doesn’t mean what it used to…) who take just about anyone. They take a wide range of patients, so you can have a patient with cellulitis, another who fell and broke their hip, another who had an appendectomy, a prostate removal, a patient with abdominal pain……you get the idea. On my first unit, I joked that we took anyone and everyone as long as you were at least 14 years old and didn’t need a heart monitor (and weren’t in labor). Med/surg units are busy places – we usually had 5-6 patients (and no techs), and each patient has different needs. Some med/surg nurses may laugh because they routinely carry 8-10 patients.
Some say that medical/surgical nursing is foundational to building your nursing skills and therefore new graduate nurses should start there to develop their skills. It’s true that you learn a lot of about a wide variety of diagnoses, tests, and treatment because you’re exposed to so much. You don’t necessarily get that when you start in a speciality. I remember I once floated to a step-down unit, and I got report from another nurse from my unit. The patient had some sort of laparoscopic surgery (where they inflate your abdomen with gas to allow more room to work without making a large incision), and the patient’s abdominal pain was fine, but was complaining of shoulder pain. The nurse didn’t understand where the shoulder pain was coming from, but from my time on med/surg, I knew that the gas used for insufflation of the abdomen can cause shoulder pain. Simple? Yes. Would you have learned that in nursing school? Maybe. Is it make or break? Probably not.
Others say that you need to do some time “in the trenches” before moving on to a specialty. Calling med/surg units “the trenches” is a bit degrading to med/surg – it’s not an easy unit to work on! The work is very different than an ICU, but it’s still challenging. Med/surg nursing isn’t for everyone, and the thinking that everyone should start there may lead some people out of the profession. My first year in it was so bad that I seriously considered leaving nursing. I know other nurses who really love med/surg nursing. There’s something for everyone.
Which leads me to my point that…..I don’t think you NEED to spend time on a med/surg unit prior to specializing. I’d even argue that medical/surgical nursing is a specialty! (Fun fact: You can get a certification in med/surg nursing, just like critical care!) Is med/surg nursing “easier” than critical care nursing? Well, that’ll start a debate for sure. It takes different skill sets to manage one very critical patient than it does to manage six-eight lower acuity patients. When I worked med/surg, I felt like I never had enough time to dedicate to each patient. I remember doing the math for my eight hour shift and thinking, “Once you take out report and the idea that I should eat/pee at some point, each patient gets an hour of my time. An hour. For everything. For assessing, giving meds, charting, calling doctors, doing any labs/procedures, helping them to the bathroom, answering questions, and all trying not to seem like I’m rushing through everything.” An hour! In an eight hour shift! Crazy.
I learned a lot during my time on med/surg. I also hated nursing at the time and wanted to leave. (This may have been more due to the lack of support at my hospital than the actual unit, but who knows!) I don’t think it’s worth spending time on a unit if you don’t think you’ll like it – you wouldn’t tell someone to go to psych nursing for a bit just to get the experience. We all have different interests, and you’re allowed to the pursue those interests right out of the gate. The foundational aspects of nursing can be found just about anywhere, so you’ll learn that on orientation wherever you end up. (“Nursing is nursing” is what people will say, which is why you can float to other units and not be unsafe despite never having seen certain diseases or equipment.) If you love psych, go for it! If you love oncology, please do! I don’t like either of those specialities, so I’m glad someone does.
Not to mention……it’s really expensive for a unit to hire a new nurse because most places will have you on orientation for 3-4-ish months. During this time, they’re basically double paying nurses as you’re being precepted. I don’t know the actual numbers, but I heard a nurse has to stay for at least two years for it to be “worth it” financially for the hospital to have hired you. If you go to a unit with the intention of leaving after a year (which I did, oops?), it’s costly for the hospital and can put a lot of stress of the nurses of the unit who constantly have to train new nurses.
We hired a fair amount of new graduates on the burn unit. I always felt the burn unit was a challenging place for a new graduate to start because we had such a wide variety – the ICU patient, a little more med/surg-like with patients who had smaller burns, pediatrics, psych patients with burns, and then over flow ICU patients when the other ICUs were full and needed a bed (we often had neuro patients). And not to mention the wound care! But we had many, many new graduates, and they all did fine. Some took a little longer to come around, but that happens anywhere. I do feel like my med/surg background helped me in the beginning (and occasionally when floating), but I think the playing field evens out with time and any nurse who is on top of their game knows enough to know when to ask questions or look something up if they haven’t encountered a disease/situation/equipment/testing.
I think it’s more important to find a unit you’re interested in working on and pursing that rather than working med/surg because “everyone needs to start there.” If you’re interested in what you’re doing (and not constantly thinking about leaving!), you’re probably more engaged with your patients, always looking to learn more, and will invest in your unit and the people around you. Nursing is a tough job, and you should like what you do when you go to work. I was always way more excited to take care of a burn patient than I ever was to take care of a neuro ICU patient – but I’m sure the neuro felt just the opposite! Which is why we have specialities, among other reasons.
Some units won’t hire you without experience, sometimes they say med/surg experience. You’ll learn a lot of if you start there, but it’s also totally fine to pursue what you love.
Nurses – What was your first unit? Do you think all nurses need med/surg experience?