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The great med-surg debate

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Another clinical rotation has finally finished! ICU was a great experience, actually, it really surprised me. All those pre-conceived notions I had in the beginning were just nerves. Now that it’s over, I’m finally realizing that I only have 9 months left of this program…and then I will finally get to sign, “Ani Burr, RN, BSN!” It seems so surreal, and as we finished our last day on the floor, I realized that I wouldn’t be working in a unit again until my last quarter when I get to precept! How incredibly exciting is that!?

I finally feel like I am getting the hang of it, like I really am going to be able to handle being a nurse. My new job has definitely helped boost my confidence too. I think that 9 more months will really get me prepared and ready to go. But as we were leaving the unit the other day, one of my instructors mentioned something to us. She said, “specialties are nice, and you want to do what makes you happy, but you really want to get your adult med-surg experience in because you want to keep your skill sharp, you never know what job you’ll have to take on.”

So… I get her point, obviously. Med-surg nursing is essentially the basis for everything we do, and adult med-surg is where that experience is . But, what if that’s not what I want to do? At all? Yes, I could do adult-med surg, but I would rather do pediatric med-surg. I would rather do ICU than med-surg. In fact, I’d rather do just about any other specialty than adult med-surg (with the exception of Psych, since we all know how I felt about my psych rotation!). It’s not that I don’t like the adults, it just wasn’t for me. I didn’t get that “tingly” feeling I got with peds, or even OB. My feelings are that if you love something – if you truly love that specialty – then go for it! Why not do what makes you happy? After all, when you’re doing what you love, you’re bound to strive to do your best.

On the other hand, I understand where my professor and all other’s who’ve said it before her are coming from. Adult med-surg is where the skills are, it’s where you’re bound to see just about everything. I understand it, but I don’t believe it’s necessary. Student nurses: what have you been hearing about going into a specialty right out of school? Is it med-surg first?  Seasoned nurses: what are your thoughts?

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Ani Burr, RN

I'm a brand new, full-fledged, fresh-out-of-school RN! And better yet, I landed the job of my dreams working with children. I love what I do, and while everyday on the job is a new (and sometimes scary) experience, I'm taking it all in - absorbing everything I can about this amazing profession we all fell in love with.
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31 Responses to The great med-surg debate

  1. Colleen

    some nurses who have told me to start at a med surg have started there themselves. those who have started in a specialty unit like peds/ob etc don’t regret their decision because it’s what they loved since day 1.

    for myself.. i just wanna go where i wanna go. i know it would be a good experience to go to med surg first and perfect skills but i just wanna go straight into a specialty. i mean i can perfect basic nursing skills there too. if i switch around like from peds to adult ICU or OB i will have to try and get used to their environment. sometimes i don’t think it matters much because it seems like we’ll always be learning new things in nursing!

  2. Leasa

    I’ve been a nurse for three years now and started out in an Intermediate (predominantly cardiac) floor. It was a of Stepdown unit between ICU and the regular floors like ortho, med/surg, tele, and all those. I would highly recommend starting out in what you love. Nursing school has given you the basics, orientation (especially for new nurses) will give you what you need in your specialty, and you will get patients that have med/surg needs and learn a lot no matter what you do. You are going to learn in any field you go into but I’ve heard from many M/S nurses that they are scared to transition higher. I worked Intermediate for 6 months then became a travelling nurse and have been able to work in M/S, ortho, tele, intermediate, neuro, stepdown, and trauma without trouble. If it ends up being too much or not for you, that’s the beauty of nursing! You can always switch. In my opinion, go for it! Do what will make you happy.

  3. EndoRN

    26 years ago I listened to my instructors and got a job in Med-Surg… ok mostly Surg. I didn’t love it… really didn’t even like it. I thought I wanted to do OB for the rest of my life. But I worked there for almost 3 years before moving over to OB. 10 years later we moved to a small town with a small rural hospital and only a Med-Surg opening. I’m so glad that I had the 3 years of experience to get me through. I’m now working in Same Day, Endoscopy and have never loved a job more.

  4. Ginger Mcmasters

    Ani,
    Congratulations on the opportunity to make a choice in our field of medicine provided you pass the NCLEX and a state Registers you to be licensed. The proper way to identify credentials after your name is degree, registery, certifications and if you have prior degrees or cetifications those go first. As in my name: Ginger Ann McMasters BSBA, BSN, RN, PHN, NE. There are numerous certifications I hold in the industry but these are the heavyweights.
    If one does jump to a specialty first, which if you test out of the competency exams the unit administers, you may or may not get the position. Remember, for each position and facility you apply there is testing for the area you apply. Tests include: 1 medications- calculations by hand for drugs, drips, administration, effacacy and interventions 2- age related competency exam referencing Maslow, Erickson, Jung, Frued 3- diseae process & interventions 4- nursing process. 5-If ICU, PACU, L&D or Cardiac there is also an EKG strip monitoring test – you interpret the EKG wave form with approproate interpretation & nursing interventions. So, learn it now for future reference. Passing score for these exams is always 80%. NCLEX is 75%. Some facilities allow retakes others don’t.

    If one bypasses the Med-Surg step because of boredom or lack of interest well, it could be interpreted as lack of interest or knowledge in human anatomy, disease processes and related standard nursing protocols. It is possible to pass the exams and hire on with a preceptor for 3-12 months in many specialty areas. Others won’t without the year of med-surg.

    When one bypasses this step of the process and proceeds to a specialty area then, decides to go to another specialty area, that is where the 1 yr Med-Surg step comes into play and the unit may require 1 yr of general medical-surgical nursing first and you do not get the position because you skipped this step. Or you decide to take a break for kids or hubby and going back you don’t have the 1 yr of med-surg so, they have you spend $500 for a refresher course before hiring you on anywhere of quality. Facilities HR departments abide by the prerequisites for each position, no matter. This can haunt you and lock you out of positions of interest later on regardless of how many successful years in a specialty you earned. It is best to do the year but, you will do what God has in store for you as a healer. God Bless and hope you make it through. Remember statistics don’t lie: 60% qualified, quit within 2 years. It is a serious dedication to other’s lives we make and not all can hold up to the expectations or demands. Worthwhile work for God goes a long way in the Rewards department. good Luck, we need great nurses.
    Ginger

  5. Ginger McMasters

    As for Psychiatric Nursing, “Everyone has a psyche, they don’t leave home without it!” Majority of hospitalized patients take psychotropic medications and guess where you want to work, hospital. This means they have psych issues whether you want to deny it or not. Most, will deny or minimize their disease process associated with the medications also. Remember, you are in reality, the nurse. The families may have psych issues too so be prepared cause it is All Psych and if you disagree, upset a patient and then you will see or go ignorant and you shall see. God blessed us all with a psyche and as a RN if you can always tend to the mind of your patient, then you are a great nurse healer.

  6. Jennie Thompson

    I get real sick of ICU nurses thinking that they are above med/surg nurses!!! I am 25 years old and I have been a nurse for 2 and a half years. I started in a med/surg area and worked there for about 6 months and then I moved to another town and got a job in an ICU. I currently work in both areas and there are pros and cons to working both areas. However ICU nurses have this mentality that they are smarter and work harder than the med/surg nurses and that is not necessarily the case. I tell those ladies that I work with, they need to got upstairs and take care of 5-7 patients at a time and see how they handle it. They look like a deer in the headlights every time they see me. All new grads should start off in a med/surg area so that they can learn time managment with patient care instead of trying to do it when standing around not knowing what to do can potentially kill someone because ICU patients are a lot sicker. I don’t know about you all but when a patient comes to the hospital they come for nursing care and that’s what they get from me. I don’t understand why some nurses that have speciality certifications think they are better than anyone else. New grads do not have the right stuff and critical thinking skills necessary for ICU work and thus they should spend a little time in a med/surg area to get their feet wet.

  7. Barbara Campbell

    I’ve been a nurse for 37 years, and I recommend a year of med surg nursing for all new grads. There are many, many things you can do with a nursing degree, and to be at the top of the applicant list, have med surg nursing on your resume. Think about this: Would you rather put in your first NG tube on a MS unit in a controlled environment with time and support, or in a critical situation where the pt is vomitng clots the size of grapefruit? Listen to your professor, med surg nursing is necessary. I precepted a new nurse a couple of years ago who thought she “had that med surg thing down pat” and went straight to advanced care. After a horrible experience, she vowed to quit nursing entirely, but thankfully, was convinced to come to a med surg floor, and is now a very happy, capable nurse. Don’t rely on that “tingly” feeling, and instead do something good for yourself right out of school–you won’t be sorry. Besides, a year is very short and then you can go for tingly.

  8. Leticia

    I agree that you should go where your heart is, because you WILL do your best if thats where you truly want to be and you will also be happy. However I think that it’s easy to get “stuck” in whatever field you first go into…with that said you can always pick up an extra shift in Med/Surg or try it for the first year to get all those skills so you will at least be exposed to them!

  9. Bob Thomas

    I want to do two years on Med/Surg so that I can specialize in Hospice. The only other ward I rotated through in school that had as many terminal patients was the Renal Unit. I don’t consider my Oncology patients “terminal” because they just hadn’t reached that point yet, still fighting with the full arsenal of chemo et radio. I don’t feel that my skills are up to snuff for working on the Renal or Onco Units just yet so it’s M/S for now and then we’ll see what happens.

    I guess I think of the “two years Med/Surg” the same way I did my first two years of college…I didn’t know what I wanted to do so I just finished my General Education studies pattern.

  10. MishiRN

    Yes, you will get to hone your skill set in med surg, but that is not the only place you will encounter a variety of patients and acuities; the ER, for example. I started out there just fresh out of school in an inner city. I figured if I could make it there, I could work anywhere. Not only did I get a HUGE array of patients and conditions, I learned invaluable time management and critical thinking. Im still there after 6 years, and I pretty much learn something new everyday. Hope that helps, and good luck!

  11. Mary

    I have been a nurse for nearly 20 yrs, 9 of that as a travel nurse, and although I understand that some new nurses come out of school really believing they know what their purpose in life is, I will always believe until the day I die, that every nurse should work in a basic med/surg atmosphere for at least a year, just to learn the basics about nursing, and that is the best place to learn it. Specialize after that, but learn how to walk in a general medical area. It creates a firm foundation of understanding.

  12. Krista Harmuth

    I’ve been a nurse for over a year and I still don’t know the answer to this question. I work on a primarily telemetry floor with mostly cardiac/respiratory patients, but we do get a lot of med-surg type things (more med than surg most of the time). I was one of the people who said I’d never work med-surg because I’m really not a fan. I still don’t like it- I much prefer telemetry- but I do think the med-surg experiences I get are valuable. I have the same ratio of patients, usually 5 or 6 to 1, and the ICU nurses who are pulled to my floor are always beside themselves because they’re used to only having 2 or 3 and have no idea how to handle it. I guess if I had to pick a side, I would say having at least a year of med-surg or something similar to it would be preferable to not having it.

  13. Christo

    This seems like a moot argument right now. There will be exceptions, but with the job market the way it is not too many new grads are going to have the option of going into a specialty area.

  14. Jude

    Without question, every nurse should serve their time in a med-surgical unit. It is so basic, like basic training. You are exposed to basic patho-physiology in all sorts of hidden forms. It provides a BASE from which to launch your future practice. You learn organizational skills, how to think on your feet, both under pressure and planned; There is no down side to this, other than the misery that can be experienced working in the trenches while being exposed to the many faces of the ill patient. They can arrive sick, dirty, confused with multiple challenges. To walk with them through the process of getting well, clean, maybe less confused, but with an outcome and a plan much different than when they arrive allows you to carry these experiences with you and learn and grow.
    Don’t avoid it. Even if you plan on working in the psychiatry field, or want to push on to an advanced degree quickly, you will never learn as much about the human condition as you will in a med/surg unit.
    It was in the first med/surg unit that I developed the personal philosophy of treating every patient like I would want my mother to be treated. That is an exercise that I practice as often as I need,
    And who can forget that first patient, say with internal unexpected bleeding who suddenly becomes pale, clammy, tachycardic in front of our eyes? You begin to put together the why of what we do and how our participation in this process protects our patient and allows them to get the medical care they need.
    I would counsel any new nurse to be sure to build it into their plan of “care” of how to be the best nurse they possibly can.
    I have been an RN for 35 yrs, worked in Peds ICU, Transplant, Forenesic Psychiatry, Case management, substance abuse, and currently am a public health nurse in one of the country’s largest HIV Clinic, located in Harlem, NYC. I owe it all to working first in Columbia-Presbyterian Hospital’s old ward system on 14 West – Male surgery, 12 bedded wards – one big old room with curtains. Those were the days. We’ve come a long way, but basic physiology is the same: if you lose enough blood, your body changes to try to adapt, and we as nurses are placed there to recognize it and intervene in time. I worked with a nurse a few years ago who came straight out of nursing school and was temping in our outpatient clinic and could not tell the difference between who was sick and who was not sick, of when to act and when to relax.

  15. Heather Austin

    I have been in nursing for 10 years and started out in med/surg and feel very blessed to have had the experience. I have worked with many nurses who did not have any med/surg experience, and they lack some very basic knowledge and skills. As an new grad, you may think you know where you want to work ,but you may not end up liking it when you get there. Get at least a year of med/surg experience, and you can do anything!!!!!!!

  16. Terry

    Against my inner voice that screamed “No no no, this is not for you!”, I took all the advice and worked a telemetry floor that got a lot of med-surg and pulmonary patients in addition to the cardiac cases. I gave it my ll for 11 months, and hated every minute of it, for all the reasons I didn’t want to do it in the first place. I then went became a Hospice nurse, which is what I had wanted to do since the start of nursing school. I can’t say I’m sorry for the experience, but if i had to do it again, I’d start directly in Hospice. The stress of working in an area I found overwhelming and exhausting was not worth the very small amount of relevant knowledge and skills I gained, all of which I could just have easily learned working in inpatient Hospice. I am now an experienced Home Hospice nurse, and I love my job!

  17. I am in the same boat as you- I graduate in 9 months. I recently interviewed for a psych tech position- not my first choice but a job. The nurse manager talked for quite a bit about how he felt that all nurses should work in psych first rather than med/surg, as skills relating to people, especially those in acute stress/anxiety/psychosis, etc, and those taking psychotropics (as was previously mentioned in the comments) are essential and won’t be learned as profoundly as on a psych unit. I’d never heard that as I’ve always assumed I’d need med/surg experience first as everyone has been saying. It makes a lot of sense. Never thought I’d consider working in psych!

  18. Jen

    My ICU professor told our graduating class that this old adage about doing your time im med-surg was dated. Do what you love. We all know that new grads know just fundamental things and we all have to start out somewhere as the new grad. Residency programs are a great way to transition from nursing school to real world nursing. No matter where you work, time management will always be an issue for you to find your niche. Even transferring to a new unit or entire new system will force you to reorganize your time management. In most jobs as a nurse you will float to other units if census is low in your area. I was a new grad that loved peds and applied for a position and got it. I did a residency program to help that transistion. It was wonderful. Do what you love and seek support from those who will support you and help to teach you as a new grad. There are numerous nurses out there with years of experience…seek them out (if they are safe practicers) and learn form them. You will learn so much from them and they will appreciate and respect you for comprehending the fact you know very little. Be humble, be confident in what you do know, and never be afraid to ask for help. Good luck.

  19. Kristin Gebhart

    Ani, I agree with Jen, this idea of doing Med/Surg for the first year is something that a lot of older nurses recommend. It seems they did it that way, it was profitable, and thus you should. I recommend doing what you love. I have worked in the ED for almost 2 years now and have had to use almost all the skills I learned in nursing school and I have learned more. I have had both pediatric and adult patients, put in IVs in all ages, and had everything from ingrown toenails to GI bleeds to Pneumonia to gun shot wounds. I recommend you find a hospital that is invested in your success as a nurse and has a great internship for new nurses. If you find that you want to go the ICU/ED route, then they are looking for critical care experience. Areas that are considered critical care are: ICU, ED, PACU, and I believe OR. OR is very specialized and thus you might want to only go there if you are confident you want to do this for a while.

    I encourage you to do what you love and ask a lot of questions. We prepared to be wrong and be confident in what you know to be true. Being teachable will keep you out of trouble. Different floors have their own culture, so don’t be surprised if some nurses are arrogant or hard to get to know. The studying doesn’t end when you pass the NCLEX, so be prepared to learn more and grow in what you know.

  20. The scariest thing about a new nurse is that you don’t know what you don’t know. And, in a specialty unit, you really do have to know or at least have an idea and more than that you have to be able to admit when you don’t know something. I think med-surg should be a prerequisite for every new nurse; and, I never thought those words would come out of my mouth. I hated med-surg as a new grad, but am so glad I put in my time. I’ve seen overly confident new grad nurses just out of preceptorship but still a nurse for less than a year, make life threatening mistakes or not question an order because he/she didn’t know that the order didn’t make sense. I work in a busy ER, and w/o the experience of working w/and administering the common meds, you just don’t know to question an order for any one of those meds when it’s inappropriate if you haven’t had the experience of giving it over and over and over. And, w/o that experience, you may not have the gumption to question an order or you may be easily swayed to do or not do something bc that’s the way it’s always been done and not bc there’s sound science to back up why you’re doing it. You need all of these tools to be efficient and safe in a specialty unit. You need the experience a med surg year will give you and the confidence it will instill in you. Rather than focusing on the title of med-surg, refocus on the title of nurse and just be one…go provide good competent safe care to many many basic med-surg pt’s so that you will be able to provide top notch specialty nurse care later on.

  21. Linda

    I have been a nurse since 1971. Started out as a diploma graduate which means I already had 3 solid years of med surg when I graduated! We were the mandatory volunteers who boosted the staffing and took on the sickest patients for a learning experience.
    It was a great experience and we sure did learn how to set priorities, juggle difficult assignments, nasty staff nurses, big headed physicians and we learned how to be members of a team.
    We were quizzed and critiqued daily by some of the toughest instructors in the business. So when I graduated, I was certain that I wanted to do coronary care. In fact I knew that when I applied to nursing school and so upon graduation, I went straight into critical care and never looked back.
    After 2 years of learning the stuff we did not get in nursing school, I was in my glory and would have worked for free just to be able to do what I was born to do.
    The med surg pre-requisite in my opinion, is a ploy to boost poorly staffed units. Juggling 7 patients, a floor of medications, and 30+ IV infusions per day, ony teaches you how to manage tasks. You are too busy to learn arrhythmias, and having been on the code team for 20+ years, I am certain that it gives you zero ability to function in a crisis. That said, some people love that kind of nursing and for them, that is wonderful. It was not for me. Hearts is my life, my career and my reason for being a nurse.

  22. Cindy

    Med-surg is a must for any new grad. Six months minumum. I have precepted many, many new grads in ICU and ER. They are never prepared and do not have the experience level to perceive when to act and when not to.
    As a nurse, the time spend on med-surg is invaluable. You will have to hone your assessment skills to notice the subtle changes in your patient WITHOUT the benefit of monitors and other equipment to assist you. And if you think that having all that equipment around you really assists you greatly in an ICU or ED setting, you are wrong. Many times the monitors tend to confuse new grads who tend to focus in one what the monitor says and not what it MEANS. Or, worse yet, they are not able to assess the differences in the patient prior to changes in vital signs or condition.
    You will learn organization, assessment, and priority setting. Critical thinking skills will be honed.
    Going into a specialty right out of school is something every nurse wants to do. It is UNSAFE for the patient however, because 3 months of precepting does not prepare you to take on the sickest of the sick. Med-surg is a firm, brain stimulating environment and one that is necessary to get your feet firmly on the ground. I have been nursing for 21 years and I can tell you of just a handful of nurses I have precepted in the last 10 years that were able to grasp the MINIMAL concepts to function in the ICU and ED. I have precepted hundreds, and booted many back to med-surg.
    Don’t think that med-surg isn’t a specialty in itself. There is a certification for that!!
    Good luck!!

  23. B

    Hello, I’ll just share my experience. I’m a new nurse that graduated Spring 2009, and other than my first 6 weeks on a tele floor, I have only worked in the ICU, and have had an awesome and amazing first year of nursing! ICU is my passion, and I love it! I don’t regret not doing any M/S one bit.

    I love the constant challenge of working with really sick patients. I just had my first yearly competency test a few months ago, and did very well, and scored 95% on my rhythm strip exam! (you CAN learn rhythms as a new nurse, you just have to keep studying and re-learning them, especially the rhythms you don’t see frequently).

    I will say that what has helped my success is that I had a 4 month orientation with an AWESOME preceptor, and lots and lots of ICU specific classes, plus lots of ongoing education, AND I read a lot outside of work…not only because I need to in order to function, but because I ENJOY reading and learning, and expanding my knowledge base whenever possible…And, my fellow RNs and CMs are wonderful. I never, ever, ever feel alone at work, and have always felt tremendous support and encouragement! =)

    Warmest of Wishes,

    B

    I wanted to do ICU from the moment I stepped in the unit as a patient, and by golly I made my mind up that I was going to work there, and haven’t looked back.

  24. Jessica

    I am a Certified Medical-Surgical nurse. I have worked med-surg for four years. It is an awesome specialty for nurses to go into, and it probably wouldn’t hurt others who want to go into other nursing specialties to have at least two years of it under their belt. I’ve always said that if you can make it on a Med-Surg floor you can make it anywhere. And the knowledge that you gain from working Med-Surg is essential in building strong foundation. You not just become skilled at one thing but many. We Medical-Surgical nurses are skilled in surgery, cardiac patients, stroke patients, pulmonary, cancer…we see it all! So you can find exactly what you love to do, and it Med-Surg is not your specialty, than move on to what you love to do.

  25. Kelley

    I have been a nurse for 15 yrs…when I graduated I thought that I should do what I thought I loved as well…was NOT crazy about the idea of Med Surg. Thought I wanted Peds. My first position as an RN was as a Home Care/ Respite RN for chronically ill children. There were 2 critical errors in that choice… I arrogantly thought that I had more than enough skill, and passion to do this job, and do it well. Experience is much more valuable than I ever could have calculated. Home Care is not a good place for new grads. In the home setting you have to be able to improvise (safely); a skill that no new nurse posseses. You also don’t have colleagues with you to trouble-shoot ideas or help you navigate from a difficult problem. I learned a lot from these kids and their parents, but was that really fair to these people who had already suffered a great deal? Same goes for any specialty really-whether it is home care or not. Patients with specific issues are looking for health care providers who have seen the good, bad and ugly. I left that first job and took a position on a Med Surg unit. That experience was invaluable. I was hired for nights. ( The last shift I wanted.) There were 3 RNs on that shift for 28-30 pts. The work was stressful and the nights were endless. We didn’t even have a PCA for the first 2 yrs I was there. The turning, lifting and “butt-wiping” were done as a team b/w the 3 of us. I cried a lot, but I laughed a lot and learned even more. My co-workers had all worked as med surg nurses for 25-30yrs. I had over 100 yrs of nursing experience to draw from. I stayed in MedSurg for 4 yrs…did nights, days and charge positions. I left that job 10yrs ago and have been a dialysis nurse ever since. Dialysis pts are very ill, and require a good knowledge of diabetes, cardiac, respiratory and vascular. I am frequently the only nurse with up to 14 pts at a time. I am floor nurse and charge nurse. I can cannulate and I can assess. I know how to talk to physicians effectivley and not make them yell-most days. MedSurg for new RNs? Definetly. Do yourself and your patients a huge favor…go apply your new knowledge and gain invaluable experience FIRST!

  26. I hated Med/Surg in school and cringed when my instructors all told me that I needed at least a year before specializing. Well…I did 7 years on the Med/Surg and intermediate wing while I worked on my nurse practitioner degree and never regretted it one bit. I covered the ER and ICU a few times over the years and realized that it wasn’t my cup of tea. I was a charge nurse and realized that I didn’t want to get caught in the middle between the nurses and the bosses. You should do what you love but you need the experience in order to recognize the outliers that can happen. I agree that if you can handle Med/Surg with the usual loads, then you can handle just about anything!

  27. Gina

    I agree with the majority of replies to do what you love, but in some instances, a brand new nurse who has not had any medical training behind her, should do a year in med/surg. I was fortunate to go right to the ER as an LPN 16 yrs ago and when I finish my RN program (finally) in December that’s where I will still be. But our dept has an RN who graduated in 2009 who started with us a few months ago as her first job and it’s really not working out. She’s finished her preceptor period and we help her as much as possible but our department is too busy to be babysitting her all shift. Someone up above should have made a different choice about her.

  28. Katherine

    Thanks for posting the replies. I am a recent new graduate who obtained her nursing license and was offered an orthopedic surgical position. The working environment and the nurse manager would be amazing to work with. I was not only excited to be offered this position because its been hard finding a job, but I have always been interested in surgery. However, my concern is the fact that I eventually want to go back to school and I feel that jumping into OR without obtaining any basic training in Med-Surg may affect my future. Does anybody know if its hard to get a med-surg position if you started off in a surgical position? Thanks for sharing

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  30. jlh464

    Hi I’ve worked as a nurse for less than a year. My first paid nursing job was an RN residency on a cardiac step-down unit. There were many challenges as a new grad on my floor. Some days I had wished I had some previous med/surg experience like most nurses hired on my floor. Unfortunately, the reality of job market is that many of my peers are finding it hard to get jobs as a new nurse. No one wants to hire a new nurse and when they do, it seems to come only twice a year for a select few. Acute care nursing jobs for new grads is in reality, far and few between. My instructors in nursing school also told us to do med-surf first; however, there are not enough med/surg jobs to go around for new grads. So if you find a job would prefer doing instead of med/surg I say go ahead and try, because if you wait for a med/surg job to show up before you specialize, you may be waiting a long, long time.

  31. Katrina Milam

    This is probably an old post but I’m going to reply anyway, because it’s a great question and one I hear from many of the student nurses who pass through our unit. I work on Progressive care. In our facility that is part of the critical care team but we mostly have cardiac patients and patients who are just too high acuity to be on the medical floors.
    Generally, getting a good foundation on a med/surg unit is recommended, but it depends on the grad. If you aren’t completely sure what type of nursing you want to do, med/surg might be best. On the other hand, if you are positive you want to work in pediatrics or OB or psych or some other unit that hasn’t got a lot to do with general med/surg, you might be better off sparing yourself the torture of months or years of doing something you don’t love.
    As for ICU,CCU and ER, some new grads do it, it’s true, but it’s not the best situation. You need to learn a lot of basics like time management, prioritizing, hospital politics, and, importantly, what is the first thing you do if you need to do everything right now. Those things are best learned on med/ surg. Don’t be too upset though. You only really need a good solid 6 months to a year on a floor to gain those skills. If you don’t start out in med/surg you may miss a piece of the puzzle that may take years for you to recover. I actually started out in home health and it really put me behind. Then I had to explain why I’d been a nurse for 4 years already and didn’t know a darn thing.
    I work in a PCU now and I love it. On PCU (or an IMCU) you’ll learn most of the same skills you’ll learn on the med/surg floors and a lot of the things you need on the ICU units as well. You’ll get a lot of experience with cardiac patients and cardiac meds,ACLS etc. If you can find a PCU or IMCU that will hire you as a new grad that would be ideal, but typically they like someone with experience. In fact, the only time I have heard of someone being hired directly into an ICU, CCU or ER as a new grad is if they already worked in the hospital in some capacity while they were in school and they were such a top notch employee and made a fantastic impression.

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