Now feathers may ruffle with this blog post…
Most seasoned nurses will often suggest that new graduate nurses begin their nursing career on a Medical-Surgical (Med-Surg) unit to lay the groundwork for their nursing career. Moreover, the Academy of Medical-Surgical Nurses supports that sentiment by stating, “Medical-Surgical nursing is the foundation of all nursing practice.” And in that respect, being the largest specialty of practicing nurses, Medical-Surgical nursing is often regarded as one of the most respected and most demanding choices in nursing practice today.
Along with the belief that Med-Surg is an excellent foundation for nursing practice, there is a certain creed among the nursing profession that new graduate nurses should begin their nursing career in this specialty regardless of their desire to work in other areas.
Unfortunately, however, this can sometimes lead to new graduate nurses who may feel stressed and unfulfilled in their day-to-day work and disenchanted in their career choice. Eventually leading to new graduate nurses quitting the nursing profession altogether… before they even move into the specialty of their choice.
Case in point:
Extremely excited about critical care nursing, I had the opportunity to work in the Coronary Care Unit (CCU) during my senior practicum with another classmate. Both of us were hopeful to get a position on the unit after graduation, but had our hopes dashed when the director of the unit told both of us that she didn’t hire new grads and that we should first gain nursing experience on a Med-Surg floor. She also suggested that after we get our experience, we could later apply for the CCU.
At the time, I was very disappointed about this because I thought the opportunity to do my practicum in a critical care area would give me an excellent chance to get my feet into the door of the ICU or the Emergency Department, my desired specialties. And truthfully, at that time, I was dreading working in anything else but critical care.
After graduation, I was offered a position on a Med-Surg floor as well a position on a Burn/Trauma step-down unit, the latter which I accepted. And although it wasn’t my first choice, the Burn/Trauma step-down unit became my stepping stone for the Emergency Department.
The Myth
Medical-Surgical Nursing is where all nurses should start their career.
The Reality
Any specialty in nursing can give you a foundation in your desired nursing practice.
Here are 4 reasons why seeking a position in your ideal specialty is a good idea:
- At the risk of sounding cliché– Life is short. If you’re truly interested in one line of work, do what you love and not what’s expected. Yes, the competition is high for certain specialties, but if you’re truly interested in Labor & Delivery, ER or Neuro ICU, go for it. You’ll still learn about the art and skill of nursing, just in the specialty that you desire to work in. Moreover, there is something you can learn in every specialty of nursing that you can apply to another field of nursing.
- You handle stress well. If you handle stress well, you’re likely confident in your ability to handle fast and frequent change. And as a nurse, you’ll find that stress is a part of learning any specialty. Albeit, the stressors may be different, but it’s important to seek out ways of self-care to help you deal with it. And, if you already handle stress well, this won’t be an issue. Which brings me to the next point…
- You have a good support system. With any change, it’s great to have a circle of family and/or friends that can help you through stressful times and help give encouragement when you’re at your lowest. With a good support system, stress becomes more tolerable which makes returning to the day-to-day much easier.
- You’re a fast learner and you’re self-motivated. Just starting out on your own as a new nurse, you’ll find the growth curve can be steep. If you’re a fast learner and have the motivation after a long day at work to go back and review and study the material that you learned that day, going into a your desired specialty is a no-brainer.
So, as a new nurse, feel free to learn about specialties that you find interesting and don’t be afraid to apply for those positions. You may find just what you’re looking for. Good luck in your choice!
This post was written as part of the Nurse Blog Carnival. More posts on this topic can be found at http://thenurseteacher.com. If you are interested in participating find out more details and sign up.
Photo Credit: “Army Reserve Nurse Delivers Baby in Rural Uganda – United States Army Africa – Natural Fire 10 – AFRICOM” by Maj. Corey Schultz is licensed under CC BY 2.0
I complete agree with you. Unfortunately in many areas there is so much competition for jobs for new nurses that I’m sure those nurses are willing to take any job.
In my area the jobs weren’t impossible to find, but it was extremely difficult to find a job in a nursing speciality, although not impossible. A handful of the nurses I graduated with landed in the specialties of their choosing. A bigger chuck of us landed in whatever we could get. However, I don’t think that a few years in a specialty you don’t love is a bad thing. You might actually find that you enjoy that specialty or it may really confirm that you want to do something different.
This is a fantastic post, by the way!
Thanks for reading Brittney!
I agree… If you’re placed in a undesired specialty, it’s not necessarily a bad thing. There’s always something to learn in any opportunity!
As a former manager of Oncology, I fought very hard to get a new grad in my department. I had to go up against the beliefs of the admin above me. But I went to bat for a new grad, and they let me hire here. It was hard on her, but she’s still there in that outpatient unit and loving it! I always believe you should have to fight to live out your passion.
Hi Joyce! Thanks for reading. It’s great that you supported a new grad in her desires to work on your unit. Hopefully, the trend is moving in that direction.
Hey Joyce,
You sound like you made a great choice going to bat for her especially considering that she is still there! One thing that is often overlooked is the advantage of hiring a new grad in a specialty area (as long as they have a long preceptorship program) is that new nurses do not have ingrained “bad” nursing habits. Old habits and ways of doing things can be hard to break in experienced nurses. New grads can be taught correct evidence based nursing practices from the get go.
Thanks for your response Erica! Orientation programs are amazing when you have them, and it helps new grads tremendously in their practice by providing a knowledge and skills’ foundation from the start.
I agree. I still hear the outdated “I don’t hire new grads in my ICU” even after there are studies out there to show if nurses work in areas they want, they are happier, which translates into retention in that unit, and in nursing.
Hi Teresa! Thanks for reading and your comments!
I’m glad to see established nurses writing pieces like this. I am still in nursing school but thinking about my future job search and I hope that I can apply for jobs in a variety of areas rather than feeling like I only have one option.
Hi Tina! You do have more options. If you’re able, and depending on the area you’re in, apply to teaching hospitals. Trauma centers are better if you can find them. They often have new graduate orientations and will sometimes have programs for new grads in critical care or other specialties if you’re looking to start somewhere besides a Medical-Surgical unit. Good luck!
I am a senior in nursing school, I will be graduating in may. This has to be the most uplifting and motivating article I’ve read. Thank you, I will be sharing with my fellow classmates.
Hi Schaina! Thanks for reading and sharing with your classmates. If you’ve made the decision on where you want to go in nursing already, pursue that! You’ll get the foundation necessary for your desired practice. And, good luck in May. You’re almost there!
I, too, am interested in something other than Medsurg. However, it’s being on the PICC team. They have hired new grads, but I’m dissuaded by a large percentage of people I share this with. What’s the worse case scenario–having to start on a Medsurg without new grad status (read leniency)? Wouldn’t L&D or psych run into same dilemma? Your thoughts?
Hi Em! Thanks for reading and your comments. If PICC team is where you want to be, I say go for it. Worst case scenario would be regretting not doing it a year, 5 years or 10 years from now, right?
Very imformative article. I am also in my last semester of nursing school and I am also a tech on med-surg unit. Nurses on my floor (med-surg) have different opinions on this med-surg myth. I am having several interviews with med-surg, ED, and PCU. Well.. of course I will get what I am given but still being undecisive what path I want to take.
“Working at Med-surg is a waste of time, hard to get any critical nursing care opportunities.” A quote from my co-worker today. Would you agree? I do not mind working at med-surg floor but I still want to have some hopes after 2 years when I am done with my contract. So what’s your thought?
Hi Rika. Thanks for reading the post. I think all specialties of nursing provide tremendous learning, and none are a waste of time… including med-surg. I also believe in pursuing a specialty that you’re interested in. Just remember, you’ll get a foundation in any practice. And, any practice can prepare you for the next. You just have to believe you’ll learn in the process. Good luck with your interviews, and keep me posted!
Hi Marsha,
Spot on again! I started in pediatrics (what I wanted) and have stayed there (practice and teaching) all these years. Guess it was a good choice for me! I say follow your heart and do what you love.
Hi Donna! Thanks for contributing, and I’m glad you had the opportunity right off!
Very interesting, Marsha and for me of the older school, I had to work a little to stay open to the idea. And I think you have supported your reasoning with a great example and tips for making it work. I have to say that I think cultivating enthusiasm is extremely important in both new grads and seasoned nurses!
Looking back, I think I would have enjoyed my first year more in med-surg if I’d had more support i.e. better staffing and less vertical and horizontal violence to deal with. I also wonder, in the big scheme of things how much need there is to staff w/ med-surg and then what do we need to do to make it appealing for nurses to work and stay in such positions.
Thanks for educating me in a new way of thinking!
Thanks for being open Beth. And I also think that support really makes a difference in keeping nurses satisfied in their careers, new and seasoned!
Marsha, excellent post especially for us ‘older nurses’! I have always proposed that new nurses need to have a few years experience before moving into advanced practice and management. Professionals like case managers need to have the experience that comes with working in areas such as Med Surgical nursing to be able to recognize obstacles that they will encounter assist patients and their families with resources and taking the time to educate and empower those who face new diagnoses and life long chronic conditions.
I do agree that those who want to start out in specialty areas such as the OR, Pediatrics and Oncology can get that experience in these area….vs. starting in Med-Surgical Nursing.
With jobs being so tight for new grads, I would like to see hospitals open up internships in various areas where new grads can gain experience and decide where their niche is.
We as seasoned nurses also need to mentor new graduates, welcome them to the profession and assist them in learning the ropes. This is so important for retention and to ensure nursing remains a caring profession.
Nursing has been a wonderful career for me and has opened doors that have been personally and professionally fulfilling. It is my turn to give back!
Thanks for your thoughtful post Anne. And thanks for supporting new grads who would like to start in specialty areas first. Teaching hospitals, especially the higher level trauma centers, are great for this as they often have critical care internships. And I agree, nursing has been wonderful… and there is so much you can do with our experiences!
Love this post, Marsha Ann. I was one of those who went against the grain and didn’t go into Med-Surg after nursing school. I never thought I was going to become a nurse growing up, so the thought of doing something nurse-y freaked me out. Love your four-point check list on figuring out if we can go for it and follow our dreams! Totally agreed with your points and am able to see why I ‘made it’ as a psych nurse starting out.
Awesome Elizabeth! And as a nurse with an ER/Trauma background, we loved our psych nurses! Thanks for your contributions!
I took the first job offered (and the only one I applied for) because I was desperate to have a job secured before graduation to relieve the financial burden on my family. It was a nurse residency program. I was not informed at the time that I would not be allowed to work in the ER or Newborn Nursery or PACU – my three areas of interest – because they don’t hire new nurses into those specialties unless you precepted at their facility. I precepted in ER at a different facility. I was devastated but already signed a contract. Now I’m 5 months into working MEDSURG and I hate it more than anything. I’m actually considering leaving the profession altogether.
Hi Allyson! I’m so sorry to hear about your situation.
Maybe now with more experience you’ll be able to apply to another facility, maybe the one where you precepted. If you can get in touch with the nurse manager or recruitment and let them know how you feel (calm, cool and professionally), maybe they can help you with other options. Or, since you already precepted at another facility’s ER, maybe now is the time to request making a move into another area that interests you at your own facility. Speak openly with your supervisor/manager and let them know how you feel. You may be surprised at the options they may be able to offer. Also, reach out to your nurse educators. They may have some insight or ways that could help.
Another option: contact managers in the areas of your interests and ask if you can shadow a nurse for a shift. Tell them about your interests. You never know where it could lead.
If those options don’t work, you may have to consider leaving your contract (have something in place first though). Would the money you would have to pay back be just as important as your reducing current stress level and overall well-being? If so, the payment may be worth it.
Please keep me posted on your decision!
Sorry but someone who is willing to even entertain the idea of leaving the profession after 5 months simply because they didn’t get what they wanted is absolutely ridiculous in my book, the fact that she is where she doesn’t want to be is more than likely the reason she hates it. Instead of embracing the experience and looking at the fact that any job will give you experience and only help you in the end. As a nurse you are not to good to work anywhere, her attitude is actually what is wrong with this current generation of nurses. I have been in healthcare for 24 years worked in a hospital mostly in the ER as a tech, been an EMT from basic to intermediate levels, and just recently had to take a nursing grad job on a medsurg unit, no it is not what I wanted and the person that got the ER job was a far less qualified graduate than me but, life isn’t fair and you don’t always get what you want or deserve, but how you handle yourself is what defines you as a professional. Her attitude makes me question how she does patient care if she is truly unhappy. I grew up in a hospital and had truly amazing nurses to shape my ideal picture of a nurse and while I thank you for you positive attitude and all you do to make our profession better this new attitude of I’ll just quit if I don’t get my way is what is killing the profession.
This is so refreshing to read! My senior practicum was in an ambulatory surgery unit and I just loved it. I’ve just been offered a position on the unit and some of the nurses have suggested I get med-surg experience before I try to work in ambulatory surgery, and that it’s more of a place for people with significant experience. I really want to take the job but now I’m worried that there won’t be opportunities for me if I want to transition out of the ambulatory surgery/perianesthesia nursing specialty one day because I won’t have that broader background that comes with med/surg.
I completely agree. When I was in nursing school my instructors encouraged us to get at least one year of med/surg experience before we branched out. I knew I wanted critical care. I also knew that if I worked in med/surg for a year I would most likely leave the profession. I have the utmost respect for med/surg nurses because I know I cannot due their job. I cannot multitask for 5-6 patients. Let me focus on 1 or 2 critically ill patients.
Thank you Marsha! I am finding your article in a rather random and desperate google search. I am a new graduate of 6 months. I have been working/orienting in a med-surg/tele unit at a community hospital for about 2 months. This hospital is one of the few hospitals in the area that hires associate degree nurses, due to the common magnet programs. Quiet frankly, I hate working in this unit. It doesn’t help that the hospital is disorganized and continually short staffed. I feel like this area of nursing is just not for me. I originally wanted to work in ICU/CCU and so far I feel like a failure at nursing in general. It has been so ingrained in me that you have to succeed at med-surg before moving on to “more difficult” areas of nursing. I have been very down and dread going to work. I have spoke to my AUM and director, and I recently asked to be moved to nights or if possible transferred to the psych unit. I have to make a decision by Monday…such a dilemma. Reading your article and the following comments has helped me to decide to ask to be moved to psych. I really enjoyed my psych rotation in school and love talking and educating patients. Thanks again!!!
I’m so bummed you feel this way! I never realized just how lucky I was 20 years ago to hire directly into OB right out of school. I knew my instructors had recommended med surg, but before nursing school even started, I knew OB was my jam. I have never regretted that even one tiny bit. I’ve stayed in OB this whole time. It breaks my heart to hear about nurses who feel miserable in their position because of some outdated “rule.”
Hi Marsha, This was such an inspiring post. I currently was a pct on a cardiac med-surg floor. I don’t really hate it. But I’m not fond of it either. I really want to get into OR nursing. I have a feeling that I will hate nursing if I am stuck on the med-surg floor. I’ve been told that it’s best to do med-surg even from a friend who hated it. Thanks for the enlightenment!
Thank you for this article. I actually went into nursing to pursue midwifery. I started the education journey a while back, taking prereqs little by little. By a while back I mean 2007 lol! I’m now going into my last semester in nursing school. I’m currently working as an extern in an oncology unit at the hospital where I want to work after graduation. My externship is going really well, I mesh w/ the nurses and techs on that floor really well and I thin I have a pretty good chance of getting hired there if I apply when I graduate. I just (in the last two weeks) did my NICU and mother/baby clinicals at this hospital and I hated it. It seemed boring and slow compared to my job as an extern. I’m also not loving my OB class. Not so much the content, but the class. I’m already a birth doula and I was so looking forward to OB and my clinicals in OB. However, I’m now so confused and heartbroken. I’m not sure if this is where I’m supposed to be although I have wanted to catch babies since I was little. When I go to work as an extern, I feel excited and my heart feels alive. When I work as a doula, same thing. But my recent clinicals made feel like I was wasting my time.
I had a chat with a clinical instructor that I admire and love who is a women’s health NP, used to be a midwife. I asked her this very question, if I should apply for the L/D residency or if I should work in med surg for a few years to solidify my skills. Her answer was exactly what you wrote about….apply for L/D because life is too short. My concern now is that I didn’t love it as much as my externship floor. My ultimate goal is to open a birth center locally and give women more delivery options in my community. Thinking of this makes me excited and motivated, however, how can I work in a unit that makes me bored and depressed? I’m leaning toward applying to my current unit as a resident and then reevaluating when I begin grad school. Do you think it would be a waste of time to not work in L/D until I get my masters? I’m not sure what to do. The application for the residency will open in a few weeks and I need to decide where I will be for at least the next year.
Got a job in critical care right out of nursing school. Did okay for 20 weeks of training but then alone, things have gone downhill. I feel so unprepared. Lots of 7p to 7a and mandatory overtime. I am unable to sleep well and have exhaustion. I am afraid I will not receive a good reference if try to find something I am more comfortable with. Any suggestions?
Excellent post about Medical-Surgical Nursing. Really very like it. I’m also pursuing career as RN. And this post very helpful for me. Thanks for sharing.
Marsha am so greatful and appreciate you with much love from my heart for creating this forum for nurses.When i got out of nursing school,i felt i was the most frustrated about which area to apply to with the Medsurg myth.So circumstances led me to start with Psych with which i had a peaceful clinical rotation. Been there 1 year now and believe me there are times i feel useless especially when needing to do basic procedures which i know from nursing school are commonly done on the medsurg units.At this point, i have decided to revisit medsurg, even if it is only going to be for 2 months.I have an interview coming up. What am praying for is proper orientation and support as i learn from other nurses just like other colleagues have mentioned above.if i have supportive orientation i will do great. My medsurg instructor scared the hell of medsurg out of me during clinicals. What they fail to realize is that we come to nursing school with different experiences.some get it fast and some get the skills progressively. Am relying on my enthusiasm to pick up the broken pieces.Will appreciate any in sights from you and other nurses.thanks again.
I agree with this article. Just a tip for anyone considering nursing or is in school now: geography is going to be a big factor in your ability to get into your choice of job. Some locale are saturated with new grads. Willingness to work in rural areas/inner cities for a few years is a way “in” to some of the more desirable specialties as there are fewer applicants. Just something to keep in mind.
My first job out of nursing school was on a med-surg floor. After 10 months of struggling to make this work I was ultimately terminated because of patient complaints. No matter what I did for the patient or how much I did for them they still found something to complain about and administration does not like patient complaints. I had already had 20 plus years experience in Radiology as a CT Tech. They did allow me to resign however which would look a little better on my resume. I just could not make med-surg work for me. I would like to try working in the emergency room which is where I’m most familiar since most of my CT patients came from the emergency room. I was told by my director that I do have the personality of an ER nurse so I’m hoping that will work a little bit better. What I don’t understand is what I needed to do differently so that patients didn’t complain?
I’ve always taken patient complaints with a grain of salt. Patients are already feeling miserable because of their health. The real sick ones tend to complain about everything. I once had a patient complain about me because Fox news wasn’t working on his TV. Another patient had an outburst because the doctor wanted her on a low potassium diet. Of course to the patient, it was my fault. Another grown adult patient of mine cried because the unit ran out of orange juice, and all I could offer was apple juice. Another complained because I came into to take their blood pressure. Americans are entitled, thus pt complaints are the norm.
I don’t agree. New grads should start somewhere with more stable patients. For example, ICU is extremely difficult. A new grad could easily find themselves in over their heads. This can lead to burnout and even worse, fatal errors and loss of license. A new-grade going for ICU is setting themselves up for failure. Yes, med-surg has a larger patient assignment, but the patients themselves are much more stable and actually require less effort to care for than more acute units. I’ve been working in a PCU for 3 months as a new grad and I’m just about finished with it. I rarely have breaks, I literally run around the halls to speed up productivity. My patients have non-stop medications and treatments spaced out throughout the entire shift. I’m suppose to chart full assessments q4h, which take hours out of my day. Put a rapid response on top of that and its no longer humanly possible to handle. Meanwhile, whenever I have time to sit down, my work phone starts ringing. I am learning a lot, but I’m burning out quickly. When I did practicum in a med-surg unit, I had time to sit down and actually think about my patient’s conditions and create plans. I could take breaks and even talk to other nurses. I’m just saying going into your preferred specialty from the beginning could lead to burnout and failure. Delayed gratification is a good thing. Build your foundation first, then go into your dream specialty.