Medical Surgical Nurses: Why are They Considered Second Rate?

Posted by Beth Hawkes in Dirty Little Secrets, Speak Out Speak Up // 2 Comments

You may be a nurse if you found the urethra and it made your day!
You may be a nurse if you found the urethra and it made your day!
Amanda is a new nurse who just landed a job in a large, well-known hospital. In conversations with her family and friends, she is asked “Congrats! What area are you working in?”

Amanda proudly replies “Medical Surgical Unit!”

To which they smile and nod vaguely. They’re sure it’s a good thing, but “Medical Surgical Unit” doesn’t have quite the distinctive ring of “Intensive Care Unit” or “Emergency Department”.

According to the Academy of Medical Surgical Nurses (AMSN), Medical-Surgical nursing is “the foundation of all nursing practice”. Medical-Surgical nursing is a board certified speciality. As the backbone of the nursing profession,Medical-Surgical nurses make up the largest group of nurses.

Sounds impressive, right?

Why are Medical Surgical nurses second place?
Why are Medical Surgical nurses second place?

But in reality, Medical-Surgical nursing is not regarded as a speciality so much as a default career choice, or at best, a stepping stone to other areas.

Medical-Surgical nurses are not accorded a high place in the nursing hierarchy.

The Contradiction
Jeanette, ICU manager, is scrolling through applications.

She sees on Kaitlin’s app that she has almost 3 years of Medical-Surgical experience. Jeanette is thrilled. She rushes to call Kaitlin for an interview before someone else scoops her up.

Before someone else scoops up this nurse with 3 years of managing hypoglycemia, hyperglycemia, and hypertension. Jeanette knows a nurse with Kaitlin’s skill sets has mastered procedures, PICCs, PCAs, post-op patients, and acute CHF exacerbation.

Kaitlin can handle a flash pulmonary edema or a frank GI bleed in the course of a shift. She recognizes early signs of sepsis and wards off Code Blues on a slow day. This while she is precepting a new grad and helping to plan the monthly birthday potluck.

While no one denies the value of having MedSurg experience, not much value is assigned to being a MedSurg RN.

What is the reason for this seemingly cognitive dissonance?

Cognitive Skill Sets
Medical-Surgical nurses pretty much do the impossible every shift and often before noon.

Not until an ICU nurse floats to Med-Surg and attempts to manage 5-7 high acuity patients plus two or three discharges and admits, does she/he appreciate the Medical-Surgical nurse’s ability to organize, prioritize, and make decisions.

More than multi-tasking, it’s cognitive stacking. Cognitive stacking in chaos.

Medical Surgical nurses manage a team of patients who are constantly going off the floor for diagnostic procedures, or coming and going from Surgery. They are transferring patients to ICU who should never have been sent to Med Surg in the first place, discharging patients home, or accepting ED admits and StepDown transfers.

Donna Wright, the Nursing Competency guru, says “The core skill set of a Medical Surgical nurse is knowing where their patient is at all times.”

Technical Skills
Never mind calling an ICU nurse to start an IV. They rarely start IVs. Call Med Surg where a typical nurse can skillfully start an IV on an elderly patient with fragile veins (doesn’t use a tourniquet), an obese patient with no visible veins (palpates veins with eyes closed), and a dark-skinned patient (uses alcohol swab to make veins show).

He/she can find a hidden urethra and insert a Foley with no problem. Tell a patient to “swallow” and place an NGT before the patient knows what happened.

Are Med-Surg nurses the unsung heroes of nursing? Do they deserve more recognition?

What really underlies this disrespect for Medical-Surgical nurses?

It’s time to stop diminishing each other and instead value and recognize what we all have to offer.

What are your thoughts? I’d love to hear.