You Don't Have to Start in Med-Surg as a new Grad nurse

In reflecting on my career, I'm reminded of something I heard a lot of as a student: start in Med-Surg. I got lots of reasons. In hindsight, It would've been better to do the thinking myself regarding what I wanted instead of listening to those telling me how it is supposed to go. 

Do You Have to start in Med-Surg as a new graduate nurse? No. That is my opinion after working in different specialties of nursing. It is not a bad idea to start in medical-surgical nursing but it is not a requirement or an absolute necessity. If you get the opportunity to work in a specialty you would like to end up in, please go ahead and take that opportunity. Your body will thank you later. 

When I was graduating from college, a professor I admired told me to start in med-surg. And back then, it wasn't uncommon to here people say "start in med/surg". One of the reasons I sort of recall was so you can learn the basics of nursing and what not. Another rationale was that because you are new, you want to give yourself time to learn and expose yourself to a wide variety of cases. Sometime within the last 6 or so years, I have looked back and either thought or said to myself that if I had to do it again, 

• I'd find a small hospital where major stuff gets shipped out
• I'd get a position in a recovery room somewhere and resign myself to PACU Nursing (Please note that not all PACUs are the same, some are easy and some can make you question if floor nursing is really worse. I've worked in different ones so that's a story for another day. I'm referring to a chill PACU here although some of the "chill" ones can have their drawbacks.)
• Taken that ICU position at Methodist Hospital instead of listening to people tell me to go to a med-surg unit at Penn. (And I think Methodist paid more also. That's what you get from listening to people who are not you. I should've followed the money). Why? CRNA school requires ICU experience. By the time I got the chance to work in an ICU, I was about 5-6 years into my career and already planning an exit.
• I'd have gone back to school for my masters - not for the money but to leave the bedside early. I do have a Masters degree but it's not in Nursing. Ha.
• Maybe considered psych (and they paid a whole lot more also) and I actually like it.
• many other thoughts I'd reserve for another day.

I don't even think you have to start at the bedside if your goal is to work and stay in the clinic setting or community setting. Just know that for some specialties, there is a significant downside when you later decide to switch to the hospital settings. If I recall correctly, there was a psych nurse who was orienting on a med-surg floor many years ago and she was like a new grad as she wasn't used to a lot of things. Still, you don't have to start at the bedside. I used to volunteer for a  clinic over a decade ago. During the Great Recession, there was a nursing glut and some people couldn't find jobs. One lady started volunteering at the clinic with another person and she went back directly for her masters. Last I checked about a year or two ago, she is there on staff as a Nurse Practitioner. Do I think she is qualified and good at her job? Yes, I think so. Having worked there, I did some interesting things that most nurses may not even do at in the hospital. Also, the place was actually staffed with doctors and had two medical directors along with other doctors. In addition, there were other experienced nurses and professionals there to learn from. Considering it's the same patient population she's dealing with, I think she's more than qualified in her role. She is one person who dodged the hospital and became a nurse practitioner. I'm glad she didn't listen to the naysayers. That clinic was a place I enjoyed volunteering at. 

One of the arguments is that you'll learn things in med-surg like how to insert a Foley and other things. I think OR nurses put in more Foleys and I've had the pleasure (or should I say displeasure 🤨) of putting them in post-surgical patients who are in pain and not really interested in getting a Foley put in. There are nurses at the bedside who don't know how to put in a Foley or they are simply not comfortable with it. They simply tend to ask someone else to do it. And when it comes to things like NG tube, there are some who dodge it because they have not bothered to  learn how to insert one. I recall telling a newer nurse one time who left it for me to go put it in. The order was from much earlier in the day and she had not bothered to do it. It wasn't because the order was from earlier in the day, I've had things forgotten at 9 a.m and I understand that people get busy; it was because it was a pattern - she would leave it for the next shift and I was done with her continuously doing so. I realized it was because she didn't know how to do it so I asked, hoping she would  learn and she simply went and got another nurse to insert it for her. I hope she learned. Although I wouldn't be surprised if she's now an NP. That goes to show you that bedside experience doesn't mean a lot these days as people at the bedside just go through the motions and avoid doing certain procedures. 

If you are a new grad contemplating the ER or ICU like I was, please go for it. Don't let someone tell you that you have to start in med-surg to learn the basics. That's what nursing school and Clinical rotations are for - teaching the basics! Do an externship and learn the basics then. I knew how to draw blood and insert IVs before starting due to such internships and externships. I think it's wise to know what you want to do with nursing and start that journey from the start. If you want to go to Los Angeles from Boston and can get a direct flight to Los Angeles, is there any reason to fly to New York and take a flight from there? Or is there a reason to fly to drive to NY and take a flight simply because it's a bigger airport? I don't think it's any different from a new grad who knows they want to be a CRNA wanting to work in the ICU. There's no need to take the scenic route of going to med-surg when you will be doing most of the things and more in the ICU. Heck, you're likely to put in more Foleys, IVs and even fecal bags in the Unit than the on a med-surg floor. 

The choice is yours: you can take the direct route or the scenic route. My suggestion is to not let people dictate your life. Nursing is not an easy job. I'm not talking of just the physical aspect; I'm also referring to the mental and emotional toll it exacts. I really don't think bedside nursing should be done for more than 10 years. Yes there are nurses who have done it for 30 and 40 years. Please keep in mind that patients these days have a much higher acuity and multiple comorbidities. And how many of them can say they had patients in the '70s who weighed over 600lbs?!