Promoting the Value of Medical-Surgical Nursing Experience

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Nurse leaders of Medical-Surgical units find themselves in a tough place in today’s tight nursing job market. It has grown increasingly more challenging to recruit new nurses. The media message is clear on both TV shows and in the movies. The excitement in healthcare is found in critical care units, emergency departments, operating room and labor and delivery. It is not surprising that most new graduates come into healthcare seeking a position in one of these areas. Often, they take a medical-surgical position with the intent of transferring to a specialty area as soon as possible. When health systems try to put a one year transfer policy in place, they find they may lose some of their best nurses to other organizations in this competitive job market.

These units, their nurses and leaders are unsung heroes in healthcare. Most inpatient care occurs on medical-surgical units. Over time, patient acuity has increased as has the number of daily admissions, discharges and transfers. This new employment trend has been devastating in many settings. Leaders tell me that medical-surgical units today have a shrinking pool of core staff as many Baby Boomer nurses have begun to retire. The staff turnover in some of these units now exceeds 40% each year. Preceptors are burning out as there is an endless cycle of new nurses to orient. The quality of patient care suffers as it becomes harder to standardize care with the continuous turnover of staff. The staffing mix of many medical-surgical units is predominantly nurses with two years or less of experience.

Historically, nurse leaders turned to foreign recruitment as a strategy to staff medical-surgical units during staffing shortages especially on the night tour. With immigration changes, that option is now not feasible for most organizations. Instead, vacancies are often filled with nurses on 3 to 6 month travel contracts. A medical-surgical manager recently told me that 35% of her positions are now filled with nurses on travel contracts.

The impact of this new normal in many markets has led to high turnover among medical-surgical nurse managers who are often held accountable for variables that they have little control over. Highly committed medical-surgical nurse leaders and their executive leaders are trying various strategies to meet their challenges. One organization now uses a $30,000 sign-on bonus for a two-year commitment to remain on their medical-surgical units. Leaders in other organizations are redesigning care by designating their medical-surgical units as Dedicated Education Units (DEUs) through which every new graduate now rotates for a short period of time. These units are staffed with highly experienced Clinical Specialists, CNLs and ARNPs who are there 24/7 to support the clinical care given by staff.

We know that the skills gained on medical-surgical units help to build a very strong foundation for new graduates. Like many nurses my age, I started my career on a medical unit. I had every intention of transferring as soon as I could. But something interesting happened – I fell in love with the challenges of working with a diverse group of complex patients with a wide range of diagnoses. I enjoyed juggling the care of a group of patients. I really liked teaching patients and helping to plan their discharges. I quickly moved into a charge nurse role because there were more leadership opportunities. I sat for one of the first certification exams in medical-surgical nursing. I had a fantastic “head nurse” who coached all of us to be better every day. I felt like I did work on a specialty unit albeit different than others.

Over time, we have devalued working on medical-surgical units and it has been to the detriment of patient care. I am concerned as I work with young medical-surgical nurse managers because many feel their situation is dire, and no one seems to care unless there are issues with the unit’s performance measures.

It is time as a profession to focus energy on working to resolve the many challenges in medical-surgical nursing today. I spoke with a CNO who is committed to do this. One of her medical-surgical units has had 3 managers in the past five years. She recently recruited two of the best leaders she knows to act as executive directors of her medical-surgical units and nurse leader coaches to the young nursing staff. They have been staffed with a business manager and each unit has a dedicated educator. She is providing funding for both a certification review and the exam for every eligible staff member. Her goal is that both of these units achieve the PRISM award – the highest honor achievable for medical-surgical units from the Academy of Medical-Surgical Nurses. This is a very good start to restore pride in a worthy specialty.