A League of Their Own
Med/surg nurses deserve recognition as a specialty

By Carol Bradley, MSN, RN, California Editor
September 10, 2001

When you turn around and look back at the many changes in health care in the last two decades, I suspect it is the med/surg nurse who can tell you, in the most dramatic terms, how they have affected the care of patients … for the good, as well as for the bad.

While no one in nursing has escaped the earthshaking changes that DRGs, managed care and patient care restructuring have wrought, the epicenter clearly occurred within the med/surg units of our inpatient hospitals. That is where the greatest changes in length of stay, patient acuity and technology rapidly transformed the care of patients. Unfortunately, it is also where the cost-focused "redesign" consultants aimed their guns most often.

These sweeping changes in care (both good and bad) are also what made med/surg nurses specialists in their own right. Increasingly, med/surg care has become subspecialized and tailored to meet the needs of specific patient populations. Regardless of care setting, many of these patients have lifelong chronic diseases that will be managed by an experienced, specialized med/surg nurse. As more care has moved into the community, it is the nurses with strong med/surg backgrounds who are in demand and worth their weight in gold.

Most hospital nursing leaders agree that it is the med/surg nurse who has the toughest job today. This is the area where the most diverse knowledge and skill expectations exist, where the pace of care has accelerated beyond what anyone expected and where a relentless workload allows for little or no pause. Amazingly, this is the environment that the majority of our new graduates first experience. It is also where the pressures for improving quality and service tend to be emphasized, yet needed infrastructure and resources can be lacking.

When it comes to historical hospital capital investments, we all know that resources far more often have been directed toward the specialist and his/her new high-tech toy than for basic IV poles, wheelchairs, electric beds or computerized documentation for a med/surg unit. In my assessment, a demonstrated commitment of resources for nursing care in these areas has been a good indicator of a hospital's real priorities. Physician colleagues have confirmed that they, too, can measure a hospital by the quality of the nursing care on the general medical and surgical units.

I predict that our med/surg colleagues are in for some long overdue positive attention. As everyone rushes to address the issues of work environment, staff retention, staffing resources, patient workload and support infrastructure, it is certain that med/surg nursing will be central to the ultimate solutions. Savvy employers already are turning their attention (and resources) to their med/surg nurses and patient care environment as the keys to larger organizational issues and challenges.

For example, med/surg is clearly where the core issues around the staffing debate (aka staffing ratios) need to be focused. All you have to do is look at the diverse med/surg staffing ratios reported by California hospitals.

While I am not a proponent of staffing ratios, it is a sorely misinformed person who would suggest that the care requirements of healthy postpartum moms justify a staffing ratio that exceeds that for complex and unstable med/surg patients. It has never been a truer statement that if you can work med/surg, you can handle anything. Yes, there is reason that some specialty nurses resist floating to med/surg.

Perhaps the greatest recognition in the nursing profession in the last decade is that med/surg nursing and its many varied subcomponents are deservedly true specialties in their own right.

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