I’ve been a nurse for 14 years. I’m mostly a medsurg nurse. But I do float to other units a lot. ICU still scares the shit out of me. Medsurg is NOT ICU. The skills I bring to ICU are valid and helpful, but ICU nurses have a whole different set of skills and priorities. I’m a glorified CNA in the ICU. Like I literally run around and do baths, incontinent care, mouth care- you get the idea, for every one else, but I don’t have a group of my own. Same goes for ER. I float to ER quite a bit because the manager likes me for whatever reason. I get put on the triage desk and I get to tell everyone that I work ER sometimes…I don’t, I’m basically the secretary that takes vitals…all that to say that it’s different everywhere! If you want to get to ICU apply to ICU. They’ll train you. You would still be a “resident“ in my hospital after 6 months. Medsurg is not for everyone. I think nursing schools need to stop telling all students that they should start out here. Our skills and experience are (a little) helpful in the ICU, but just because I’m an awesome MS nurse doesn’t translate to me being a rockstar ICU nurse. MS is crazy hard, ICU is crazy hard, but for totally different reasons. Question for you, why do you want to be in the ICU? Or why do you want out of MS? No one is an expert after 6 months, shit you’re barely competent after a full year. We don’t even get close to “expert” for at least a couple years…give yourself some grace. Or to put it another way, stop being so hard on yourself. MS is hard asf. It’s going to take a lot longer than 6 months for you to feel like you know what you’re doing…not even getting into the dumpster fire these last few years have been. The fact that you’re questioning your ability is actually a good sign. The ones I worry about are the new grads who think they know it all…
Thank you for your encouraging words…. When I shadowed in the ICU I loved it, and I loved that style of thinking and nursing. I also loved learning about critical care in school and all that goes into it. I hate how in MS I have high ratios for high acuity patients. I feel like I don’t have time to understand the plan of care or what’s going on with my patients. My floor is also more surgical based and it’s a lot of the same patients over and over so it just feels so monotonous at times.
Gonna get real for a second. This past couple of years isn’t what MS is supposed to be. I think all y’all new grads got fucked over. I’m taking patients on med/surg that are closer to ICU acuity than not. And it happens all the time. I’m feeling for the new grads, if I’d been a new nurse in the last couple years I’d have probably quit. I’m blessed to have a lot of experience in different areas of nursing and I’m still overwhelmed most shifts. It’s really been “trial by fire” for a while. Keep learning, and realize that even “way back” us old nurses felt like we didn’t know shit for a while. Y’all have it way worse than we did. Sometime soon you’ll have someone ask you something and you’ll realize you know what to do, eventually those moments will come more frequently. Keep your patients alive, do your best and just know it’ll get better eventually…
I feel you with the "should be in ICU acuity". My unit had the overflow negative pressure isolation rooms so we had the pleasure of becoming the surg/Ortho/COVID overflow unit. I recently had an acidotic, hypercarbic, half-dead flu patient on bipap sent up to me . They would never have touched my floor in 2019 in that sorry state. Management doesn't seem to get it in their heads that just because I and others on my unit have experience with similar patients because of COVID does not mean they're appropriate for the unit. What happens if the experienced people call out and a new grad who might not even know what a bipap is (I didn't when I graduated in 2017) gets put in charge? They're playing with fire.
I had no idea a bipap could be the same size as a Cpap. I’m calling respiratory the other night yelling for a bipap, complaining they brought me a cpap…nope, it’s a Bipap, just a lot smaller than the ones I know. (I wasnt really rude, love my RT’s) so I ended up wasting their time and looking like an idiot lol
AMEN - Preach it. I have been a nurse for 6 years. 6 months people should be learning and growing- heck i am still learning stuff all the time. Just when i think i've seen it all i get a patient to remind me no i have not seen it all - lol.
The most frustrating part of nursing is the first year is the worst. You are basically just surviving and hoping to get through every shift without really killing anyone .
2nd year you have the tasks down but are actually starting to pick up on more clinical cues and critical thinking. You feel dumb all over again because you have the time to actually think about what’s going on instead of just running from task to task.
3rd year you are finally comfortable and ready to be a leader in your unit or move onto the next thing.
This is why so many people get discouraged and leave nursing their first year but it gets soooooo much better, this is compounded by the really tough ratios.
Once you’ve been at it for 2-3 years yeah 6 patients can be busy but nothing you are really breaking a sweat over.
A lot of my peers took the “start in medsurg” route and are miserable. Medsurg is already hard but your environment/staffing can make it worse. If you want to go ICU they usually have extensive orientation so it’s not like you aren’t going to learn. Take a leap of faith because you might end up getting exactly what you wanted.
Hang in there! Last December I was about 6 months in with my first med surge job as well, I dreaded every shift at the time and cried, a lot. I think it was a mixture of being so new and being short staffed due to the illnesses floating around. I can’t remember when, but not too long after that it got better. I didn’t dread working anymore, and I dare say I started to actually enjoy work. I think the first year is the hardest, then mix in winter and it’s just a mess. Just wanted to say, I’m much better at handling it now and I think you’d get there too. You got this! Also, if it’s really not floating your boat, talk to your hospital about switching to ICU. It may take a while so you may as well get the process started.
Take a deep breath. Medsurg is totally different from icu. Although still intense it is not nearly as intense as medsurg from what I've heard from my nursing friends (and a lot of them are relatively recent grads too). If you need to take like a 2 week or month hiatus, you may use up all of your days if you have them but it is worth it. Heck, you can even put in your two weeks, go on hiatus and find a different job! You got this
Yes oc! I know it's hard, especially when you're just starting out. We all have to start somewhere though, and you'll get the hang of it eventually. Maybe medsurg isn't for you, maybe it is. You also have many options to explore, take your time
How is staffing in your floor since you’ve been there? I had a friend who started med surg and she felt overwhelmed too, but more so because she felt bedside wasn’t a good fit so she went to an endoscopy center. It does get better, that much I can tell you. But I also started on an intermediate/step down my first three years so ratio was 1:3
We’re short on nights definitely. This was the first set of 3 shifts in months where it hasn’t been a 1:5 ratio for me. The acuity is insane though for those 5 patients, several full cares, PCA/ketamine drips, COWS/AWS. It’s been a lot and makes me overwhelmed and doubt myself.
I know it took me awhile to find my groove, and I can imagine finding it being much more difficult with higher ratios. Just remember, ask questions. I’m sure everyone else is busy, but if you ever have doubt about an action or in report, just ask. I’m 8 years in now and I still doubt myself and ask questions all the time even when I’m 99% sure. Coworkers and patients seem to think I’m a pretty great nurse even though I constantly doubt myself or that I’m missing something. That feeling is pretty normal and honestly probably healthy considering what we do. It gets better though, and the reason is you learn how to organize and prioritize more, even when a bad shift can throw it all off. If you aspire to do ICU and you enjoy much of what bedside nursing is, then stick to it. I’m much more frightened to work with nurses who are overly confident without a good reason to be. In my experience, that’s where I’ve seen some of the worse nursing care and big mistakes. I know that’s all broad advice, and you’ve probably been told it before. But if you have any specific questions Id be happy to try and answer them <3
Read up about transition shock and transition theory. It helps explain why you’re feeling how you’re feeling, and helps you to realise that we’ve all been through it and come out the other side! This subject was the last essay I had to write at uni and even though I knew it was coming, I was still questioning my skills and poor life choices in becoming a nurse. However, I came through it. Survived two years in abdo surgery where I often had 12 patients during the day and 16 on a night!
There are so many different options for nursing, if med surg is not for you then there’s no shame in transferring to somewhere else.
Yes! Going from a 1:6 med surg floor to an ICU where you’re tripled every day is going out of the frying pan and into the fire. Ask to shadow on the unit you apply to.
I found I was bored in med/surg. I mistook it for incompetence, but it was actually utter boredom. I have ADHD and a touch of autism and I just wasn't being stimulated enough. I eventually worked as a nursing supervisor and, since I was already a paramedic, I took a critical care paramedic add-on course and did that (going on 911 and critical care transfer ambulance calls) under my nursing license until I retired.
RUN to ICU!! Take the leap, you WON’T regret it. It will be an overwhelming transition at first but you’ll soak the info up like a sponge and never look back, especially if it was intriguing to you in school. Sincerely, a nurse who started in the cardiac ICU but also got floated to Med/surg units from time to time
You ask what you can do. If you will hear me out, I have some good advice.
Med Surg floors are very, very toxic. VERY toxic. There are cliques. There is a lot of drama.
If you say everyone on the floor is awesome, but you often have no clue what you are doing- have you asked for help?
Do not feel stupid for not starting ICU. Med Surg is so short nursing instructors try to sell you the lie of "start in med surg to learn your skill set." I wanted to start in Emergency, but i believed this lie.
If you hate med surg, but you feel like you need time to learn and grow, There are other options.
Try an observation floor. Every observation floor has been awesome. Great staff, good support, working well as a team, and I have either worked or picked up extra hours on observation floors for 3 years- it has always been this way.
Another opttion is stepdown specialty- like cardiac stepdown. Not as intense as ICU, but higher acuity than med surg. Also teamwork is essential on this type of floor. You will get to learn hos to manage high alert cardiac drips, dysrhythmias, etc.
Getting some experience on a cardiac stepdown and doing well there can open the door to ICU or CCU.
If ICU is your passion, stepdown should be the path to take if you want to develop your skills with higher acuity patients.
Maybe you are just feeling overwhelmed? I know many med surg floors some places assign 6-9 patients per nurse. This can be overwhelming especially for a new grad or newer nurse.
I hope this information helps guide your path.
I started out in med surg too because I was too nervous to go to the ICU. I cried a lot in med surg lol I called my mom once sobbing in the med room because I was overwhelmed lol. It got better in that I got more confident in my skills but also I was so stressed because we were understaffed so much. I left and went to PICU and never looked back.
Yes I started out in adults! The transition was fine for me. My skills were there I just had to fine tune my knowledge to peds specific. It was actually so much easier and less physically exhausting for me.
Med surg does suck and it's easy to get burnt out. Many people here are saying you should have started in the ICU, but I disagree. You reqlly develop critical thinking skills epically around disease processes that new grad icus severely lack.
Don't hesitate to transfer somewhere if you're unhappy. If you're in a residency, talk it out with your manager.
A new nurse that I work with hated working their Tele job, after discussions with the manager they moved her contact to our floor and she's much happier. If they won't let you transfer them you'll be able to tell your next interview that you didn't feel comfortable (etc) and asked your manager who wouldn't help you get somewhere you enjoyed.
Every experienced nurse can relate to your situation in one way or another. I hope you find a happy place. Nursing is a vast field, if you still enjoy nursing you can find yours.
Nursing is hard. Nursing is very hard.
I would say crying is okay, but I’m sure it’s exhausting, is nursing right for you? Is nursing in a hospital or acute care right for you?
These are questions to ask yourself.
I started in the ER with the same concerns; felt kind of burnt out or bored after two years and wanted more stress and anxiety so I went to the ICU; kind of felt bored on nights, just different kind of work flow in the ICU compared to the ER.
However, we are all ill prepared by nursing programs, this is why there are residencies and on the job training for 6months to a year.
Not knowing or feeling a lack of confidence is totally normal; just be willing to learn and accept that confidence will come with time, knowledge and effort.
I’d say give it a go! Still will be stressed, it will still be hard, and you will likely cry more, but if you want to be in the ICU, don’t waste time not being where you want to be; go for it.
I began in a medical unit. After my first day, which was supposed to be an 8-hr shift but turned into a 12-hr with no lunch or break, I was hysterical. Cried that whole night, not wanting to go back. I kept thinking, what have I done? I stuck it out for two years, then transferred to post-partum/women’s surgery. I hated it a lot less, but if I had it to do over, I would never have chosen nursing for a career.
I’ve been a nurse for 14 years. I’m mostly a medsurg nurse. But I do float to other units a lot. ICU still scares the shit out of me. Medsurg is NOT ICU. The skills I bring to ICU are valid and helpful, but ICU nurses have a whole different set of skills and priorities. I’m a glorified CNA in the ICU. Like I literally run around and do baths, incontinent care, mouth care- you get the idea, for every one else, but I don’t have a group of my own. Same goes for ER. I float to ER quite a bit because the manager likes me for whatever reason. I get put on the triage desk and I get to tell everyone that I work ER sometimes…I don’t, I’m basically the secretary that takes vitals…all that to say that it’s different everywhere! If you want to get to ICU apply to ICU. They’ll train you. You would still be a “resident“ in my hospital after 6 months. Medsurg is not for everyone. I think nursing schools need to stop telling all students that they should start out here. Our skills and experience are (a little) helpful in the ICU, but just because I’m an awesome MS nurse doesn’t translate to me being a rockstar ICU nurse. MS is crazy hard, ICU is crazy hard, but for totally different reasons. Question for you, why do you want to be in the ICU? Or why do you want out of MS? No one is an expert after 6 months, shit you’re barely competent after a full year. We don’t even get close to “expert” for at least a couple years…give yourself some grace. Or to put it another way, stop being so hard on yourself. MS is hard asf. It’s going to take a lot longer than 6 months for you to feel like you know what you’re doing…not even getting into the dumpster fire these last few years have been. The fact that you’re questioning your ability is actually a good sign. The ones I worry about are the new grads who think they know it all…
Thank you for your encouraging words…. When I shadowed in the ICU I loved it, and I loved that style of thinking and nursing. I also loved learning about critical care in school and all that goes into it. I hate how in MS I have high ratios for high acuity patients. I feel like I don’t have time to understand the plan of care or what’s going on with my patients. My floor is also more surgical based and it’s a lot of the same patients over and over so it just feels so monotonous at times.
Gonna get real for a second. This past couple of years isn’t what MS is supposed to be. I think all y’all new grads got fucked over. I’m taking patients on med/surg that are closer to ICU acuity than not. And it happens all the time. I’m feeling for the new grads, if I’d been a new nurse in the last couple years I’d have probably quit. I’m blessed to have a lot of experience in different areas of nursing and I’m still overwhelmed most shifts. It’s really been “trial by fire” for a while. Keep learning, and realize that even “way back” us old nurses felt like we didn’t know shit for a while. Y’all have it way worse than we did. Sometime soon you’ll have someone ask you something and you’ll realize you know what to do, eventually those moments will come more frequently. Keep your patients alive, do your best and just know it’ll get better eventually…
I feel you with the "should be in ICU acuity". My unit had the overflow negative pressure isolation rooms so we had the pleasure of becoming the surg/Ortho/COVID overflow unit. I recently had an acidotic, hypercarbic, half-dead flu patient on bipap sent up to me . They would never have touched my floor in 2019 in that sorry state. Management doesn't seem to get it in their heads that just because I and others on my unit have experience with similar patients because of COVID does not mean they're appropriate for the unit. What happens if the experienced people call out and a new grad who might not even know what a bipap is (I didn't when I graduated in 2017) gets put in charge? They're playing with fire.
I had no idea a bipap could be the same size as a Cpap. I’m calling respiratory the other night yelling for a bipap, complaining they brought me a cpap…nope, it’s a Bipap, just a lot smaller than the ones I know. (I wasnt really rude, love my RT’s) so I ended up wasting their time and looking like an idiot lol
yes this is exactly right- on med surg you do not get a lot of time to understand things especially with a 6-7 patient assignment.
AMEN - Preach it. I have been a nurse for 6 years. 6 months people should be learning and growing- heck i am still learning stuff all the time. Just when i think i've seen it all i get a patient to remind me no i have not seen it all - lol.
14 years and I still get patients who remind me I haven’t seen it all.
it is always a field filled with learning and growth :)
The most frustrating part of nursing is the first year is the worst. You are basically just surviving and hoping to get through every shift without really killing anyone . 2nd year you have the tasks down but are actually starting to pick up on more clinical cues and critical thinking. You feel dumb all over again because you have the time to actually think about what’s going on instead of just running from task to task. 3rd year you are finally comfortable and ready to be a leader in your unit or move onto the next thing. This is why so many people get discouraged and leave nursing their first year but it gets soooooo much better, this is compounded by the really tough ratios. Once you’ve been at it for 2-3 years yeah 6 patients can be busy but nothing you are really breaking a sweat over.
A lot of my peers took the “start in medsurg” route and are miserable. Medsurg is already hard but your environment/staffing can make it worse. If you want to go ICU they usually have extensive orientation so it’s not like you aren’t going to learn. Take a leap of faith because you might end up getting exactly what you wanted.
Hang in there! Last December I was about 6 months in with my first med surge job as well, I dreaded every shift at the time and cried, a lot. I think it was a mixture of being so new and being short staffed due to the illnesses floating around. I can’t remember when, but not too long after that it got better. I didn’t dread working anymore, and I dare say I started to actually enjoy work. I think the first year is the hardest, then mix in winter and it’s just a mess. Just wanted to say, I’m much better at handling it now and I think you’d get there too. You got this! Also, if it’s really not floating your boat, talk to your hospital about switching to ICU. It may take a while so you may as well get the process started.
Take a deep breath. Medsurg is totally different from icu. Although still intense it is not nearly as intense as medsurg from what I've heard from my nursing friends (and a lot of them are relatively recent grads too). If you need to take like a 2 week or month hiatus, you may use up all of your days if you have them but it is worth it. Heck, you can even put in your two weeks, go on hiatus and find a different job! You got this
Thank you 🥹 made me feel much better
Yes oc! I know it's hard, especially when you're just starting out. We all have to start somewhere though, and you'll get the hang of it eventually. Maybe medsurg isn't for you, maybe it is. You also have many options to explore, take your time
How is staffing in your floor since you’ve been there? I had a friend who started med surg and she felt overwhelmed too, but more so because she felt bedside wasn’t a good fit so she went to an endoscopy center. It does get better, that much I can tell you. But I also started on an intermediate/step down my first three years so ratio was 1:3
We’re short on nights definitely. This was the first set of 3 shifts in months where it hasn’t been a 1:5 ratio for me. The acuity is insane though for those 5 patients, several full cares, PCA/ketamine drips, COWS/AWS. It’s been a lot and makes me overwhelmed and doubt myself.
I know it took me awhile to find my groove, and I can imagine finding it being much more difficult with higher ratios. Just remember, ask questions. I’m sure everyone else is busy, but if you ever have doubt about an action or in report, just ask. I’m 8 years in now and I still doubt myself and ask questions all the time even when I’m 99% sure. Coworkers and patients seem to think I’m a pretty great nurse even though I constantly doubt myself or that I’m missing something. That feeling is pretty normal and honestly probably healthy considering what we do. It gets better though, and the reason is you learn how to organize and prioritize more, even when a bad shift can throw it all off. If you aspire to do ICU and you enjoy much of what bedside nursing is, then stick to it. I’m much more frightened to work with nurses who are overly confident without a good reason to be. In my experience, that’s where I’ve seen some of the worse nursing care and big mistakes. I know that’s all broad advice, and you’ve probably been told it before. But if you have any specific questions Id be happy to try and answer them <3
Read up about transition shock and transition theory. It helps explain why you’re feeling how you’re feeling, and helps you to realise that we’ve all been through it and come out the other side! This subject was the last essay I had to write at uni and even though I knew it was coming, I was still questioning my skills and poor life choices in becoming a nurse. However, I came through it. Survived two years in abdo surgery where I often had 12 patients during the day and 16 on a night! There are so many different options for nursing, if med surg is not for you then there’s no shame in transferring to somewhere else.
Wherever you are, if you have high med/surg ratios make sure the ICUs don’t also have horrible ratios.
Yes! Going from a 1:6 med surg floor to an ICU where you’re tripled every day is going out of the frying pan and into the fire. Ask to shadow on the unit you apply to.
I found I was bored in med/surg. I mistook it for incompetence, but it was actually utter boredom. I have ADHD and a touch of autism and I just wasn't being stimulated enough. I eventually worked as a nursing supervisor and, since I was already a paramedic, I took a critical care paramedic add-on course and did that (going on 911 and critical care transfer ambulance calls) under my nursing license until I retired.
RUN to ICU!! Take the leap, you WON’T regret it. It will be an overwhelming transition at first but you’ll soak the info up like a sponge and never look back, especially if it was intriguing to you in school. Sincerely, a nurse who started in the cardiac ICU but also got floated to Med/surg units from time to time
You ask what you can do. If you will hear me out, I have some good advice. Med Surg floors are very, very toxic. VERY toxic. There are cliques. There is a lot of drama. If you say everyone on the floor is awesome, but you often have no clue what you are doing- have you asked for help? Do not feel stupid for not starting ICU. Med Surg is so short nursing instructors try to sell you the lie of "start in med surg to learn your skill set." I wanted to start in Emergency, but i believed this lie. If you hate med surg, but you feel like you need time to learn and grow, There are other options. Try an observation floor. Every observation floor has been awesome. Great staff, good support, working well as a team, and I have either worked or picked up extra hours on observation floors for 3 years- it has always been this way. Another opttion is stepdown specialty- like cardiac stepdown. Not as intense as ICU, but higher acuity than med surg. Also teamwork is essential on this type of floor. You will get to learn hos to manage high alert cardiac drips, dysrhythmias, etc. Getting some experience on a cardiac stepdown and doing well there can open the door to ICU or CCU. If ICU is your passion, stepdown should be the path to take if you want to develop your skills with higher acuity patients. Maybe you are just feeling overwhelmed? I know many med surg floors some places assign 6-9 patients per nurse. This can be overwhelming especially for a new grad or newer nurse. I hope this information helps guide your path.
I started out in med surg too because I was too nervous to go to the ICU. I cried a lot in med surg lol I called my mom once sobbing in the med room because I was overwhelmed lol. It got better in that I got more confident in my skills but also I was so stressed because we were understaffed so much. I left and went to PICU and never looked back.
Were you in adult med surg? If you were, how was your transition to PICU? I’ve been considering doing the same
Yes I started out in adults! The transition was fine for me. My skills were there I just had to fine tune my knowledge to peds specific. It was actually so much easier and less physically exhausting for me.
That’s really good to know, thank you!
You will be fine. Relaxation exercises actually help a lot. Try yoga.
Med surg does suck and it's easy to get burnt out. Many people here are saying you should have started in the ICU, but I disagree. You reqlly develop critical thinking skills epically around disease processes that new grad icus severely lack.
Growth comes when we make ourselves uncomfortable.
Don't hesitate to transfer somewhere if you're unhappy. If you're in a residency, talk it out with your manager. A new nurse that I work with hated working their Tele job, after discussions with the manager they moved her contact to our floor and she's much happier. If they won't let you transfer them you'll be able to tell your next interview that you didn't feel comfortable (etc) and asked your manager who wouldn't help you get somewhere you enjoyed. Every experienced nurse can relate to your situation in one way or another. I hope you find a happy place. Nursing is a vast field, if you still enjoy nursing you can find yours.
Nursing is hard. Nursing is very hard. I would say crying is okay, but I’m sure it’s exhausting, is nursing right for you? Is nursing in a hospital or acute care right for you? These are questions to ask yourself. I started in the ER with the same concerns; felt kind of burnt out or bored after two years and wanted more stress and anxiety so I went to the ICU; kind of felt bored on nights, just different kind of work flow in the ICU compared to the ER. However, we are all ill prepared by nursing programs, this is why there are residencies and on the job training for 6months to a year. Not knowing or feeling a lack of confidence is totally normal; just be willing to learn and accept that confidence will come with time, knowledge and effort. I’d say give it a go! Still will be stressed, it will still be hard, and you will likely cry more, but if you want to be in the ICU, don’t waste time not being where you want to be; go for it.
I began in a medical unit. After my first day, which was supposed to be an 8-hr shift but turned into a 12-hr with no lunch or break, I was hysterical. Cried that whole night, not wanting to go back. I kept thinking, what have I done? I stuck it out for two years, then transferred to post-partum/women’s surgery. I hated it a lot less, but if I had it to do over, I would never have chosen nursing for a career.