The Old Eat Their Young

I have heard this excuse time and time again by instructors and preceptors over the years, “We had to go through hell, so it’s a rite of passage for you to do the same”. Why? Why is this hazing and torture expected? It’s the same thing going through college as a student. Those who become professors understand how stressful and emotional it can be, and yet there is no sympathy. Those who weather the trials and tribulations of the system would rather put those who follow through the experienced hell than amend the process to align with current evidence-based practices.

This is true, especially in the nursing field. Every nursing student heard this at one point in their final year of school: “You have to have at least two years of med-surg experience before transferring to a specialty”. I call bullshit on that one. Yes, there is validity in the need to gain general medicine experience as a med-surg nurse, but that should not disqualify someone from applying to and being accepted into specialty positions like cardiology or oncology. If a nurse has a passion and knows what they want to specialize in right out of the gate, what should stop them from jumping straight to that field? I can see how this statement would be valid for someone wishing to go into the ICU or the NICU since these areas might require sharper skill sets and generalized experience.

Look at me, I started in Telemetry and didn’t fall into the Med-Surg trap.

The med-surg units are destroying nurses young and old. It’s literally the dumping ground for the hospital no matter what way you look at it. This unit is the ‘catch all’ for the medical facility where anything ranging from a GI bleed to a gieriatrich psych patient need to be cared for. Units like med-surge are usually understaffed and those who do work there are overworked. Nurses are handed completely unsafe assignments where they and the unit are not equipped to provide effective care. The providers are usually in charge of 20-30 patients and are beyond burnt out.

Med-Surg units are where nursing careers are born and die.

It seems as if many who have gone before me were all forced to start their nursing careers on units like this and now they make it impossible for new nurses to choose any alternative path. Part of this is the tradition, “If I did it you have to do it too.” It probably doesn’t seem fair to these experienced nurses that they had to climb the ladder slower than some nurses today. Here’s the thing: unless you are working in an ICU or Maternity, all floors will turn into a Med-Surg unit somehow. Take my floor for example.

I was hired as a nurse resident on my floor, which was labeled as a specialty Telemetry/Cardiology floor. My manager sold this floor to me as one that would allow me to learn all about cardiac patients and medications. The other residency openings were on Med-Surg units and I honestly didn’t want to deal with a floor like that. When I worked as a Patient Care Tech, I worked on a Med-Surg floor. The random ailments and detoxing patients were a handful and there was no sense of normalcy on the floor. A non-Med-Surg floor sounded like absolute heaven and I was sold.

That didn’t last long. There are two primary causes why even specialty floors like mine eventually reverted back to Med-Surg floors. The first is obvious: COVID. I had the unfortunate coincidence of beginning my nursing career at the beginning of the pandemic. Every hospital in the country was overloaded, and every empty bed needed to go to COVID patients. My floor very slowly started adding one or two COVID patients until we were overrun. We were told there was no other floor that could take them, and it would be temporary. It’s been over a year and guess what? I am still taking care of COVID patients. The second reason is the staffing shortage. The other floors in my hospital will do anything to move patients off their schedule. Any possible cardiac activity or medication? Boom, let’s send them to the Telemetry floor.

My floor is a Med-Surg floor, even if it doesn’t have the name.

New nurses are handed inappropriate assignments where they know, before they meet their patients, that the shift is going to be hell and that they will cry before they make it home. We should not be getting to that point; it should not be normalized where nurses break under pressure and cry because of unbearable stress every shift. “I used to cry on my way home everyday and did not feel comfortable for at least 8-12 months after starting here”. Okay, what can you do or did you do to help to change that working environment? Just because our predecessors had to endure such stressful working environments and experience such hardship does not mean that we, as new nurses, should have to go through the same hell.

Let’s play ‘Devil’s Advocate’

There is another way to see how the work environment has become so toxic; it all goes back to the concept that hospitals are businesses. Medical facilities are running on fumes when it comes to staff; they are utilizing bare minimum staffing to produce the same amount (if not more) profit. There is no time for senior nurses to mentor new nurses; they have their own difficult assignments. Why go easy on the nurse residents and give them a free ride if that same treatment was not given to the more senior nurses? Everyone is burnt out and it is getting worse; but if we all realize this, then there should be more of an effort to provide support to one another instead of acting as if the staff isn‘t a team? We are all in this together, and there should be one unified effort to make it through each shift and have reciprocated support. If a fresh nurse comes on to the unit with aspirations to further their education or transition to an alternative speciality, we should support their aspirations and encourage them, not discourage. Fostering camaraderie in any workplace is difficult and can seem hopeless; but this is yet another reason why nursing is my cardio.