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“Don’t I need to work in a med-surg unit first?” asked another about-to-be-licensed stellar new nurse. I had just delivered my updated session, “Career Fitness — How to Land Your Right Job,” for the 15th consecutive year to hundreds of students in Nashville at the 2018 National Student Nurses’ Association’s annual convention. Once again, I confronted this anxious query — one I heard every year from this audience.
EDITOR'S NOTE: Robert G. Hess Jr., PhD, RN, FAAN, is OnCourse Learning's executive vice president and chief clinical executive, and founder and CEO of the Forum for Shared Governance. As an editor for Nurse.com, Hess has penned several editorials on career topics. As a presenter at professional conferences, Hess often addresses participants on how to find the right job and steps for building a successful career.
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What's the attraction?

So, if things are so average, what is it that attracts and retains med-surg nurses? Variety. A study of 1,569 NLRNs identified the more variety and autonomy a job offered, the more likely a nurse would stay in the job. This preferred characteristic of med-surg nursing was backed up by social media. A query on my Facebook page shows that by and large, med-surg nurses can be a happy lot and, unprompted, were articulate about how they value variety. Sioban Mooney Maslar, MSN, RN, CMSRN, bedside nurse, Medstar, Georgetown University Hospital, and clinical instructor in care of the adult (med-surg), Georgetown University, writes, “I have been a med-surg nurse for 22 years. I love the variety, the fact you get different patients every time you work and being able to actually discharge people ...I also teach med-surg. I am that passionate about it.” Mary Ellen Levine, MSN/Ed, RN, CHPN, hospice nurse and adjunct faculty, Karen Ann Quinlan Hospice and Caldwell University School of Nursing and Public Health, seconds the sentiment: “While I have changed my path to hospice, I was a happy med-surg nurse. Thought you’d find me spending my life there …I was a ‘never-the-same-day, same-patient, always-teaching, supporting, sending-the-healthful-message’ kind of nurse!

"Loved the diversity in care and always updating the plan when it came to admitting, treating and discharging," she continued. "With complexity of care and the complexity of individual health status of our populations, the challenge was and is real. Med-surg is in my blood!” Medical/surgical nursing is not for the faint of heart. The Academy of Medical-Surgical Nurses relates the unique characteristic of these practitioners is playing the role of master coordinator, remaining calm while juggling many patients and orchestrating care among many healthcare disciplines and nursing personnel. They become adept at assessing multiple body systems, often without the safety net of technology. “Med-surg nurses need to have much sharper assessment and response skills than critical care nurses because they do not have the benefit of the monitors and equipment that critical care nurses have,” said Betty Nelson, PhD, RN, President & CEO, Informed Practice International Inc. “They need to be prescient, to say the least.” As a new nurse, maybe critical care was the place for me, where I needed technology and experienced nurses around to support me. I’m not sure I could have handled med-surg nursing at the beginning of my career. But if you think your skills are up to it, you might want to consider this field.

The outpouring on social media from nurses that went straight to med-surg nursing and stayed there assures me that there are enthusiastic practitioners out there to support you.
“Wherever med-surg nursing is practiced, new and experienced nurses should give this specialty a good, hard look as a solid career option.”
Robert G. Hess Jr., RN
I’m still not sure who continues to perpetuate the notion that newly licensed RNs must seek a med-surg nursing job as an essential bridge between graduation and their eventual “real” specialty areas. Obligatory time as a “floor nurse,” an epithet much disliked by its practitioners, was not part of my career path. With an extensive orientation, I successfully went right into critical care from my diploma school in 1975. These days not only do some new RNs bypass med-surg for their targeted career specialty right out of school, but 11% are bypassing any hospital practice altogether. Still, these same nurses could find themselves working in med-surg because it is no longer practiced exclusively in the hospital. Today, it occurs in home and hospice care areas as well. Wherever med-surg nursing is practiced, new and experienced nurses should give this specialty a good, hard look as a solid career option.


Get certified and be satisfied First officially introduced as a separate specialty in 1991 by the Academy of Medical-Surgical Nurses, med-surg nursing — with an estimated 650,000 nurses — is the largest nursing specialty in the U.S. Its nurses do practice primarily on hospital units, caring for adult patients who are recovering from surgery or who are acutely ill with a variety of medical problems and diseases.

Nurses certified in this specialty as a CMSRN by the Medical-Surgical Nursing Certification Board have almost doubled from 19,280 RNs in 2013 to 31,419 in 2017, a year in which 4,881 nurses were newly certified and 2,230 were re-certified. The current pass rate for the certification exam is 81%. An examination of Nurse.com’s 2018 Salary Survey data shows the annual average salary of about $70,000 for this specialty group is lower than the average salary of any nurse of about $73,663, despite specialty, in the U.S. Yet, almost half of med-surg nurses are satisfied or very satisfied with that salary figure, which again, almost exactly matches the satisfaction with the salaries of all specialties combined, and this is in a specialty that ranked salary as the number one compensation aspect to job satisfaction.

And by and large, our med-surg sample was as content to stay in their present jobs as any nurse. The percentage of med-surg nurses who were actively looking for another employer (15%), not actively looking (32%), or who were not looking but would consider changing employers (51%) closely reflected our U.S. sample as a whole.
The specialty is for RNs who are up for a challenge
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By Robert G. Hess Jr.
PhD, RN, FAAN Executive vice president and chief clinical executive
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Med-surg nurses never live the same day twice
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