Hospital Leaders Attempt to Bust the Myths That Have Led to a Shortage of Medical-Surgical Nurses

Medical-surgical care is the single largest nursing specialty in the United States. According to the American Association of Colleges of Nursing, nearly 58% of registered nurses work in general medical and surgical hospitals nationwide. Despite the specialty’s prevalence, however, it is often – and confoundingly – considered a second choice to other nursing career pathways.

We recently sat down with Barbara Zinner, DNP, RN, NE-BC, CENP, Chief Nursing Officer at Cleveland Clinic Marymount Hospital, to discuss the current landscape of med-surg nursing and evolving perceptions of the specialty. Dr. Zinner is the executive sponsor of Cleveland Clinic’s medical-surgical nursing affinity group.

Q: Why is medical-surgical nursing a smart career choice?

As a medical-surgical nurse, you’re responsible for providing care to any patient who is medically compromised, or preparing for or recovering from surgery. It’s one of the rare specialties that involves an incredibly diverse group of patients and diagnoses. There is so much variety — you see it all, and the cases are often complex and challenging. Because it’s common for these patients to have multiple diagnoses and comorbidities, care must extend well beyond one specific clinical area.

Med-surg nursing is a rewarding career that requires critical thinking, superior decision-making and excellent prioritization. Our caregivers are always “stacking” – thinking about what tasks they need to perform and when. I often tell my team, “Let’s stack it to see what needs to be done first.”

Our nurses focus on the entire patient, and that includes closely evaluating the current state of their health and even assisting their family members. Med-surg medicine relies heavily on building, creating and sustaining interpersonal relationships with patients and their families. This dynamic adds an extra layer of responsibility, but it also creates wonderful opportunities to build longstanding relationships. That familiarity can be life-affirming for the professional registered nurse.

Q: With all that medical-surgical nursing has to offer, why do you think it’s a less-popular career choice than other specialties?

I think the specialty’s reputation suffers from several common myths and a general lack of awareness. In the greater nursing profession, medical-surgical care is recognized as a vital specialty that requires a vast clinical skillset, and those of us who work with med-surg nurses are well aware of how competent and talented they are. Unfortunately, individual and community-wide misperceptions persist. Because the specialty is sometimes viewed as “basic” – and perhaps less exciting than other clinical areas – some consider med-surg to be a stepping stone rather than a fulfilling career path.

Many nurses also mistakenly assume med-surg work is more strenuous than other specialties. When students participate in clinical rotations, for example, they often notice that nurses in the intensive care or behavioral health units may manage fewer patients than nurses in the med-surg unit. The difference in volume seems significant, but you really have to dig much deeper to understand the goals and workflow of each and all specialty units (including med-surg).

Q: How are you addressing the national nursing shortage at Cleveland Clinic?

A general lack of awareness and interest in medical-surgical careers has further exacerbated a nursing shortage that peaked during the COVID-19 pandemic. Before the pandemic, is wasn’t uncommon for Marymount Hospital to hire 30 medical-surgical nurses over the course of one summer; now, however, every hospital across the country has openings that need to be filled.

One way we’ve been able to mitigate the shortage is by leaning more heavily on patient care nursing assistants (PCNAs). These caregivers are crucial members of our med-surg team. By supporting PCNAs, we not only help them succeed in their jobs, but we also help alleviate current workload burdens while building our future nurse pipeline.

Our med-surg PCNA support program is based on three key areas:

• Retaining strong PCNAs to support current nurses.
• Enabling and assisting PCNAs to apply for and attend nursing school.
• Guiding and supporting PCNAs through nursing school and graduation.

One of my passions is counseling PCNAs on nursing school admission requirements. There are a variety of ways that nurse leaders can support PCNAs — from coaching them on the right questions to ask when considering a nursing program to showing them what classes to take, how to secure proper financial aid and how to capitalize on Cleveland Clinic’s tuition reimbursement program.

Cleveland Clinic also has a work-development training program for newly hired PCNAs that empowers and prepares them with the skills and support needed to overcome work-readiness barriers. Additionally, we’re exploring professional development and enhancement options to ensure our PCNAs are working at the highest level their training allows.

Q: Have you implemented any specific recruitment or retention strategies?

Perhaps most importantly, we’ve developed a strong partnership with our talent acquisition team, which is always finding innovative ways to attract new nurses. Cleveland Clinic’s Chief Caregiver Office also goes above and beyond to retain and meet the needs of our current caregivers.

When it comes to med-surg nursing, however, we remain challenged to overcome the misperceptions I’ve already mentioned. The simple truth is that we need to do more. For starters, we’ve revamped our affinity group and are refocusing our work. We used to spend a lot of time analyzing and developing policies and procedures; as important as those things are, that approach doesn’t address our current obstacles. Our primary focus now involves sharing best practices that support our recruitment and retention strategies.

To better prepare med-surg nurses for the many patient scenarios they may encounter, we’ve been inviting nurse directors and leaders from other specialties to our affinity group meetings. Guests are asked to describe the clinical work they do and offer advice on how to best manage their specific patient populations. The insight is passed on to all medical-surgical nursing teams across the health system.

We are also beginning to hold “quick-burst education talks” in our med-surg units. Led by clinical nurse specialists, each 15-minute education session covers a different topic — for example, one talk might address caring for behavioral health patients on the med-surg unit. Prior to each quick burst, our nurses provide their managers with feedback on what they want or need to know. Future sessions are then created to address these questions, challenges or needs, and participants are awarded contact hours for every two sessions they attend.

Q: What can healthcare leaders do to change the perception of medical-surgical nursing?

We want hospital leaders to shout the merits of med-surg nursing from the rooftops! By spreading the word, we want to help people understand the critical role these caregivers play in every health system. Years ago, most nursing students were required to undergo med-surg training because of the clinical skills and knowledge base that the specialty entails. Although times have changed, I believe all nurses – especially those who are early in their careers – could benefit from spending time on a med-surg unit.

We encourage nursing schools to partner with hospitals and healthcare organizations to create awareness campaigns that showcase medical-surgical nursing as the wonderful foundational specialty it is.

We also urge hospital leaders to recognize and reward their medical-surgical nurses. By creating an environment in which these caregivers feel valued and special, we can ensure that their unique expertise reaches their patients and fellow clinicians.

Q: Any final thoughts?

Healthcare is at a critical crossroads. The industry-wide nursing shortage has made the field more competitive than ever before, so now is the time to address any misperceptions about med-surg nursing. Medical-surgical units are the bedrock of every hospital, and I’m confident that through emphasis, awareness and recognition, this remarkable specialty will prevail.