Medical-Surgical Nurses Build Relationships While Providing 24/7 Care

In spring of 2020, Megan Nichols, BSN, RN, worked as a clinical nurse in a primary care office. “When COVID-19 hit, appointments were canceled and I was sitting in an empty office feeling professionally useless,” she says. “I decided I needed to go back to the hospital.” She landed a job where her career began in 2012 – as a clinical nurse on a medical-surgical unit.

In July 2020, Nichols joined a 38-bed orthopaedic unit at Cleveland Clinic main campus. “We do a little bit of everything,” she says. “Even on a specialty unit, ortho patients aren’t the only patients we get. Any med-surg unit in any hospital gets plenty of overflow from other areas.” On any given day, Nichols might have two orthopaedic patients, someone who had gastric bypass and a patient who had their gall bladder removed. In addition, orthopaedic patients often present with co-morbidities, such as diabetes or congestive heart failure, that require care.

“As a med-surg nurse, you have to be a jack-of-all-trades and maintain a broad skill set,” says Nichols. The variety is what attracts many nurses to medical-surgical nursing, the single largest nursing specialty in the United States. Nearly 58% of registered nurses nationwide work in general medical and surgical hospitals, according to the American Association of Colleges of Nursing.

The backbone of nursing

When people consider nursing specialties, they often envision working in fast-paced settings, such as intensive care units and emergency departments, or with certain demographics, such as pediatrics or geriatrics. But medical-surgical nursing is indeed a specialty. A 2019 statement from the Academy of Medical-Surgical Nurses describes the specialty as follows:

“Medical-surgical nurses provide care to adults with a variety of medical issues or who are preparing for/recovering from surgery. They have a broad knowledge base and are experts in their practice… . Medical-surgical nursing is practiced in several settings across the healthcare industry, including hospitals, outpatient settings, in homes, via telemedicine and other non-traditional settings. The specialty of medical-surgical nursing happens in almost every care environment because medical-surgical nursing is what you practice, not where.”

Craig Tobias, BSN, RN, assistant director of nursing at Cleveland Clinic Marymount Hospital, calls med-surg nursing “the backbone” of nursing. “You see it all – different specialties, different disease processes, different types of care,” says Tobias, who oversees eight medical-surgical units. “I credit being a med-surg nurse for the first 10 years of my career with getting me where I am today.” In March, he will earn an MSN and MBA.

Six soft skills necessary in med-surg nursing

Because med-surg nurses deal with a broad spectrum of patients, their clinical skill set is vast. But Tobias says equally important are the soft skills that make med-surg nurses successful, including the following:

• Communication Skills – Providing clear communication to patients, their families and medical providers is critical for medical-surgical nurses, who are responsible for the patient plan of care. “You are the hub of that patient’s care,” says Tobias. “You have the responsibility – and privilege – of managing each patient’s care and making sure that everyone has the required updates and is on the same page.”
• Relationship-Building – “The special part of being a med-surg nurse is you take care of patients 24/7,” says Tobias. “You are with them when the hard work of healing begins to take place, providing emotional support and educating them. You have the ability to create and nurture a relationship with patients to make sure they are healthy, and that’s something special.”
• Educator Skills – Med-surg nurses spend a lot of time teaching patients about their conditions, medications, lifestyle decisions, preventive measures and more. “The person who comes for gastric bypass banding is going to go home with a completely new diet,” says Nichols. “You have to be able to teach them what to do and what to expect when the unexpected happens, like an infection.”
• Teamwork – It’s imperative for nurses on med-surg units to lean on one another. “You learn to work together as a team to make sure patients are safe,” says Tobias. “As a new nurse, every day is chaotic. As you grow, you learn to say, ‘I have some free time. Who needs help?’” As a nursing director, Tobias teams with his nurse managers, who in turn take care of their assistant nurse managers and clinical nurses. “When we all work as a team, we impact hundreds of patients each day,” he says.
• Emotional Intelligence – Med-surg nurses need to understand and manage their own emotions to properly communicate with others and overcome possible conflicts. This can be challenging when you’re dealing with several patients. “One person may feel angry and the next is sad and crying,” says Tobias. “You have to balance the roller coaster of patients and their families, all while keeping up with the pace of work and managing your time.”
• Customer Service – “There is a customer service aspect to medical-surgical nursing,” says Nichols. “You want patients to be happy with their care so they will be comfortable coming back next time they need something. Even if you can’t fix all their problems, you have to address them all and let the patient know you are doing your best.”

Serving your neighbors

As a nursing student, Nichols did her senior practicum in labor and delivery. She loved the specialty and was upset when her preceptor recommended she work as a medical-surgical nurse for a couple years upon graduation before moving into labor and delivery. Nichols began her career on a step-down medical-surgical unit.

“I never went to work in labor and delivery, and the more time I am away, the more grateful I am that I didn’t,” says Nichols. “You get exposure to so much more than one narrow focus when you work on a med-surg floor. And you might find your true passion there, whether it’s wound care or cardiac care or as an educator.”

Tobias encourages nurses to keep an open mind about medical-surgical nursing. “If you get into nursing because you really want to take care of people, there is no other subspecialty like it,” he says. “Marymount is a community hospital, and the people who come here are our neighbors. Our med-surg nurses impact people and build relationships with hundreds of patients in their careers.”