post written by Dan Kashulines

I’ve been working as a travel nurse for just under a year now, and have remained in the medical/surgical setting (med/surg) the entire time. It’s been incredible working in a variety of different hospitals while getting the chance to live in cities I never thought I would. Med/surg is generally seen as the entry level position for nurses when it comes to working in the hospital setting, and I agree with that in many ways. I was always instructed to at least get my first year of med/surg under my belt before specializing. This certainly made it seem entry level to me, but I’ve come to realize it’s not that simple.

I’d like to take some time to discuss that and what I’ve learned about working med/surg here. If you want to travel nurse in med/surg, you will likely need at least a year of experience. But once you get there, what can you expect?

Job & Patient Population

The med/surg nurse can often be seen as a jack of all trades. This setting sees a variety of patient populations, and therefore prepares nurses to handle a variety of situations. Within med/surg, I have seen several instances of subspecialties like med/surg-tele, med/surg-oncology, med/surg-neuro, and even med/surg-psych. In other words, just because you are assigned to a unit that is labeled “med/surg” doesn’t mean you know exactly what type of patient population to expect. As a result, I would argue that med/surg nurses have the opportunity to be uniquely well rounded in caring for different types of patients.

My take on the good and the bad

Patient load

One of the biggest drawbacks to working as a travel nurse in the med/surg setting is the heavy patient load. In general, this type of unit is for the patients that are in need of the hospital, but typically not frequent intervention. At least theoretically. For this reason hospitals tend to staff med/surg nurses with the heaviest of patient loads because “they don’t need that much attention.” Sounds good in theory, but in practice it’s often a different story.

If you’ve worked as a med/surg nurse for any length of time, then you know how that logic can play out. Sure, if you have patients who aren’t diabetic, don’t have any wounds, and aren’t on any antibiotics, maybe you’ll have a good day. But then there are those days when out of your six patients, five of them are requesting pain meds all day, four of them are on insulin, two on airborne precautions, two need dressing changes, and one is in restraints. Oh, and on top of that, you’ll have two discharges and two admissions… not a good day.

Most hospitals that I’ve worked at implemented some way of measuring patient acuity so as to balance out the load between nurses, so no one gets the assignment described above. Unfortunately, these acuity algorithms aren’t perfect and they will sometimes fail you. Regardless of whether they do work or not, you can probably expect to care for more patients at once as a med/surg nurse than on any other unit. In my time working as a travel nurse I’ve seen patient loads ranging from as few as 4 patients to a nurse, to as many as 10 (with a sidekick LPN), so something to keep in mind.

Getting floated

An event most nurses dread when it is their turn: getting floated. New environment, new patients, different coworkers; getting floated can really mess with the flow of your shift. If you are one who despises being floated to other units, I would caution you against traveling med/surg. I’ve met nurses who have written into their contract that they are not willing to float, but this has not been my experience. I would imagine you’d have a much harder time landing contracts with that stipulation.

I will say this, it definitely depends on the hospital. In my experience, most of the hospitals I’ve worked at required me to float when there was a need on another unit. And one thing I’ve found is that the travel nurse is typically the first to get floated, not the core staff (another word of caution). I think it’s quite common to get floated as a med/surg nurse in general because most larger hospitals have several different med/surg floors. Even if you don’t get floated to those because they are staffed, you may get shipped to the ED to take care of boarding patients, or to the PCU to take care of patients pending transfer to a med/surg floor.

Overall, I would say there’s a good chance you will float to other floors when you travel as a med/surg nurse so be ready for that!

Receptivity of unit to travelers

The final area of my experience that I want to talk about is how receptive staff nurses and hospitals are to med/surg travel nurses. I think this is one of the major fears of travel nurses, facing hostility from their coworkers when they land an assignment. I have heard horror stories of nurses getting unfair assignments, being blamed for things they didn’t do, and generally just getting bullied in the workplace.

Unfortunately, there is reason a lot of the time to have fears like this, but thankfully I have found that in my personal experience this has not been the case. As long as I show I am there to work hard, to prioritize the patients, and to help out the rest of the nurses when I can, I’m treated fairly. To the contrary of the horror stories listed above, I have often been thanked for coming on assignment, and I have witnessed managers instructing staff nurses to treat travel nurses respectfully.

Maybe it has to do with the heavy patient load that med/surg nurses often have. Perhaps since we’re all feeling overworked, we tend to give each other a little more slack. Every assignment has the risk, I suppose, of encountering hostility as a travel nurse, but in my time working in med/surg as a travel nurse I have not experienced that at all.

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Overall, I have enjoyed my time working as a med/surg nurse in the traveler community. I have had some very difficult hospital assignments at times, where I felt like almost every day on my way home I wanted to quit. But I will say this: I believe sticking with med/surg, has made me a better nurse, and I have made many friends along the way. I hope sharing my experience is helpful to you and that you’ve learning something about what it looks like to work as a travel nurse in the med/surg setting.

What experiences have you had working as a travel nurse in the med/surg setting?