Hospitals work to end stigma on med-surg nursing

While hospitals and health systems have seen improvements in nurse turnover and recruitment since the height of the pandemic, many continue to have a particularly hard time staffing medical-surgical units. 

At The Ohio State University Wexner Medical Center in Columbus, around 90% of agency dollars are being spent on nurses to work in med-surg, the hospital's chief nursing officer, Deana Sievert, DNP, RN, recently told Becker's. Many health systems across the U.S. are experiencing a similar situation.

A history of stigma attached to med-surg — the units that typically account for most of a hospital's beds — is driving this challenge. Often, it's considered a steppingstone to other specialties, rather than its own. It's also thought of as more strenuous than other specialties, given med-surg nursing requires a broad range of knowledge to care for patients who may have very different conditions and needs. 

Shifting the narrative 

Putting a more positive light on the specialty's reputation requires a shift within the nursing field itself, leaders say. 

"We have got to partner with our academic partners because over the years, there has been a stigma that has been secured by faculty," Dr. Sievert said. "Nursing students coming out are saying to us, 'Listen, my faculty told me don't take a job in med-surg. You can't take care of patients very well there because they give you too many.' I think we've got to definitely work with our academic partners [to change that]." 

Med-surg nurses typically manage five to seven patients at a time, higher than the typical patient load nurses in areas such as the ICU may care for. To make med-surg more attractive, hospitals are working on giving nurses additional support so they can focus less on tasks that take them away from their patients. 

For example, some hospitals are leaning more heavily on patient care assistants to better support med-surg nurses with non-nursing tasks. Investing in virtual nursing and technology is another way health systems are working to change the perception of med-surg nursing. 

Tommye Austin, PhD, RN, senior vice president and chief nursing executive at St. Louis-based BJC HealthCare, previously told Becker's the system is exploring how robots and technology can be integrated with vital sign machines and other equipment to mitigate the burden of repetitive tasks. 

"If I'm a registered nurse working in a med-surg unit, I should be able to expect that I don't have to double document vital signs," she said. "I don't have to double document IV drips and things of that nature. … I think there are certain things organizations should put in place so that the work environment is a lot easier." 

At OSU, leaders are considering whether med-surg unit staffing can be improved with money currently being used on agency nurses. 

"You can generally employ one and a half nurses for the cost of an agency nurse, and sometimes even two," Dr. Sievert said. The hospital is in the middle of an analysis to see whether a shift to a sole RN model where nurses could expect a standard patient load of three patients, with an occasional flex up to four or five, would be comparable to the current model, which involves a lot of agency nurses and patient care assistants. 

"Is there a different way to spend our dollars and can we do it wiser to really recruit our own team?" she said.

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