Grab a coffee, your stethoscope, and a vein finder. Today is all about the fast-paced medical-surgical nursing specialty.
Regardless of your reasons for stopping by, this comprehensive overview of med-surg nursing will answer your questions—and others you hadn’t even thought of asking.
What’s the Average MedSurg Nurse Salary?
Nurse salary is affected by many variables.
Location is one of the most important factors affecting nurse pay. For example, according to the U.S. Bureau of Labor Statistics, registered nurses in the highest-paying states make approximately $70,000 more per year than their counterparts in the lowest-paying states.
Pay also varies based on specific work settings. Even in the same city, a nurse typically makes more in an outpatient care center than a hospital. In turn, hospitals have different pay rates. For example, on average, state-owned hospitals pay more than privately owned hospitals.
Nurses’ salaries can vary greatly due to these and numerous other factors. That said, the following table shows the average wages for different nursing professionals in various settings providing medical-surgical care.
How do these amounts compare to the average salary for each license type?
For registered nurses, working in outpatient care centers or hospitals pays more than the average wage of $94,480 annually. The same is true for certified nursing assistants, who earn an average of $39,610 annually. Interestingly, LPNs/LVNs earn less than average ($60,790 per year) in hospitals. However, they also make higher pay in outpatient care centers, as do other nursing professionals.
Medical-surgical nurses usually earn less than nurses in other hospital specialties, such as ICU or ER. However, even this is relative. For instance, with PRN med-surg shifts, nurses can make significantly higher hourly rates than nurse employees in other areas. Certified nursing assistants can also pick up high-paying PRN CNA med-surg jobs to significantly increase their hourly rates.
What Is Medical-Surgical Nursing?
Medical-surgical nursing is a specialty that focuses on the care of adult patients with a wide range of conditions. Many consider med-surg an entry-level position, but it is the largest nursing specialty in the U.S.
The Academy of Medical-Surgical Nurses (AMSN) commissioned a task force in 2014 to define medical-surgical nursing in medical terms. The AMSN revised this definition in 2019 and stated that the definition will continue to evolve along with the medical-surgical nursing practice. Based on the AMSN definition, the following are characteristics of medical-surgical nursing:
- Medical-surgical nursing is the largest nursing specialty in the United States.
- Nurses provide medical-surgical care in numerous healthcare settings, including hospitals, outpatient care settings, home health, and more. In fact, medical-surgical nursing is in practically all care environments because it is not dependent on a location.
- Medical-surgical nurses care for patients with various medical issues or those preparing for or recovering from surgery.
- Med-surg nurses are knowledgeable and experienced in their practice.
- Med-surg nurses have advanced organizational, prioritization, assessment, and communication skills.
- Nurses who work in med-surg coordinate care among the interdisciplinary healthcare team members.
What Is a Hospital Med-Surg Unit?
Medical-surgical units typically have the most beds and patients of all hospital wards.
Healthcare professionals who work on medsurg units provide care 24/7. Furthermore, patient bed assignments are based on healthcare needs. For example, a patient at risk for falls will typically be near the nurses’ station.
Medical-surgical units have a variety of medical equipment that facilitates monitoring and patient care. These units may have the following technology:
- Continuous telemetry monitoring and pulse oximetry monitoring
- Machines for continuous renal replacement therapy
- Targeted temperature management
- Disposable bronchoscopes
Med-surg units may have private or shared rooms for patients. Some hospitals may have rooms with isolation capability and rooms for morbidly obese patients.
Sometimes, family members are encouraged to stay at all times, such as to accompany pediatric patients. In those cases, hospitals provide extra beds or recliners for the parents or other caretakers. Aside from special cases, visitors usually have limited hours to see patients. Some hospitals also limit the number of visitors a patient can have at a time.
Which Patients Are in Med-Surg Hospital Units?
Patients can be admitted for medical-surgical care in the following ways:
- Direct admission: A primary care provider may refer the patient for hospital admission.
- Emergency room (ER) admission: Emergency room staff may recommend admitting a patient to the hospital.
- Swing bed admission: Swing Bed Utilization RNs, hospitalists, nursing and rehab managers, and pharmacists consult to determine whether a patient meets the criteria for a swing bed admission.
- Observation status: Sometimes, patients enter med/surg for monitoring and observation. Within 48 hours, they are either discharged or admitted as acute care patients.
The following are the admission criteria for medical-surgical units:
- Acute admission: An acute admission is considered when a patient is experiencing an acute or potentially acute illness or injury or a worsening of a chronic condition affecting one or more body systems.
- Swing bed admission: A swing bed Medicare admission is appropriate when a patient has completed an acute inpatient stay of three consecutive midnights in the previous 30 days; their medical condition has the potential for rehabilitation, or the patient can have a medical benefit from the stay; a patient needs skilled nursing care, such as wound or medication management, or rehabilitation therapy; the skilled nursing services a patient requires are more appropriate for the hospital setting.
- Observation admission: Patients are admitted for observation when they need short-term diagnostic testing and monitoring.
If a patient’s condition requires a higher level of care, the medical-surgical setting may not be appropriate. The following criteria illustrate aspects that disqualify patients from receiving med-surg care:
- Medical-surgical care is meant for acutely ill patients but not critically ill patients.
- Patients who require mechanical ventilation, invasive monitoring, titrated medications to control malignant cardiac arrhythmias, or titrated inotropic or beta blocker drugs to maintain hemodynamic stability are not admitted to med/surg. If these patients are already in a med-surg ward, they must be transferred to receive a higher level of care.
Which Conditions Are Treated in Med-Surg?
Medical-surgical nurses care for patients with various care needs throughout the lifecycle. Med-surg patients may require testing, observation, or care for an illness or surgery.
The medical-surgical nursing specialty covers a wide range of subspecialties, including the following:
- Oncology
- Neuroscience
- Neurosurgery
- Acute rehabilitation
- Gastrointestinal treatment/care
- Otorhinolaryngology
- Urology
- Cardiac conditions
- Gynecology
- Orthopedics
- Vascular conditions
- Thoracic surgery/care
- Plastics
- Bariatrics
- Maxillofacial surgery/care
- Transplant
Patients undergoing surgery will likely receive med-surg care before the operating room (OR) and after the post-anesthesia care unit (PACU). For example, patients undergoing abdominal surgery, such as gallbladder removal, hysterectomy, colon surgery, appendectomy, and hernia surgery, require preoperative and postoperative nursing care. Patients undergoing orthopedic surgery, such as carpal tunnel surgery, total hip and knee replacements, and rotator cuff repairs, also need med-surg care.
What Healthcare Professionals Work in Med-Surg?
Med-surg patients receive care from a variety of healthcare professionals. This interdisciplinary team collaborates to develop each patient’s care plan. The following are the professionals who typically provide input for patients’ care plans on Medsurg units:
- Physicians
- Nurses
- Pharmacists
- Social workers
- Registered dietitians
- Physical, occupational, speech, and respiratory therapists
- Home and Community Care (HCC) Coordinators
Other med/surg staff who contribute to patient care include the following:
- Laboratory staff
- Diagnostic imaging staff
- Nursing assistants
- Unit clerks
What Are the Duties of a Med-Surg Nurse?
In hospitals, nurses provide medical-surgical care around the clock. Both registered nurses (RNs) and licensed practical or vocational nurses (LPNs/LVNs) can provide this care. However, duties vary based on licensure, and RNs must supervise the care provided by LPNs/LVNs.
The ratio of RNs to LPNs/LVNs may vary by state and healthcare facility. For reference, LVNs may constitute half of the medical-surgical nursing workforce in California, which is a state that heavily relies on LVNs for staffing ratios.
The following are typical duties of practical/vocational nurses in settings providing medical-surgical care:
- Providing nursing care to assigned patients under the direct supervision of the registered nurse and following the patient care plan
- Performing general nursing duties with adequate supervision
- Collecting data through observation
- Communicating information, such as results of diagnostic studies and symptoms, to assist the supervising nurse in patient assessment and care planning
- Participating as a member of the healthcare team
- Accepting delegation from the supervising nurse to meet the needs of patients and family members
- Communicating with patients and family members
Registered nurses are essential members of medical-surgical teams. They provide nursing care, delegate tasks, and supervise other care team members. The following functions illustrate what registered nurses do in medical-surgical settings:
- Coordinating with healthcare team members to assess, plan, implement, and evaluate patient care plans
- Delegating tasks to practical/vocational nurses and nursing assistants and supervising these members of the healthcare team
- Preparing, administering, and recording medications (orally, subcutaneously, intravenously)
- Reporting adverse reactions to medications or treatments
- Educating patients on surgical procedures
- Recording patients’ medical information and vital signs
- Monitoring and adjusting specialized equipment used on patients and interpreting and recording electronic displays
- Initiating corrective action whenever the patient has adverse reactions to treatment
- Providing bedside care for a wide variety of medical patients, including preoperative and postoperative patients
- Teaching patients and family members how to manage their illnesses/injuries after discharge
- Changing dressings, inserting catheters, starting IVs
- Preparing equipment and assisting physicians during patient examinations and treatments
- Responding to emergencies and providing basic life support
- Participating in discharge planning
- Recording all care information accurately and promptly
How Can I Become a Med-Surg Nurse?
The fastest way to work in med/surg as a nurse is to obtain a practical or vocational nursing license. Aspiring nurses may complete practical or vocational programs. These programs typically take one year. They must also pass the National Council Licensure Examination for Practical Nurses (NCLEX-PN). Additionally, candidates must meet other state-specific requirements, such as criminal background checks, to obtain LPN/LVN licensure.
Aspiring medical-surgical nurses may also pursue RN licensure. Candidates typically complete Associate Degrees in Nursing (ADNs) or Bachelor of Science in Nursing (BSN) degrees. ADNs take two to three years, whereas BSNs generally take four years. Candidates must also pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN). Additionally, they must meet other state-specific requirements to obtain licensure.
Even after licensure, nurses with ADNs may decide to obtain BSNs. RN-to-BSN programs typically take 18 to 24 months. However, experienced nurses may be able to complete these programs in as little as one year.
Besides nursing licensure, medical-surgical positions typically require nurses to have Basic Life Support (BLS) certifications. Some settings may also require Advanced Cardiovascular Life Support (ACLS) and Pediatric Advanced Life Support (PALS) certifications. The American Heart Association offers all of these certifications.
Although usually not required, one or two years of nursing experience may be preferred.
What Are the Responsibilities of a Med-Surg CNA?
Certified nursing assistants are also valuable members of medical-surgical teams. Nursing assistants allow nurses to concentrate on nursing tasks by completing basic care tasks. This assistance is critical amid a nurse shortage that has hit medical-surgical nursing particularly hard. The following are typical duties of nursing assistants in medical-surgical settings:
- Assisting with basic patient care, including nutrition, elimination, comfort, mobility, and safety
- Transporting and transferring patients using appropriate equipment, such as ceiling lifts
- Assisting with lifting and ambulation
- Maintaining the environment and equipment safe and clean
- Procuring equipment and supplies during emergencies
- Observing, collecting, and documenting patient information obtained while providing care, such as vital signs
- Reporting significant changes in the patient’s condition to the supervising registered nurse
- Working collaboratively with the healthcare team members to effectively communicate and document accurate information
- Participating in staff meetings
How Can I Become a Medical-Surgical CNA?
The requirements to become a CNA vary slightly from state to state. Typically, candidates must hold high school diplomas or their equivalent and complete CNA training programs. Some states require candidates to pass tests and undergo criminal background checks. Moreover, medical-surgical settings typically require nursing assistants to hold BLS certification.
Although experience is always a plus, med-surg positions typically do not require previous CNA experience.
What Are Physical Requirements to Work in Med-Surg?
The work of nurses and nursing assistants has a significant physical component. Not only are nursing professionals on their feet and on the go most of the time, but they also must lift, move, and transfer patients. Everyday medical-surgical tasks require nursing professionals to have the following physical abilities:
- Walking and standing for long periods
- Bending, leaning, and stooping
- Having a full range of body motion
- Possessing fine motor skills and visual acuity
- Possessing a normal range of hearing
- Lifting 20 pounds frequently
- Lifting 50 pounds when moving, lifting, or transferring patients
- Lifting 100 pounds with assistance
Is Med-Surg Nursing Just a Stepping Stone?
Can the largest nursing specialty in the United States be considered nothing more than a stepping stone to other specialties? Unfortunately, many nurses see it that way. However, it is high time this myth was busted.
Med-surg is the nursing specialty that needs nurses the most and that needs most nurses.
In other words, as one of the specialties most affected by the nursing shortage and one of the acute care areas with the most patients to care for, med-surg needs many new nurses to enter its ranks and stay.
Frankly, gone are the days when nurses needed one or two years of med-surg experience before moving on to the emergency room or the neonatal intensive care unit (NICU). New graduates can enter any specialty straight out of nursing school through residency or fellowship programs. There is no need to enter a specialty or setting just to get experience if your goal is to work elsewhere.
Med-surg is a specialty in its own right. Caring for patients with diverse conditions and needs requires a broad range of knowledge and skills. Medical-surgical nursing can very well be a career-long choice. In fact, many medical-surgical nurses are experts in this specialty and have the certifications to prove it.
Best Medical-Surgical Nursing Certification: ANCC vs. AMSN
Obtaining specialized certifications is optional for nurses. A med/surg nurse is one who provides medical-surgical care—with or without a certification. However, many nurses with experience providing a particular type of nursing care decide to certify to prove to themselves and others that they have expert knowledge and skills in their specialty. Many nurses feel that certification provides a sense of confidence and achievement.
There are two main certifications in the medical-surgical nursing specialty: the Certified Medical-Surgical Registered Nurse (CMSRN®) and the Medical Surgical Nurse - Board Certified (MEDSURG-BC™) credentials.
Certified Medical-Surgical Registered Nurse (CMSRN®)
The Academy of Medical-Surgical Nurses grants the Certified Medical-Surgical Registered Nurse credential. It is a recognized path for medical-surgical nurses to demonstrate their commitment, confidence, and credibility.
The following are the eligibility criteria to sit for this exam:
- Hold an unencumbered and current RN license from the United States or Canada. Candidates outside the US or Canada can also apply by meeting additional requirements.
- Have 2,000 practice hours in a medical-surgical setting accrued within the past three years. These hours include practice as a clinical nurse, manager, or educator.
Furthermore, the AMSN recommends that candidates have two full years of RN practice in medical-surgical settings.
The CMSRN credential is valid for five years. After this time, nurses can recertify through examination or contact hours. Nurses may also choose to pause their certifications.
Medical-Surgical Nursing Certification (MEDSURG-BC™)
The American Nurses Credentialing Center (ANCC) offers the Medical Surgical Nurse - Board Certified credential. The ANCC grants this credential after the successful completion of a competency-based examination. After initial licensure, the exam provides a valid and reliable assessment of the entry-level clinical knowledge and skills of nurses in the medical-surgical nursing specialty.
To sit for this exam, nurses must meet the following requirements:
- Hold an active RN license from the United States or the equivalent in another country.
- Have 2,000 hours of clinical practice in medical-surgical nursing within the last three years.
- Have practiced the equivalent of two years full-time as a registered nurse.
- Have completed 30 hours of continuing education units (CEUs) in medical-surgical nursing within the last three years.
The MEDSURG-BC™ credential is valid for five years. Nurses must keep their licenses active and meet other requirements to renew their credentials after that time.
MEDSURG-BC vs. CMSRN: Which Is Better?
Both credentials are excellent options for medical-surgical nurses. Both are accredited by the Accreditation Board for Specialty Nursing Certification (ABSNC) and accepted for the Magnet Recognition Program®.
Work Experience
Which one is best depends more on personal circumstances. For example, the ANCC certification requires two years of full-time nursing practice, whereas the AMSN only recommends it. Therefore, a nurse who has only worked for 12 or 18 months will likely opt for the CMSRN.
Furthermore, the AMSN accepts a greater variety of work experience, whereas the ANCC only accepts clinical practice hours. Again, this may not be an issue for nurses with sufficient clinical experience, but it may tip the balance for certain nurses.
Continuing Education
Continuing education credits are another aspect to consider. The AMSN doesn’t require CEUs, whereas the ANCC does.
Many states require 30 CEUs per licensing period. Therefore, this requirement does not require extra work for nurses living in California or Alaska. On the other hand, this requirement does imply extra work for nurses who live in Arizona or Colorado, where CEUs are not required.
That said, nurses pursuing specialized certifications are generally highly invested in their nursing careers and participate in nursing conferences, workshops, and training programs whether their state requires continuing education or not.
Recertification
So far, the AMSN certification seems to be the better option. However, when it comes to recertification, the ANCC offers some advantages.
Whereas the AMSN requires 1,000 practice hours in the past five years for recertification, the ANCC doesn’t require any.
Furthermore, although the AMSN doesn’t require continuing education for certification, it requires 90 hours for recertification within the previous five years. The ANCC only requires nurses to obtain 75 CEUs in the past five years. However, it also requires nurses to meet one of eight additional certification professional development categories.
Nursing Association Membership
Finally, nurses may want to consider becoming members of one of these organizations because of the discounts and other benefits membership provides. For example, a nurse who is already a member of the American Nurses Association (ANA) receives a discount to take the MEDSURG-BC exam.
Therefore, membership in a nursing association is also a determining factor in the choice of certification.
Patient-to-Nurse Staffing Ratios in Med-Surg
Med/surg, which typically accounts for most hospital beds, is one of the settings most affected by the nursing shortage. Higher patient-to-nurse ratios are one reason nurses avoid medical-surgical nursing.
According to a Becker’s Hospital Review article titled “Hospitals work to end stigma on med-surg nursing,” med-surg nurses typically care for five to seven patients. In contrast, nurses in intensive care units (ICUs) typically care for one or two.
To address the nursing shortage in this area, hospitals are looking for ways to support nurses so they can focus on their patients. For example, certified nursing assistants and patient care techs (PCTs) can help with basic care. Health systems are also exploring how robots and other technology can take and monitor vital signs. This technological advancement could reduce the time nurses must spend on these repetitive tasks.
Another BHR article, “Where are all the med-surg nurses?” references a 2018 study that found nurses spend approximately 10 percent of their time on non-nursing tasks. Therefore, the combination of technology and assistive personnel could potentially free up this 10 percent of nurses’ time for actual nursing tasks.
What Technologies Can Help Med-Surg Nurses?
Many technologies are now commonplace across healthcare settings. According to Becker’s Health IT, as of 2021, 96 percent of all non-federal acute care hospitals and approximately 80 percent of physicians’ offices had implemented electronic health record (EHR) systems.
However, many technologies are still new, and many others are only half-way materialized. According to The Medical Futurist, the following are some exciting, innovative technologies that could reduce the workload of med-surg nurses. In some places, they already are.
Robots That Reduce Repetitive Tasks
The TUG and Simeks’ Relay robots can transport medical devices, drugs, laboratory specimens, or sensitive supplies within hospitals.
Moxie from Diligent Robotics is already reducing nurses’ repetitive tasks in Texas hospitals. It autonomously picks up items from supply closets and delivers them to patients’ rooms.
Over 40 peer-reviewed studies have proven the efficacy of Xenex LightStrike Robot, a UV disinfection machine. It can disinfect a patient’s room in as little as 10 minutes and a surgical suite within 20 minutes.
Robots That Offer Companionship
Although the idea of having robots provide companionship can shock many, the truth is that medical-surgical nurses’ priority must be providing nursing care. Therefore, robot companions can free up nurses’ time by keeping patients entertained.
Pepper, Paro, Dinsow, and Buddy are robots that have proven useful in this endeavor. Pepper, the “social robot,” was used as a receptionist in Belgian and Czech hospitals. Paro, the cute and cuddly robot shaped like a baby seal, is used to help release stress and ease sadness and solitude.
Robots That Draw Blood
Vein scanners, such as AccuVein and VeinViewer, are already commonplace. However, robots that scan for veins and draw blood may be commercially available by the end of 2025.
Clinical trials of Vitestro’s blood drawing robot have shown promising results. Most patients (98 percent) indicated acceptance of the automated method of drawing blood. Additionally, 83 percent considered the procedure comparable to or less painful than manual blood draws.
Technology That Assists with Medication Management
Chatbots, such as Florence, can remind patients to take their pills. In addition, digital pills, such as those developed by etectRx and SIGUEMED, can be tracked to monitor adherence to medication schedules.
What Are the Essential Skills of Med-Surg Nurses?
With recent technological developments, many worry that robots and AI will take over their jobs. However, in nursing, at least, this is far from true, and the ongoing nursing shortage is there to prove it. Medical-surgical nursing still very much needs a human eye and awareness. It also needs a warm touch, empathy, and effective and compassionate communication skills. Here is why:
- Human observation and awareness: Technology can help reduce the time spent monitoring vital signs and other measurable indicators. However, nurses have a built-in feature that allows them to assess their patients qualitatively with just a glance. Within seconds, a nurse can know if their patient is in pain, scared, angry, or a combination of the above.
- Human touch and empathy: A robot may be able to draw blood more precisely than a nurse. However, a warm hand on a patient’s shoulder can make a world of difference in a cold and sterile environment. So can a smile.
- Compassionate communication skills: Technology has become closely intertwined with human communication. Most communication now relies on some form of technology, including EHRs, email, and phones. However, certain messages need to come from the human voice of a sentient being. Hopefully, healthcare systems will never employ robots to communicate to patients that they have terminal illnesses or inform family members that their loved ones have passed.
Is Med-Surg the Right Nursing Specialty for You?
Medical-surgical nurses are in high demand. Med-surg nursing opportunities are nearly limitless. Nursing professionals providing med-surg care can earn higher pay than the average for their licenses.
However, the question remains: Is med-surg right for you?
There is no right or wrong answer to this question, and no one can know but you. Just know that if you choose this career path, you are helping to fill a vast need.
The work you do is indispensable. You don’t need to work in the cardiovascular intensive care unit (CVICU) to save lives. Every patient you care for has a greater chance to have a better quality of life because of you.
Are you ready to get to work? Pick up a PRN RN med-surg job today.
Sources:
- Academy of Medical-Surgical Nurses: What Is Med-Surg Nursing?
- American Nurses Credentialing Center: Medical-Surgical Nursing Certification (MEDSURG-BC™)
- Academy of Medical-Surgical Nurses: Certification
- American Association of Critical-Care Nurses: Certification Benefits Patients, Employers and Nurses
- Medical-Surgical Nursing Certification Board: CMSRN Certification Handbook
