The focus is on medical-surgical nursing in this episode of the Nursing Notes Live podcast with a panel discussion on our topic. On the panel is Jill Arzouman, President of the Academy of Medical-Surgical Nurses and a clinical nurse specialist at Banner University Medical Center in Tucson, Arizona. Also joining us is Mimi Haskins, president of the Medical-Surgical Nurse Certification Board and a clinical assistant professor at the State University of New York School of Nursing in Buffalo, New York. Here’s that discussion.
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Jamie Davis: Hi, Jill and Mimi, it’s great to have you here on the show with me today and I will start off with my traditional first question for our guests. I’d like to just find out a little bit about what brought you to the nursing profession. We’ll start with Jill. Jill, tell us a little bit about why you wanted to become a nurse.
Jill Arzouman: I wanted to become a nurse because I enjoyed taking care of people. I love trying to promote wellness and I just thought it’s a sort of a wonderful opportunity to be involved in the healthcare profession. Quite honestly, I did consider medical school. I considered nursing school. I also considered physician assistant school way back when, when I first started. I thought nursing, to me, offered the most flexibility to blend family and career and more opportunities to different things over my career. Nursing has certainly offered that to me over my 30-plus years as a nurse.
Jamie: Excellent. How about you Mimi?
Mimi Haskins: Well, I started out in my former life as a cost accountant. I really became interested in nursing when my husband had some major health issues and had to have surgery. I was with him pretty much all the time while he was in the hospital. And I was just blown away at how wonderful the nurses were. The doctors and the residents came in and left, but it was the nurses who cared about him and took care of him and me. I just found that to be – it just struck me. I’m somewhat of a nurturing person by nature. So I became interested in looking into becoming a nurse. I actually did it in quite a roundabout way. I started out – I was in the Army Reserves at the time. So I became an Army medic. Then I went on to become an LPN. Then I got my RN. So it’s a road traveled and I’ve loved every minute of it to be perfectly honest.
Jamie: That’s great. I actually started as a civilian paramedic before I became a nurse and so I completely understand. We come into this profession in so many different ways, but so often, for many of the same reasons, because of our desire to help and care for others. So we’re going to go and jump on in here the main topic and that’s Medical-Surgical nursing, which I guess when I first started out as a nurse and in nursing school, I thought it was the place you went before you got into your specialty as a nurse. And I know that you both are probably gritting your teeth with me saying that because we all know now that Medical-Surgical nurses and nursing is really a specialty unto itself. So as we go through this discussion, I want you both to just jump right in, comment on each other’s things that you say because I really want to hear what you both have to say about the questions that I ask. Jill, why don’t you start off? Talk a little bit about the history of Medical-Surgical nursing as a specialized nursing career.
Jill: Well, it initially was, yes, a place for people who went to get their – they call their “basic training” and then move on to other opportunities; however, the patients have become so much more complicated. You don’t have a patient come in the hospital anymore just to have their gallbladder out or just to have their appendix out. People are coming in with more and more comorbidities. They have hypertension. They have diabetes. They have COPD. The patients that we’re seeing on the Medical-Surgical units are very, very complex and nurses need to have a wide variety of skills in order to successfully care for those patients in addition to coordinating the care and transition out of the hospital. So over the years, these patients become more complex. The skills of the Med-Surg nurse has become more complex. It really has transformed into a specialty I think. And maybe you can speak this too, but we do use monitors. We have patients around telemetry and some patients at Med-Surg units are even on monitors, et cetera, in the long-term care units. But the Med-Surg nurses really have to cultivate their assessment skills because we rely more on those than we necessarily do on the machines and the equipment that you might see in the ICU. So a Medical-Surgical nurse has to be very competent and very knowledgeable on a wide range of diagnoses in order to be safely and effectively care for these patients and provide great outcomes.
Mimi: I agree with Jill. The Med-Surg patients that we have today, even 10 years ago, were our ICU patients. So we are really seeing critical patients. We do have to have a lot of knowledge and skills. As I take my students to a hospital where half of them are on a telemetry floor and half are on a general Med-Surg floor and it’s amazing the amount of information and the skills and they watch the nurses and they’re just amazed at how much they have to know. So I can see my nurses in the hospital are really making an impression on my students as to what goes into being a Med-Surg nurse.
Jill: While some units are – so say you may have all surgical-oncology patients on one unit or gyne-oncology patients on a different unit – you still may have areas you’re taking care of a urology patient next to a peripheral vascular patient and a cardiac patient or one patient with all those same comorbidities. So it really requires a vast amount of information. Med-Surg nurses have to be very flexible and adapt to a rapidly changing environment because the pace is very, very fast.
Mimi: Agreed. Exactly. It’s funny. When I interviewed for a position at a Conference of Cancer Care Center as an educator, they asked me what areas do you think you need a little more knowledge in and I said, “Probably oncology.” And they said – well, it’s a cancer center, you would think I would hear that. They said, “No, that’s not why we interview you. We have our oncology experts but we need someone who is an expert in Med-Surg because our nurses sometimes tend to forget that we have all these other co-morbidities in Med-Surg issues and it’s not just oncology.” So I was really excited about that because it validated the fact that they respected the Med-Surg nurse. I thought that was great.
Jamie: That’s a fabulous story and, really, I think points to the fact that this is a specialty. That bringing that generalized approach to having to be able to look for everything, because how do patients get to the ICU or to the other units? It’s because a nurse in a Med-Surg unit often identified a problem that needed to move, that they needed to be upgraded for a different level of care.
Jill: And the other thing that a Med-Surg nurse that brings to the table is their ability to effectively transition patients out of the hospital. Many years ago when I was a newly-licensed registered nurse, once a patient left the hospital, you don’t think too much about that. And now we’ve talked about how planning for discharge start on the day of admission. Well, that didn’t really hit home until the changes with reimbursements and hospitals will not be reimbursed for patients being readmitted. Plus it’s not good patient care if a patient gets readmitted. So the medical-surgical nurse has to truly be planning for discharge upon the day of admission. There is no getting around that, and they have to coordinate not only with their ambulatory care nurses, but the rest of the disciplines. The patients have the resources that they need moving out, whether it’s back to home, back to a nursing facility, to a rehab. They have to be aware of the long-term effects of the care they’re providing. What this patient will need to be successful once they walk out the front door of the hospital. So the critical thinking skills are so important for the Medical-Surgical nurse.
Mimi: Oh, absolutely. It’s the bedside nurse that’s really driving these patients because they go to the case managers, the care coordinators and they’re saying, “Look, this is what this patient needs. I’ve been with them every day. I know. This is what I’m hearing from the family, what I’m hearing from them.” And so they are really, many times, the driver of getting – the beginning of that coordination of care and transition to the next level because they’re the ones that are with them the most, with those patients the most.
Jamie: Mimi, it kind of steers us into the thought of certification. It is important to be an actively certified part of your specialty and become a clinical specialist or whatever the case may be. Can we talk a little bit about why that’s important and what certification brings to the table for that nurse that reaches out and decides, “I’m going to get certified as a Medical-Surgical nurse”?
Mimi: Oh, yes, we can. It’s one of my passions, this certification. I’m constantly promoting it. Obviously, I’m biased because I am president of the Medical Surgical Nursing Certification Board, but aside from that, I just feel like it’s so important. We actually did a survey of our certificants, looking at what the value of certification was to them and why it was important. We just recently did another survey asking our certificants, what certification or how has it impacted on your practice. And this theme that has come across time after time is it validated their knowledge. It gave them more confidence in their skills. It gained the respect of their peers and of the physicians and they become the go-to people on the floor both informally and formally as leaders. It was absolutely amazing to listen to the anecdotal evidence and hear that. We’re also looking to re-do some research. There’s a lot of anecdotal research right now that floors that have more certified nurses have better patient outcomes. It’s so important to get that point across especially to employers, because sometimes in these particular times, especially if they are pulling back from funding, educational opportunities for nurses unless they’re in a Magnet Environment. So it’s so important to let them know. Therefore, what we’ve been trying to do is to share that information, because it does make a difference. I always say when I’m doing any talks on certification, because I’ll talk to the new graduates and things like that, and I’m going to tell them I was the same person of the day I took my test as I was the day I opened that letter saying I passed. But when I opened that letter, it was like, “Oh, man, I’m the best. I did it.” It was so exciting to find out and it just validated everything for me. That’s exactly what we hear from everybody. So certification really truly is the way to go. I believe it. It also helps to keep nurses on top of what’s going on, because any certification requires continuing education, to recertify, or you have to have so many contact-hours or you’ll have to take the exam again. I don’t think there’s anyone who wants to take an exam again. So it gives them that opportunity. My thoughts are is no matter if you drag somebody kicking and screaming to an educational program or get them reading articles, that somewhere that’s going to kick in when they’re at the bedside and they have a situation they go, “Oh, I just read that article and this is what they did.” So it’s always there and I just think it’s so important. I hope I didn’t come across as too excited about certification.
Jamie: No, I think that it’s important. And, Jill, I’m just going – kind of leaning over to you as the president of the Academy of Medical-Surgical Nurses, you obviously can see the importance of being certified, but also being a member of your professional organization.
Jill: This is true. I’m going to tag on to Mimi’s – about certification quickly before I talk about the organization – but I was one of those folks who certification was not as promoted when I graduated many years ago. And then when it was becoming important, I thought, “Oh, well, do I really need to go take another test? I have my RN license.” Then I thought, “Well, other people are doing it, I should probably do it.” So I studied really hard. I did not tell anybody. I snuck out of work one day, or after work, and went, took the test and I passed. I thought, “Okay. Wow, it is very much a sense of accomplishment and then maybe I need to go back and get those continuing education credits to maintain my certification.” It is important. Healthcare changes too much not to be involved and be on top of the knowledge that’s come out. So this leads me to the professional organization. On my undergraduate program, joining the professional organization was very much promoted. I had joined early on in my career. I’m more involved now in AMSN as the president, but the advantage of belonging to the professional organization is the resources and the connections and the quick access to information. For example, the Academy of Medical-Surgical Nurses has position statements on things from the use of beds in the hallway to mandatory overtime to pain management, Patient’s Bill of Rights. We have legislative updates and resources that are available for things that are coming out; for example, information about Title IX funding for Nursing Education. AMSN has scholarships for different programs; for example, sending people to the Nurse in Washington Internship Program to learn about how the legislative process works and how we can be effective in the legislative arena. We have information on how to start research programs for evidence-based practice. A lot of information about the healthy practice environment and how nurses can advocate for that in the places where they work. There’s a place for – you can write in with clinical questions and get responses back on that. I know Mimi will agree with me the convention is a wonderful experience that we do annually. Anyone can go. You don’t have to be a member. But it’s a way to connect and get a good chunk of your continuing education units for licensure and recertification. Another thing we try to do is connecting with our members is AMSN has over 11,000 members right now that we’re pretty proud of. We do a lot of short informational pieces. For example, when we first were having the issues with Ebola in the United States, I put out a Facebook message and some things on Twitter with some messaging about where to go for resources because we were all frightened about taking care of these patients. The focus was the emergency room and the critical care units. There’s a very good possibility a patient who will contract Ebola could end up in the Med-Surg unit and we need to make sure that our nurses protect themselves. We’ve done some messaging about the Revised Code of Ethics that the American Nurses Association has recently revised. The new edition came out 2015. It just came out. And then AMSN has put together a clinical leadership development program that will be ready in a couple of months and we’re going to – we’re marketing that as a way to promote clinical leadership at the bedside. So not so much that you become a leader and you move away from taking care patients. We need nurses who are intelligent, who are leaders taking care of patients every day and working with them in the clinical setting. So it is a resource and in a way to connect with other members from across the country which is where I’ve learned so much connecting on the national level. And in a way, to volunteer. I was not as involved when my children were younger because they kept me pretty busy but I still have that connection. And now that my children are all in college, I have to have to really dive into the organization and take advantage of the opportunities that are there from a volunteer’s standpoint.
Mimi: I agree. Being involved in AMSN was one of the best things I’ve ever done. I kind of fell into it by accident when I was living and working in Ohio, in the Cleveland area. I found a chapter and got involved and, within the first year, I was already the vice president of the chapter. We did so much. One of the actual presidents of the chapter was also involved at the national level. She became my mentor. It was through being in AMSN that I started volunteering at the local and national level. It’s put me in a position I’m in today, which has also helped me within my career. I’ve been recognized – I was recently recognized for my leadership in nursing because of my involvement with AMSN and MSNCB. So it has been a wonderful thing. But like Jill said, with connecting at a convention is probably one of the most exciting things and every time you see new people, their first time, and then you see them toward the end the convention and they are just raving about how great it was and all those things they learned and what they’re taking back. I had a friend who I worked with who – I encouraged her. She had done a poster presentation and I encouraged her to submit it. So she came to the convention one year with me as it was accepted. The funny thing is, one of the things we were implementing at the hospital at the time was bedside rounding, which she was so against and she was one of the leaders on the unit. So there happened to be a program on bedside rounding at the convention. She heard from other Med-Surg nurses about how successful it had been and what has it done and it changed her entire perspective. She talked to the presenters afterwards. She went back and she was the biggest champion of bedside rounding that you could’ve found anywhere. So it really does make a difference. It’s so great. AMSN offers scholarships so that people who don’t have the money to go, they can apply and be able to attend the conference. I just think it is a great opportunity.
Jill: The other thing I think that’s important too on the whole concept of joining your professional organization – obviously, Mimi and I are very strong proponents of the Academy of Medical-Surgical Nurses – but as a member of AMSN, we collaborate with a number of other national nursing organizations. So when we go to the Nursing Organizational Affiliates, so we’re sitting there with elected leaders from other organizations – so the Ambulatory Care Nurse Association, the Critical Care Nurses, the Psych-Mental Health Nurses – and so we are able then to collaborate with some of them. For example, we are going to do some collaborating with the Psych-Mental Health Nurses and the Emergency Room Nurses about the care of the mental health patients outside of a mental health facility because that is a really significant problem that nurses face. We did happen to give the emergency nurses information when it came to Ebola. So the ability to – for these national organizations to collaborate and then bring the information back to their individual members is huge. Because nurses speaking together with one voice will accomplish more than speaking independently to lead and change our practice for the better.
Jamie: Absolutely. We can keep talking I think probably for another hour, but we’re nearing the end of the show. I am sorry for that because I think it’s a great conversation. But let’s kind of wrap up with a thought from each of you on what the future holds for Medical-Surgical nursing. You’ve talked about how much has changed from the past. But as leaders in Medical-Surgical nursing, and I’ll start with you Mimi, what do you hope for the future of Medical-Surgical nursing?
Mimi: I think that we’re only going to get stronger to be honest. I don’t hope for it, I know it. I just see that we – as Medical-Surgical nurses, we’re so flexible and probably one of the biggest qualities that we have is that ability to go with the flow because you have to. I see that we’re going to be – maybe there won’t be as many inpatient units, but there’ll be more observation units. When these patients come in, and they’re like a 23-hour observation patient, but we’re still there. We’re still doing what we do best. We’re assessing them. We’re identifying issues and we’re getting and taken care of. I see us in the care coordination and transition management. That’s a big part of it. My certification board, MSNCB, is soon launching a new certification for care coordination and transition management. We have such a waiting list of people that can’t wait to be part and take the exam. So there’ll be Med-Surg nurses that are doing care coordination and they want to be certified in that as well as in Med-Surg. So I see us as just being there and being the nurses in the future because of our flexibility.
Jamie: Jill, how about you?
Jill: I also agree with Mimi that we’re going to see an increased exposure or need for the Med-Surg nurses and working in collaboration with the Ambulatory Care nurses to coordinate the transition of care from inpatient to outpatient. As the patients in the hospitals are continuing to get more sick, we’re trying to move towards a wellness model keeping people out of the hospital. Medical-Surgical nurses will need to continue to increase their knowledge base about the care of these patients. So the need for knowledge is going to continue to skyrocket. And I think that it’s the largest practicing body of nurses in the country. The need for leadership in Medical-Surgical nursing is huge and the opportunities are endless. Whether you’re working at the bedside or you’re working in a leadership role on your units or you’re in the board room with the chief executive officer of your institution. The role and the opportunities for Medical-Surgical nurses as leaders moving forward in healthcare nursing is going to continue to expand. So I think the future is very bright for nursing in general, but of course, in particular for Medical-Surgical nursing.
Make sure you check out the entire March 2015 issue of Nursing Notes where we look at the specialty of the medical-surgical nurse. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month where I sit down with our Get to Know nurse Westley Foster, a clinical nurse at Banner University Medical Center in Phoenix, Arizona and nurse educator at Mesa Community College Nursing Department in Mesa, Ariz., and Northern Arizona University in Flagstaff, Arizona. You’ll find this and other episodes of Nursing Notes Live in the podcast area on iTunes and check out the new podcast player at DiscoverNursing.com!