acute care nursing vs med surg

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How Do You Become A Med-Surg Nurse?

Are you ready to take the next step in becoming a med-surg nurse? If so, then check out this step-by-step guide to becoming a med-surg nurse.

Step 1: Earn Your Degree

The first step in becoming a med-surg nurse is to complete your associate’s degree in nursing (ADN) or BSN . The ADN program is typically two years long and prepares nurses for entry-level positions in hospitals and other healthcare facilities. 

The BSN program takes an additional two years and prepares students for management positions and clinical practice. Both programs require that students pass national licensing exams before graduation.

Step 2: Get Licensed  

Becoming a nurse is one thing, but if you want to be a Med-Surg nurse, you need to be licensed . To become licensed, you must complete a nursing program at an accredited school and pass the National Council Licensure Examination for Registered Nurses (NCLEX). 

The NCLEX is required for all nurses who want to practice in the United States; it's how hospitals and other health care facilities can ensure that they're hiring qualified personnel.

Step 3: Apply For A Job!

Congratulations! You're almost there! All you need to do now is apply for a job.

Once you've successfully got a license, you can apply for positions as a med-surg nurse. Unlike other unit nurses, med-surg nurses don't have to get certified. They just need to get their license and start applying for jobs.

To find a job, the first thing you need to do is make sure that the facility has open positions and that they have the resources available to hire new employees. 

This can be done by calling them directly or checking their website. If they have openings, call them up and ask about the position details.

You can also check out their Facebook page or Twitter profile to see if they've posted any information about job openings recently.

Once you've found an opening at a facility that has what you're looking for, make sure that it's a good fit before applying. That means researching their benefits package, salary range, and location (if applicable).

What is the Job Outlook For Med Surg Nurses?

Since the job outlook for med surg nurses is so good, and they can be found in many different settings, it’s no wonder that they’re in demand. 

In fact, there is a shortage of registered nurses in the United States, which is expected to continue through 2030. It means the demand for nurses, including med-surg nurses, will grow dramatically. 

What is the difference Between Med-Surg Nurses and Other Nurses?

The main difference between a med-surg nurse and other nurses is that the med-surg nurse is trained to work in an acute care setting. 

A med-surg nurse usually works in an emergency room , intensive care unit (ICU), or cardiac care unit. They also work for many different types of doctors, including surgeons, gynecologists, urologists, and internal medicine specialists.

The main focus of the med-surg nurse is to assist with patient care needs related to surgery and general medical conditions. 

These nurses may perform things such as changing dressings on wounds, administering injections, and taking vital signs (blood pressure, pulse rate).

Med-surg nurses are not required to have any specific degree. However,  many do choose to pursue higher education degrees, such as an associate's or bachelor's degree in nursing (ADN or BSN).

Why Should You Choose Medical-Surgical Nursing as a Career?

There are many reasons, but we'll just cover a few of the most important ones here.

First, you will have plenty of opportunities to grow your skills and knowledge through continuing education. You can take classes at local community colleges or online—there's no limit to where you can learn about new techniques and technologies. 

The more you know about what's going on in the field, the better equipped you'll be to help your patients.

Second, you'll be able to work in any number of different environments: hospitals, nursing homes, clinics, and even private homes. This gives you flexibility when it comes time for scheduling shifts—you can choose where you want to work based on what's available at that time!

Thirdly: this job is rewarding because it helps people feel better when they're sick or injured by providing them with proper care and treatment that allows them to recover faster than they would have if left alone at home without professional assistance from someone who knows exactly what they need during each stage of the recovery process (i.e., clean wound dressing, so infection doesn't occur).

It’s A Wrap!

Med Surg nurses are the ultimate multitaskers. They have to be up-to-date on all the latest medical news, be able to handle a crisis situation, and be able to work with patients of all different ages and healthcare needs. 

Med-Surg nurses are the glue that holds hospitals together, and they're what make it possible for you to get better.

So if you're interested in becoming a nurse, we hope that this article has given you some insight into what it's like working in Med Surg nursing—and how much fun it can be!

Is Med-Surg Nursing Stressful?

Yes, but it's worth it. Med-surg nursing is stressful because you have to make sure that your patients are safe at all times.

You have to do this while also making sure that you're doing your own job correctly, and then also doing your best to help the other nurses on your team. But if you love what you do, then it's worth the stress!

How To Survive Medical-Surgical Nursing?

Learning to survive medical-surgical nursing is much like learning to survive the zombie apocalypse. You have to be prepared for anything and everything, and you need to be ready for whatever comes your way.

• Be prepared for a lot of blood and gore. In medical-surgical nursing, you'll often find yourself dealing with patients who are in their last stages of life, which means hygiene can get pretty lax in these situations. It's important to be ready for anything when it comes to blood—from arterial spurts to spurts from IVs and other equipment—and, even more importantly, understand how to clean up after yourself!
• Practice makes perfect: If you want your skills as a medical-surgical nurse to be top-notch, then it's important that you practice them often! Practice makes perfect when it comes to medical-surgical nursing, so if there's ever an opportunity where you can practice on someone without their permission (just kidding), take advantage of it!

Can an RN work as a Med-Surg Nurse?

Yes, an RN can work as a Med-Surg Nurse.  In fact, the majority of nurses in the United States are working in Med-Surg positions.

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Understanding the Responsibilities of a Med-Surg Nurse

Med-Surg nurses, also known as medical surgical nurses, are important members of a healthcare team, providing comprehensive and holistic care to patients with a wide range of medical and surgical conditions. 

Explore the article:

• What is Med-Surg Nursing

The role of a Med-Surg Nurse

• What does a Med-Surg Nurse do

What is Med-Surg Nursing?

Med-Surg nursing is a specialized area of nursing that encompasses a broad spectrum of medical and surgical conditions. Med-Surg nurses work on medical-surgical units in hospitals and other healthcare settings. They care for patients who are dealing with acute or chronic illnesses, injuries, or recovering from surgical procedures.

Assessing and monitoring patients

A core responsibility of a Med-Surg nurse is to conduct comprehensive assessments of patients upon admission and throughout their stay. This includes evaluating vital signs, medical history, symptoms, and any changes in the patient's condition. Nurses closely monitor their patients' progress and promptly address any signs of deterioration or complications.

Medication management

Med-Surg registered nurses (RNs) are proficient in administering medications and intravenous therapies. They ensure patients receive the correct medications, at the right dosage, and at the scheduled times. Monitoring for medication side effects and adverse reactions is also a crucial aspect of their role.

Wound care and post-surgical management

For patients who have undergone surgery, Med-Surg nurses are responsible for wound care, ensuring that surgical incisions are clean, dressed appropriately, and healing properly. This role works closely with other nurses, including Post-Op nurses who transfer care of the patient to the Med-Surg nurse after a surgery or procedure.

Patient education

Med-Surg RNs play a vital role in educating patients and their families about their medical conditions, treatment plans, and self-care after discharge. They provide information on managing medications, diet, exercise, and other aspects of the patient's health to promote successful recovery and overall well-being.

Collaboration with the healthcare team

Med-Surg nurses work collaboratively with physicians, specialists, therapists, and other healthcare professionals to develop comprehensive care plans for their patients. Effective communication and teamwork are essential to ensure coordinated care and positive patient outcomes.

Emotional support

Patients in the Med-Surg unit may be experiencing a wide range of emotions due to their medical conditions or surgical procedures. Med-Surg nurses provide empathetic and compassionate support to help alleviate anxiety and promote emotional well-being.

What does a Med-Surg Nurse do?

A Med-Surg nurse's role is dynamic and multifaceted, involving a blend of clinical skills, critical thinking, and compassionate care. Some of the common tasks a Med-Surg nurse may perform include:

• Administering medications and intravenous therapies
• Monitoring patients' vital signs and overall condition
• Assisting with procedures and treatments
• Performing wound care and dressing changes
• Collaborating with healthcare professionals to develop care plans
• Educating patients and families about self-care and discharge instructions
• Responding to emergencies and providing urgent care as needed

Med-Surg is a Registered Nurse specialty that provides comprehensive care to patients with various medical and surgical conditions. Medical surgical nurses work in hospital and healthcare settings across the United States , and they play a vital role in the healthcare workforce . Their ability to adapt to diverse medical needs and their dedication to promoting optimal patient outcomes make them invaluable assets in the healthcare industry.

The Med-Surg nurse truly embodies the essence of nursing care through their competence, compassion, and commitment to improving the lives of their patients.

Interested in a more flexible healthcare career?

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Med Surg Patients and Procedures: What to Expect and How to Prepare

by Kati Kleber, MSN RN | Apr 13, 2023 | Med-Surg | 1 comment

Hello to my fellow healthcare professionals and anyone interested in learning more about the world of med surg nursing! In this post, we’ll discuss med surg patients and the various procedures they may undergo during their stay. We’ll also touch on what kind of patients are on a med surg floor, the typical patient ratio, and the use of patient acuity tools.

Table of Contents

What kind of patients are on a med surg floor.

Med surg patients come from all walks of life and present with a wide range of medical conditions and surgical needs. The med surg floor is often considered the backbone of the hospital, as it serves as a hub for diverse patient populations. You can expect to encounter patients with chronic medical conditions, those recovering from surgical procedures, and patients requiring acute care for various illnesses or injuries. This diversity requires med surg nurses to be knowledgeable about numerous medical conditions and skilled in providing personalized care to each patient.

Generally speaking, some of the most common diagnoses that your med surg patients will have:

• Heart failure
• Gastrointestinal bleeding
• Renal failure
• Chronic obstructive pulmonary disease (COPD)
• Urinary tract infections (UTI)
• Pancreatitis
• Deep vein thrombosis (DVT)
• Altered mental status (AMS, often caused by infections!)
• Bowel obstruction
• Patients needing a general cardiac work-up for various reasons

If you can refresh yourself on these, you’ll be able to educate your patients better and troubleshoot common complications. (And if you don’t want want to waste time finding a solid explanation, and want one tailored specifically to your needs as a med-surg nurse,  check out this resource I made  that explains all of those!)

Med Surg Patients: Common Nurse to Patient Ratios

Additionally, the med surg patient ratio refers to the number of patients assigned to each nurse on a med surg floor. This ratio can vary depending on the hospital, the specific unit, and the acuity of patients. Generally, the patient ratio ranges from 1:4 to 1:6, although it can be higher or lower depending on the factors mentioned above. It is essential for healthcare facilities to maintain appropriate patient ratios to ensure that med surg nurses can provide safe, high-quality care for their med surg patients.

Med Surg Patient Acuity Tool

Med surg patient acuity tools help determine the complexity of care required for individual patients. This helps ensure the workload is spread out fairly among staff members, as not every patient is created equal.

These tools take into account factors such as the patient’s medical condition, surgical history, and the level of care needed to manage their situation effectively. They often categorize patients under the following categories.

Stable med surg patients would require vitals every 4 hours or less frequently. Frequent vital signs can really increase workload. They are often on room air, vitals are within defined parameters, are tolerating oral intake, normal blood glucose levels, and may have an IV attached for continuous or intermittent dosing. They should have less than a few drains (like JPs) and their pain is managed well.

Moderate Risk

Patients on alcohol withdrawal protocol (scoring low), with oxygen needs, a temperature, chest tubes to water seal, NG tubes, PCA, active vomiting, tube feeding, tachycardia.

Active delirium, alcohol withdrawal (scoring high), presence of a trach, blood transfusions, fluid boluses, chest tubes to suction, bolus feeding, pain requiring frequent management, complex discharge, isolation, complex wounds or ostomies, translator required.

Unstable vitals, chemo, copious unmanageable secretions, uncontrolled pain, unstable cardiac rhythm, chest tube with copious output, end of life, transfer to higher level of care, restraints.

A good acuity tool would also take factors into consideration that would impact a nurse’s workload, like presence of extensive wounds, needing a 1:1 sitter, frequent turns, total care, frequent toileting, and more. Essentially, the more complex, the higher the score. Everyone on the staff should get a few higher acuity (more labor-intensive) patients and a few patients that are easier to manage.

By using a med surg patient acuity tool, healthcare providers can better allocate nursing resources, balance patient assignments, and maintain appropriate patient ratios.

Common Med Surg Nursing Procedures

Med surg nurses perform a wide range of nursing procedures to care for their med surg patients. Here are some of the most common procedures carried out on a med-surg unit:

Vital signs assessment

Med surg nurses regularly monitor patients’ vital signs, including blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation. This helps to identify potential changes in the patient’s condition and guide appropriate interventions. Your CNA might obtain the vial signs, but as the RN you will be responsible for analyzing that data and responding appropriately.

Medication administration

Nurses on a med surg unit administer various medications, including oral, intravenous, subcutaneous, and intramuscular routes. They must ensure the correct medication, dose, route, and timing while monitoring for potential side effects and interactions.

Nurses provide care for med surg patients with various types of wounds, including surgical incisions, pressure ulcers, and traumatic injuries. This involves cleaning and dressing the wound, assessing for signs of infection, and promoting healing.

Intravenous (IV) therapy

Establishing and maintaining IV access is a common task for med surg nurses. They administer IV fluids, medications, and blood products, and monitor for potential complications, such as infiltration, phlebitis, or infection.

Foley catheter insertion and care

Nurses on a med surg unit may insert and care for indwelling urinary catheters (Foley catheters). This involves maintaining sterility during insertion, securing the catheter, monitoring urine output, and preventing catheter-associated urinary tract infections (CAUTIs).

Telemetry monitoring

Nurses in the med surg world will likely have many patients who require continuous cardiac monitoring. Therefore, nurses should be ready to manage these telemetry, interpret and respond appropriately, and troubleshoot.

Nasogastric (NG) tube and dobhoff tube placement and care

Med surg nurses may insert and manage NG tubes for patients who require enteral nutrition or gastric decompression. This includes confirming proper placement, administering feedings or medications, and monitoring for complications.

Patient education

Nurses play a crucial role in educating med surg patients and their families about their medical conditions, medications, treatments, and self-care strategies. This helps to promote patient engagement, adherence to treatment plans, and improved health outcomes.

Pain management

Nurses assess and manage med surg patients’ pain using pharmacological and non-pharmacological interventions, such as administering pain medications, repositioning, and providing comfort measures.

Physical assessment

Med surg nurses perform head-to-toe assessments to evaluate patients’ overall health, identify potential issues, and guide care planning.

Blood glucose monitoring and insulin administration

Nurses on a med-surg unit may monitor blood glucose levels and administer insulin for patients with diabetes or other conditions affecting glucose metabolism.

Care coordination and discharge planning

Med surg nurses collaborate with interdisciplinary healthcare teams to coordinate patient care, develop individualized care plans, and prepare patients for discharge by arranging appropriate follow-up care and providing necessary resources.

These are just a few of the many nursing procedures performed by med surg nurses. As they care for a diverse patient population, med-surg nurses must be skilled in various procedures and adapt their approach to meet the unique needs of each patient.

Preparing for Med Surg Patient Procedures

As a healthcare professional working with med-surg patients, it is crucial to be prepared for the various procedures that patients may undergo during their stay. Some essential steps to prepare include:

• Familiarize yourself with the most common med-surg procedures, mentioned above. I go over many of these skills in this resource .
• Stay up-to-date on the latest evidence-based practices and guidelines related to these procedures to ensure the best possible patient outcomes.
• Attend continuing education courses, workshops, or in-service training to hone your skills and expand your knowledge. Many of my online courses are applicable to med-surg nurses ! Check out the latest catalog here .
• Develop strong communication and teamwork skills to collaborate effectively with other healthcare professionals in managing med-surg patients.
• Be prepared to educate and support patients and their families throughout the patient’s stay, explaining the rationale behind various procedures, addressing concerns, and promoting active participation in their care.

Final Thoughts For Med Surg Nurses

Caring for med surg patients is both challenging and rewarding, as it requires a broad knowledge base and the ability to adapt to the diverse needs of patients. By understanding the typical patient population on a med surg floor, maintaining appropriate patient ratios, utilizing med surg patient acuity tools, and being prepared for various procedures, healthcare professionals can provide excellent care and support for their med surg patients. Embrace the learning opportunities and continue to grow in your practice, knowing that your efforts positively impact the lives of your patients.

More Resources for Med Surg Nurses

• Major Differences Between ER Nurses and Floor Nurses
• What Do Med Surg Nurses Do?
• Nursing Time Management Tips
• Code Blue! Surviving Your First Code Blue or RRT
• Nursing Report Basics For Med-Surg Nurses – a free mini course that includes my fav med-surg report sheet and my top abbreviations I would use when taking report!

Are you a new Med-Surg nurse?

Med-Surg Mindset from FreshRN is the ultimate resource for nurses new to this complex and dynamic acute care nursing specialty. Whether you are fresh out of nursing school or an experienced nurse starting out in med-surg for the first time, the learning curve is steep . With input from three experienced bedside nurses, this comprehensive course is all you need to learn all of the unspoken and must-know information to become a safe, confident, and successful medical-surgical nurse.

Hi, I’m Kati.

Kati Kleber, MSN RN   is a nurse educator,   author ,   national speaker , host of   the FreshRN® Podcast , and owner of   FreshRN®   – an online platform created to educate, encourage, and motivate newly licensed nurses in innovative ways.

Connect with her on   YouTube ,   Pinterest ,   TikTok ,   Instagram , and   Facebook , and sign-up for her   free email newsletter   for new nurses.

Learn about FreshRN’s mission and values and more about Kati’s professional background .

I am a fresh med surge rn nurse

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ICU vs Med-Surg Nursing: An In-depth Comparison

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Nursing, a noble profession, plays a pivotal role in healthcare delivery, providing compassionate, comprehensive care to patients and their families in different settings. Among the many nursing specialties, Medical-Surgical (Med-Surg) nursing and Intensive Care Unit (ICU) nursing stand out for their distinctive roles, complexities, and impacts on patient outcomes. While these two specialties share common nursing foundations, their differences lie in patient acuity, nursing skills, responsibilities, and the pace of the environment.

What Is Intensive Care Unit Nursing?

In the nursing world, Intensive Care Unit (ICU) nursing is recognized as a highly specialized and intensely focused area dedicated to the care of patients who are critically ill or unstable. These patients may be suffering from life-threatening conditions like severe infections, organ failure, major surgery, or trauma. The gravity of these conditions often necessitates meticulous, constant vigilance and sophisticated interventions to stabilize patients and support vital organ function.

ICU nurses are trained to provide complex care to patients often connected to an array of life-supporting and monitoring equipment. This can range from ventilators that assist or replace spontaneous breathing to advanced hemodynamic monitoring systems for tracking blood pressure and cardiac output, to renal replacement therapy machines for managing acute kidney injury. They are adept at understanding and responding to the complex data these machines provide, making them vital in a setting as high-tech as the ICU .

Furthermore, they must possess an advanced level of assessment skills, able to detect minute changes in a patient’s condition, and respond swiftly and appropriately. This demands a high level of critical thinking and decision-making skills. They must be vigilant, proactive, and meticulous in their care, as the margin for error is very slim.

ICU nurses also play a significant role in the communication chain, serving as liaisons between the patient, the family, and the multidisciplinary healthcare team. Given the severity of their patient’s conditions, they must be adept at facilitating discussions about complex medical issues, end-of-life decisions, and ethical dilemmas, often providing much-needed emotional support during these trying times.

Additionally, the ICU environment often involves an interdisciplinary approach to care, with ICU nurses working closely with doctors, pharmacists, respiratory therapists, dietitians, and other healthcare professionals to coordinate and execute patient care plans. They also often participate in life-saving procedures, such as resuscitation and advanced cardiac life support.

Overall, the Intensive Care Unit demands a high level of expertise, attention to detail, and emotional resilience, making ICU nursing both a challenging and deeply rewarding specialty.

ICU vs Med-Surg Nursing: Which One Should You Pick?

Choosing between ICU and Med-Surg nursing depends largely on your personal and professional interests. Here’s a more detailed comparison across several dimensions to help you decide.

Job Duty Differences and Similarities

While both ICU and Med-Surg nurses share basic nursing responsibilities like assessing patient conditions, administering medications, and collaborating with healthcare teams, the scope and intensity of these duties vary significantly.

ICU nurses provide focused care to critically ill patients, closely monitoring their vital signs, responding to life-threatening changes, and utilizing complex medical equipment. On the other hand, Med-Surg nurses oversee a more diverse patient population, coordinating care plans, educating patients and families, and handling post-surgical recovery.

Daily Work Flow

The pace and structure of the daily workflow can also differ. Med-Surg nursing often involves juggling multiple patients at once, requiring excellent multitasking, prioritization, and time management skills. In contrast, ICU nursing tends to be more focused, with nurses usually managing one to two patients at a time but requiring a higher intensity of care.

Types of Patients

Med-Surg nurses usually care for a broad spectrum of patients, from those recovering from surgeries to managing chronic illnesses. In contrast, ICU nurses handle cases of critical illness or injury, often dealing with life-threatening situations requiring immediate, high-level intervention.

Patient Ratios

Patient-to-nurse ratios also differ between the two specialties. Med-Surg nurses may manage 5-6 patients per shift in some cases, whereas ICU nurses typically manage 1-2 patients given the intensive, individualized care needed.

Work Intensity

In terms of work intensity, both have their challenges. ICU nursing can be intense due to the severity of patients’ conditions and the need for swift responses to rapid changes. Med-Surg nursing, while less acute, can be demanding due to the high patient volume and broad range of conditions to be managed.

Equipment Differences

Med-Surg nurses commonly use general medical equipment, such as IV pumps, patient-controlled analgesia pumps, and cardiac monitors. ICU nurses, on the other hand, become proficient with more complex devices, such as ventilators, intra-aortic balloon pumps, or continuous renal replacement therapy machines.

Specialties

Both fields offer sub-specialties. For instance, Med-Surg nursing can lead to specializations in areas like orthopedics, neurology, or oncology. ICU nursing can further specialize into areas like Cardiac ICU, Neuro ICU, Pediatric ICU, among others.

Typical Salaries

While salaries can vary based on geographic location, years of experience, and specific employer, ICU nurses often earn higher salaries than Med-Surg nurses due to the increased specialization and intensity of their work.

Personality Differences

Personality can also influence your choice. If you thrive in fast-paced, diverse situations and enjoy educating patients about their health, Med-Surg nursing may be a good fit. If you prefer high-intensity environments, complex decision-making, and are comfortable with end-of-life care, you may find ICU nursing more rewarding.

Ultimately, both ICU and Med-Surg nursing offer unique challenges and rewards. Whether you prefer the breadth of Med-Surg nursing or the depth of ICU nursing, both specialties provide ample opportunities for professional growth, job satisfaction, and the ability to make a meaningful difference in patients’ lives.

Both Medical-Surgical nursing and Intensive Care Unit nursing are fundamental components of our healthcare system, each offering distinct challenges and rewards. While Med-Surg nurses often juggle multiple patients with a diverse range of conditions, ICU nurses provide intense, focused care to fewer critically ill patients. Your choice between the two will largely depend on your personal affinity for pace, patient population, and level of intensity. Regardless of the path you choose, nursing as a profession offers unparalleled opportunities to make a positive impact on people’s lives.

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Acuity, nurse staffing and workforce, missed care and patient outcomes: A cluster‐unit‐level descriptive comparison

Maria‐eulàlia juvé‐udina.

1 Nursing Research Group, IDIBELL, Bellvitge Biomedical Research Institute, Barcelona Spain

2 Faculty of Medicine and Health Sciences, Nursing School, University of Barcelona, Barcelona Spain

3 Catalan Institute of Health, Barcelona Spain

Maribel González‐Samartino

4 Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona Spain

Maria Magdalena López‐Jiménez

Maria planas‐canals.

5 Doctor Josep, Trueta University Hospital, Girona Spain

Hugo Rodríguez‐Fernández

Irene joana batuecas duelt.

6 Multidisciplinary Nursing Research Group, VHIR Vall d’Hebron Institute of Research, Barcelona Spain

7 Vall d’Hebron University Hospital, Barcelona Spain

Marta Tapia‐Pérez

Mònica pons prats.

8 Verge de la Cinta Hospital, Tortosa Spain

Emilio Jiménez‐Martínez

Miquel Àngel barberà llorca.

9 Germans Trias i Pujol University Hospital, Badalona Spain

Susana Asensio‐Flores

Carme berbis‐morelló.

10 Joan XXIII University Hospital, Tarragona Spain

11 School of Nursing, Rovira i Virgili University, Tarragona Spain

Esperanza Zuriguel‐Pérez

Pilar delgado‐hito, Óscar rey luque.

12 Nursing School, University of La Laguna, Tenerife Spain

13 Nuestra Señora de la Candelaria University Hospital, Santa Cruz de Tenerife Spain

Adelaida Zabalegui

14 IDIBAPS, August Pi i Sunyer Biomedical Research Institute, Hospital Clínic, Barcelona Spain

Núria Fabrellas

Jordi adamuz, associated data.

To compare the patient acuity, nurse staffing and workforce, missed nursing care and patient outcomes among hospital unit‐clusters.

Relationships among acuity, nurse staffing and workforce, missed nursing care and patient outcomes are not completely understood.

Descriptive design with data from four unit‐clusters: medical, surgical, combined and step‐down units. Descriptive statistics were used to compare acuity, nurse staffing coverage, education and expertise, missed nursing care and selected nurse‐sensitive outcomes.

Patient acuity in general (medical, surgical and combined) floors is similar to step‐down units, with an average of 5.6 required RN hours per patient day. In general wards, available RN hours per patient day reach only 50% of required RN hours to meet patient needs. Workforce measures are comparable among unit‐clusters, and average missed nursing care is 21%. Patient outcomes vary among unit‐clusters.

Patient acuity is similar among unit‐clusters, while nurse staffing coverage is halved in general wards. While RN education, expertise and missed care are comparable among unit‐clusters, mortality, skin injuries and risk of family compassion fatigue rates are higher in general wards.

Implications for Nursing Management

Nurse managers play a pivotal role in hustling policymakers to address structural understaffing in general wards, to maximize patient safety outcomes.

1. INTRODUCTION

Non‐linear relationships among acuity, nurse staffing and workforce, missed nursing care (MNC) and patient outcomes are still not completely understood. The need to identify the levels of nursing staff that should be offered to warrant safe nursing care, contributing to achieve patient outcomes, is a major issue in the nursing agenda (Twigg, Kutzer, Jacob, & Seaman,  2019 ).

Patient acuity—the categorization of patients as measured by the intensity of registered nurse (RN) care necessary to meet their safety needs, in terms of required RN hours per patient day ( r NHPPD)—is a critical factor in achieving balanced distribution of workload (Sir, Dundar, Barker Steege, & Pasupathy,  2015 ), as well as in connecting variables in the network of staffing and patient outcomes, such as length of stay (Pitkäaho, Partanen, Miettinen, & Vehviläinen‐Julkunen,  2016 ).

To properly address patient acuity, staffing planning and assignment require managerial decisions to ensure sufficient resources, either in number of nurses, skill mix, education or in expertise; however, nurse staffing decisions are mostly driven by financial burden, and traditional workload measurement tools tend to simplify the complex work of nurses, with poor sensitivity to inform how to allocate RN resources according to the patient needs (Leary & Punshon,  2019 ).

Suboptimal care, featured by ward inpatient poor, incomplete or delayed nursing assessment, diagnosis, treatment or referral, which may lead to deleterious patient outcomes, emerged as a significant issue in the nursing literature by the end of the 90s, related to patient complexity and other factors (Quirke, Coombs, & McEldowney,  2011 ). Similarly, suboptimal staffing was reported in studies demonstrating wide variations in nurse staffing ratios (Aiken et al.,  2014 ), and in those examining the frequency, causes and potential effects of MNC (Ball et al.,  2018 ; Griffiths et al.,  2018 ).

The failure to carry out necessary nursing care due to inadequate time, staffing level or skill mix (Schubert et al.,  2008 ) was conceptualized as MNC (Kalisch,  2006 ; Kalisch, Landstrom, & Hinshaw,  2009 ), and its synonyms and borderline concepts include the following: errors of omission (Kalisch, Landstrom, & Williams,  2009 ), unmet nursing care needs (Lucero, Lake, & Aiken,  2010 ), unfinished care (Jones, Hamilton, & Murry,  2015 ), care rationing (Papastavrou, Andreou, & Vryonides,  2014 ) and care left undone (Aiken et al., 2001 ; Ausserhofer et al.,  2014 ; Ball, Murrells, Rafferty, Morrow, & Griffiths,  2013 ). MNC has been acknowledged as a consequence of workforce shortages, additionally influenced by the perception of nurses on their own responsibilities (Vryonides, Papastavrou, Charalambous, Andreou, & Merkouris,  2015 ). It has also been related to particular approaches of nurses’ judgement in allocating resources (Scott et al.,  2019 ), found to act as a mediator in the relationship between nurse staffing and patient outcomes (Ball et al.,  2018 ), and approached as a structural problem related to social justice (Hopkins Walsh & Dillard‐Wright,  2019 ).

Conversely, a recent study reported two thirds of adult ward inpatients match high‐acuity profiles, equivalent to an average of 5.6 r NHPPD (Juvé‐Udina et al.,  2019 ). Overwhelming demands lead nurses to prioritization of patients and care without complete situational awareness, while adequate staffing based on patient acuity is perceived by frontline nurses as a critical issue for safe patient care (Hegney et al.,  2019 ).

The aim of this study was to compare the patient acuity, RN staffing and workforce measures, missed nursing care and patient outcomes among hospital unit‐clusters.

2.1. Design, setting and participants

This is an observational, descriptive, multi‐centre design, with patient and workforce data from January to September 2019, conducted in a public hospital system, with three high‐tech, metropolitan university centres, three urban hospitals and two community facilities. The study was granted by the research ethics committee (PR 3581‐3/18).

All adult patients admitted in general wards and step‐down units (SDU) were considered. Patients from intensive care units, major ambulatory surgery areas, and maternal–child and paediatric units were excluded. Initial population estimation was 100,000 inpatient episodes.

For staffing measurement, RN working in the target units were accounted, excluding nurse managers and clinical nurse specialists acting as consultants.

To assess RN workforce measures and MNC, the sample size was calculated for a maximum uncertainty proportion ( p  = 50%), a 95% confidence level (α = 0.05) and 0.5 precision (i), resulting in a sample of 386 RN to survey.

2.2. Data collection and measures

Acuity and patient outcome data were gleaned from the clinical data warehouse containing anonymized data from the patient electronic health records. All patient data collected were blinded using a consecutive participant number. Nurse staffing data were obtained from ward structural assignment reports. MNC survey was conducted within the data collection period of the study (January to September 2019).

2.2.1. Hospital wards

Traditionally, hospitals have organised their inpatient structures into three main levels of care: acute, intermediate and critical care, although their existence depends on the type of facility, with hospitals having all them and others limited to acute care. This structure coexists with the organisational approach that dichotomized patients according to their admission profile: medical or surgical.

In the setting of this study, all hospitals but one had the three levels of care intensity structures. Acute and intermediate care units were categorized into four main groups: (a) acute care medical units, (b) acute care surgical floors (including major surgery specialties, organ transplantation and short‐stay surgical units), (c) acute care combined medical–surgical units (CMSU) and (d) intermediate care (combined medical–surgical step‐down units). Acute care units are also referred to as general wards. Intermediate care or step‐down units are also named transitional units.

2.2.2. Patient episode

At unit level, a patient episode consists of all related services for one inpatient from arrival to the ward to transfer to another unit or hospital discharge. Each patient stay in a unit is considered an episode. As during hospitalization patients may be transferred from one unit to another, the sum of cluster‐unit‐level patient episodes was expected to be higher than the overall number of episodes at hospital level, since at hospital level, an inpatient episode consists of all related services from hospital admission to discharge.

2.2.3. Patient acuity

The acute to intensive care (ATIC) patient classification system was used to measure acuity (Table  1 ). Based on the weight of the patient main problem, this tool is structured into ten acuity groups and their equivalence to r NHPPD, ranging from occasional to gigaintensive required nursing intensity (Juvé‐Udina et al.,  2019 ).

Acute to intensive care (ATIC) patient classification system

Abbreviations: H, hours; NHPPD, nursing hours per patient day; NMPPD, nursing minutes per patient day; NHPPS, nursing hours per patient shift; NMPPS, nursing minutes per patient shift; NP ratio, nurse per patient ratio.

2.2.4. Staffing measures

Available RN hours per patient day ( a NHPPD) were aggregated at unit level, according to the unit assignment reports.

The balance between r NHPPD and a NHPPD was calculated as the difference between both measures, and translated into a percentage of nurse staffing coverage (NSC), that is the proportion of r NHPPD to meet patient safety needs reached by the a NHPPD.

2.2.5. Workforce measures

It included RN expertise and RN education. The self‐assessment version of the COM‐VA tool (Peya & Juvé, 2009 ), based on Benner's framework of clinical competence (Benner,  1984 ), was used to rate RN expertise from 0 to 10, being < 6 novice and > 9.5 expert (Appendix S1 ).

All RN in the context of the study hold a bachelor's degree. RN education was categorized as bachelor's and master's degree.

2.2.6. Missed nursing care

MNC was measured using the OMICE scale, a transcultural validation for the context of the study (Rey Luque,  2017 ) of the original MISSCARE survey (Kalisch & Williams,  2009 ). MNC was rated from 1 (always missed) to 5 (never missed), while reasons for omission were rated from 1 (very important) to 4 (not important).

2.2.7. Patient outcomes

In‐hospital mortality accounted for patients deceased during hospitalization. Unit‐acquired nurse‐sensitive outcomes (NSO) as e‐charted by RN in the care plans or the ongoing assessment sections of the electronic health records considered the number of episodes or events of: central and peripheral line‐associated phlebitis, any stage skin injuries (including pressure ulcers, skin tears and frail skin injuries, and moist‐associated skin damage (MASD)), injurious and non‐injurious falls, delirium (acute confusion and psychomotor agitation), uncontrolled pain (pain intensity > 3, in a range from 0 to 10), and risk of family/caregiver compassion fatigue (based on the Zarit Caregiver Burden Inventory score and other related assessment items), not present on arrival to the ward.

2.3. Data analysis

All retrieved data were processed and merged using data mining techniques. Data analyses were performed using SPSS v15 (IBM). Continuous variables were presented as mean and standard deviation, while frequency counts and percentage were calculated for categorical data. Percentage of phlebitis was calculated for episodes of patients with venous lines. The proportion of uncontrolled pain considered episodes of patients with pain as denominator. For selected outcomes, the rate per 1,000 patient days (x1,000pd) was also calculated.

Differences among unit‐clusters were analysed using the chi‐square test for categorical variables, while for continuous variables, we used Student's t test or the Mann–Whitney U test, depending on the results of the Kolmogorov–Smirnov normality test. p values less than .05 were considered statistically significant.

The initial population included 94,283 patient episodes. The final analysis excluded 4,559 episodes (4.8%) due to data inconsistencies, duplicates or missed data.

A final sample of 89,724 episodes of adult inpatients in 132 hospital wards (37 medical units, 35 surgical floors, 37 CMSU and 23 SDU) were included in the analysis. Median age was 66.9 (Q1 52.0–Q3 77.8; mean 65.7; SD 19.3). The most frequent reasons for admission were cardiocirculatory disorders ( n  = 13,280; 14.8%). Table  2 details the distribution of ward structure, patient characteristics, patient acuity and staffing measures at overall and cluster‐unit level.

Ward cluster structure, patient characteristics, patient acuity and staffing measures

Abbreviations: Med‐Surg Units, combined medical–surgical wards; aNHHPD, available RN hours per patient day; rNHPPD, required RN hours per patient day.

Similar to those in SDU, most patients admitted to medical wards (77.9% versus 70.8%) matched the intermediate and preintensive acuity profiles, with an average of six r NHPPD. Conversely, the lowest mean NSC is observed at the medical unit cluster (44.6%).

Almost two thirds of patients admitted in surgical wards (65.2%) matched the acute and intensification acuity groups (4.6 r NHPPD; NSC 55.3%). Nevertheless, when subanalysing separately major surgery floors from short‐stay surgical units, almost half the patients admitted to major surgery wards (48.6%) matched the intermediate and preintensive acuity clusters (Appendix S2 : Table 2.1).

Table  3 shows the MNC results at each unit‐cluster. Overall, 416 RN responded to the questionnaire. Most of them were female (89.7%), and their mean age was 38.9 ( SD 10.5). Almost half the respondents held a master's degree (47.7%) and rated their clinical expertise as highly competent (mean 8.2). The majority worked as temporary staff (71.1%). 73.4% of RN reported excessive workload and 90.7% reported insufficient staffing in the wards, while 82.4% reported feeling satisfied with their job. Reported average of patient assigned in the last shift was 10.1 in general wards, coincident with the average of 2.4 a NHPPD from the assignment reports. In SDU, surveyed RN referred to an average of 6.2 patients assigned in the last shift, distant from the mean 5.8 a NHPPD in the reports.

Reported missed nursing care at cluster‐unit level

Errors of omission were referred to occur in a range from 6% to 44%. Lower frequencies were reported for: blood glucose monitoring (6%), patient assessment each shift (10%), vital sign assessment (12%), bathing, skin and would care (12%), and handwashing (14%). Average MNC is 21.0%. Appendix S2 : Figures 1 and 2 show overall and cluster‐unit MNC frequency distribution.

Similarly, the most important reported causes for MNC were related to labour resources regardless of the unit‐cluster, ranking urgent patient situations, unexpected rise in patient acuity or volume, and inadequate RN staffing first (Table  4 ).

Reasons for errors of omission

Finally, Table  5 summarizes all study measures, including patient outcomes in each unit‐cluster. Inpatient mortality rate in the medical cluster (3.5%) exceeded twice the value in CMSU (1.5%) and SDU (1.4%), and fourfold the value found in the surgical group (0.7%).

Patient acuity, RN staffing coverage, missed nursing care and patient outcomes

N ep = number of episodes (patient days at unit level). Overall number of patient episodes is 89,724 since at hospital level, a patient episode accounts for 1. As the patient may be transferred during the hospitalization, it accounts for 1 for each unit cluster they have been reaching a total 111,162. Phlebitis percentage is accounting only for patients with peripheral and/or central venous lines. The proportion of uncontrolled pain considers number of patients with pain as denominator.

The proportion of episodes with line‐associated phlebitis was almost identical in the medical and the SDU clusters (8.9% versus.9.1%), while the rate per 1,000 catheter days was higher in SDU.

Significant differences among unit‐cluster were found for unit‐acquired skin injuries ( p  < .05). The proportion of patient episodes with unit‐acquired skin injuries was similar in the medical and SDU cluster (2.7% and 2.8%); however, the proportion of unit‐acquired skin injuries in general wards (mean 75.6%) was almost threefold the value in SDU (26.6%).

The rates of patient episodes with falls x1,000pd were identical for the medical and SDU clusters (1.8), while the rate of falls x1,000pd was higher in medical wards (2.1), followed by SDU (2.0), CMSU (1.7) and surgical wards (1.2).

Frequency of delirium was higher in SDU (5%; rate 13.1) when compared to the other clusters. Values observed for inpatients in medical and CMSU were similar (4.6 and 4.8), while the rate of delirium at surgical floors (3.6) was significantly lower ( p  < .05).

Overall, 24% of patient episodes experienced uncontrolled pain. The rate of uncontrolled pain was similar in SDU and surgical floors (64.3 and 63.4, respectively) and lower at CMSU (53.4) and medical wards (41.3).

Risk of caregiver compassion fatigue was more frequently identified in the medical cluster (8.1%; rate 11.2), with similar rates at the surgical and CMSU groups (10.1 and 10.6), while the lowest rate for this outcome was found in SDU (3.5).

Appendix S2 : Table 5.1 summarizes all findings comparing general wards with SDU.

4. DISCUSSION

The main findings of this study indicate that general floors and SDU have comparable patient acuity, as well as similar RN clinical expertise and missed nursing care; however, NSC is halved in general wards when compared to SDU, and patient outcomes differ among unit‐clusters, with worse values for medical inpatients.

Regardless of the unit‐cluster, a large majority of patients matched intensification and higher acuity categories. These results follow the trend of the ones in a previous study (Juvé‐Udina et al., 2019 ).

At cluster‐unit level, patients admitted in SDU and medical wards exhibited the highest acuity profiles, followed by those in CMSU. This finding is comparable with the one found in a longitudinal inquiry, in which acuity score was higher in medical wards, followed by SDU, surgical floors and CMSU (Garcia,  2017 ). Similarly, several studies identified different acuity levels coexisting in the units (Acar & Butt,  2016 ; Sir et al.,  2015 ).

Our findings on a NHPPD for patients in the general units (mean 2.4) were significantly lower than those found in other studies, where reported mean a NHPPD in general wards varied from 4.7 (Griffiths et al.,  2019 ) to 6.0 (Gray & Kerfoot,  2016 ; Pappas, Davidson, Woodard, Davis, & Welton,  2015 ; Pitkäaho et al.,  2016 ). Our results are only consistent with the ones described by Chang, Yen, Chang, and Liu ( 2017 ), reporting an average of 2.3 a NHPPD.

Likewise, evidence suggests that RN engaging postgraduate education are more likely to improve critical thinking skills, with reported values of nurses with master's degree ranging from 48% to 57% (Altman, Butler, & Shern, 2016 ; Barbera Ortega et al.,  2015 ). In this study, the highest proportion of RN holding a master's degree was found in CMSU and the lowest in the surgical unit‐cluster, while RN in this latter group were the most experienced. Significant differences were found for years of experience ( p  < .05), with younger nurses working at SDU.

No differences were found for RN expertise among unit clusters. Average RN expertise score was slightly higher than the value reported by O’Leary ( 2012 ) using a tool under the same theoretical framework; however, in both cases RN expertise was identified at the high‐edge competent level.

Statistically significant differences were found for overall MNC between SDU and general unit‐clusters ( p  < .01). A priori less MNC was expected to be observed in SDU as they had better NSC; however, reported MNC was slightly higher in SDU when compared to general wards. This might be related to various factors. First, it has been acknowledged that younger nurses tend to omit more patient care (Blackman et al.,  2018 ). Second, patients are admitted, transferred and discharged according to the selected medical criteria. Nevertheless, these criteria do not necessarily correlate with nurses’ judgement on patient needs or required nursing intensity (Gray & Kerfoot,  2016 ), while nurses tend to accept medical criteria as uncontested (Dalton, Harrison, Malin, & Leavey,  2018 ) or objectionable according to their expertise. Third, SDU are scarce resource in the hospitals, and patient LOS in these units is minimized. Unit occupancy and activity volume are contributing factors to MNC (Jones et al.,  2015 ). In this context, some interventions, such as ambulation, might not be actually performed in SDU because patients are transferred to general wards before they are able to tolerate their execution.

In all unit‐clusters, the most important reported reasons for MNC were related to labour resources, and the most frequent omitted interventions were ambulation and mouth care, both classified as intermediate priority care interventions (Blackman et al.,  2018 ). Sleep care and multidisciplinary team meetings were ranked in the following positions. Teaching and discharge planning interventions were also frequently missed in CMSU and SDU. In this sense, overall MNC results are consistent with findings in previous studies (Ball et al.,  2018 ; Griffiths et al.,  2018 ; Jangland, Teodorsson, Molander, & Muntlin Athlin,  2018 ).

Conversely, acuity profiles and low NSC in general wards might explain part of the mortality and other NSO, although our analysis is just observational, and no causal relationship can be established.

Mortality, skin injuries and risk of family/caregiver compassion fatigue were more frequent in general wards. Intravenous line‐associated phlebitis and delirium were more common in SDU. The proportion of patient episodes experiencing one or more falls is almost identical, while the falls rate was higher in SDU. The percentage of episodes of patients with uncontrolled pain was higher in general wards; however, the rate was lower when compared to SDU.

The association between nurse staffing and mortality has been extensively demonstrated in previous studies (Aiken et al.,  2014 ; Ball et al.,  2018 ; Griffiths et al.,  2019 ), as for the relationship between staffing and falls (He, Staggs, Bergquist‐Beringer, & Dunton,  2016 ). Studies exploring the relationship between staffing and skin injuries exhibit controversial results; however, a longitudinal inquiry found significant association considering both trend and seasonality (He et al.,  2016 ).

No inquiries were located for the association between staffing and caregiver compassion fatigue, an event recently suggested as a significant NSO (Lynch, Shuster, & Lobo,  2018 ). Evidences on the relationship between nurse staffing and phlebitis or delirium were neither found. Several factors might explain higher rates of delirium and phlebitis in SDU when compared to general units. First, many patients in SDU are in transit between ICU and general wards. Although this study only accounted for unit‐acquired outcomes, patient history at ICU and selected drugs used may impact delirium and phlebitis rates. It is known that phlebitis is more likely to occur at any time, with increased catheter days and patient length of stay (LOS) (Ansel, Boyce, & Embree,  2017 ). Likewise, delirium is more likely to occur in patients with uncontrolled pain (Solà‐Miravete et al.,  2018 ), which is consistent with the findings in this study. Finally, most SDU patients in this inquiry matched a surgical profile, which might exemplify the importance of outcome sensitivity measurement when considering selected target populations. NSO sensitivity to target selected patient groups would probably benefit from further refinement work.

4.1. Limitations

This study was not intended to address causality but to describe acuity, staffing and workforce measures, MNC and patient outcomes in different unit‐clusters. Beyond those implicit in such a design, and the fact that no adjustment for hospital type has been applied, additional limitations are acknowledged.

First, patient characteristics were identified as an antecedent to MNC (Jones et al.,  2015 ). Patient acuity and individual complexity are borderline concepts but not synonyms, since individual complexity refers to particular patient features that have the potential to challenge the delivery of nursing care (Adamuz et al.,  2018 ). To what extent individual complexity influences r NHPPD and MNC is still uncertain.

Second, we did not consider the nurse work environment that was explicitly represented as an antecedent of MNC (Jones et al.,  2015 ).

Third, SDU are being used as high‐intensity and high‐churn wards (Hughes, Bobay, Jolly, & Suby,  2015 ). The use of a churn index might increase the accuracy of required nursing intensity measurement, and explain the part of current MNC, but further research is needed in this sense.

Finally, we neither consider RN unit turnover, which was previously associated with patient outcomes (Kim & Han,  2018 ), nor workflows. Nurse workflows are complex, typified by interruptions and rapid task switching, drawing irregular and non‐repetitive patterns regardless of patient acuity, assignments and frequency of interventions (Durosaiye, Hadjri, Liyanage, & Bennett,  2018 ), which might adversely influence RN critical thinking and prioritization and increase the risk of negative workforce outcomes.

4.2. Implications for nursing management

For more than one decade, nursing resources in European public health care systems have been reduced due to the economic recession, while hospitals were shifting from acute to intensive care settings (Scott et al.,  2019 ). In the context of nursing shortage and financial struggling, social value given to nursing, changes in care models, work environments and organisational approaches are factors influencing intensification of care and care rationing (Blackman et al.,  2018 ). Increased patient acuity and its eventual effects on MNC and patient outcomes might benefit from the use of acuity measurement tools based on patient attributes and nurses’ clinical judgement (Firestone‐Howard, Zedreck Gonzalez, Dudjak, Ren, & Rader,  2017 ), such as the patient classification system employed in this study. Likewise, the analysis of patient acuity and outcomes, along with RN staffing and MNC data, may contribute to reinforce the concept of RN, no longer as task performers, but as a knowledge‐based workforce (Leary & Punshon,  2019 ).

Considering that NSC is estimated for safe care, the similarities in acuity distribution between a previous study with 2016–2017 data (Juvé‐Udina et al., 2019 ) and the current one suggest structural RN understaffing in general wards. Recent studies also identify MNC as a structural problem embedded in the work environments (Hopkins Walsh & Dillard‐Wright,  2019 ; Scott et al.,  2019 ). In a context of structural understaffing, nurse managers play a pivotal role in exercising best leadership practices that consider RN expertise and patient acuity, in designing and implementing plans to improve the work environments to minimize MNC, and in hustling policymakers to address structural understaffing in general wards to improve patient outcomes.

5. CONCLUSION

Patient acuity in general wards is similar to SDU, while NSC is halved. Almost half of RN holding a master's degree and comparable clinical expertise reported MNC slightly varies among unit clusters. RN understaffing in general floors and MNC emerged as structural problems. Mortality, skin injuries and risk of family compassion fatigue rates are higher in general wards, while line‐associated phlebitis, delirium and falls are more common in SDU inpatients.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

Research Project Approval

This research project was approved by the Bellvitge University Hospital Research Ethics Committee (PR 3581‐3/18).

Supporting information

Acknowledgements.

We acknowledge Mrs. Cristina Matud Calvo, retired RN, for her contribution in previous research projects leading to this one. A special acknowledgement to registered nurses working in the setting of the study, for their commitment to improving nursing practice and patient outcomes.

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Medical-Surgical Nursing Certification (MEDSURG-BC ™ )

Credential awarded: medsurg-bc™.

The ANCC Medical-Surgical Nursing board certification examination is a competency based examination that provides a valid and reliable assessment of the entry-level clinical knowledge and skills of registered nurses in the medical-surgical specialty after initial RN licensure. Once you complete eligibility requirements to take the certification examination and successfully pass the exam, you are awarded the credential: Medical Surgical Nurse – Board Certified (MEDSURG-BC™). This credential is valid for 5 years. You can continue to use this credential by maintaining your license to practice and meeting the renewal requirements in place at the time of your certification renewal.

Effective September 10, 2024: The Test Content Outline and Reference List for the Medical-Surgical Nursing certification exam will be updated. Please access the appropriate Test Content Outlines and Reference Lists below. There will be a 8-business day test suspension period to allow for the exams to be updated. You may test before August 29, 2024, or after September 9, 2024.

The Accreditation Board for Specialty Nursing Certification (ABSNC) accredits this ANCC certification.

NOTICE: We are currently experiencing issues with new certification and renewal processes. We apologize for any inconvenience this has caused you.

Download the offline application form         Download the offline renewal form

Apply online         Renew online

See below for instruction and pricing for new and renewal applications.

Apply for Certification

Initial certification application.

You may apply for this computer-based test year round and test during a 120-day window at a time and location convenient to you. The exam allows 3 hours to answer 150 questions (125 scored plus 25 pretest questions that are not scored). For exam prep resources, scroll down to view Study Aids. If you do not pass a certification exam, learn about retesting .

STEP 1: Review Pricing, Eligibility Requirements, and FAQs

Review certification pricing and eligibility requirements below. FAQs provide a deeper dive into topics including online application, document submission, APRN and RN specialty certification requirements, and renewal requirements.

REVIEW FAQs

See Pricing & Discounts

Eligibility

• Hold a current, active RN license within a state or territory of the United States or the professional, legally recognized equivalent in another country
• Have practiced the equivalent of 2 years full-time as a registered nurse
• Have a minimum of 2,000 hours of clinical practice in the specialty area of medical-surgical nursing within the last 3 years
• Have completed 30 hours of continuing education in medical-surgical nursing within the last 3 years

Apply from Outside the U.S.

Learn about additional requirements for candidates outside the U.S.

STEP 2:  Apply

APPLY ONLINE

Step 3: Testing

To schedule your exam, visit the Prometric website at https://www.prometric.com/ancc and use your certification number to schedule your exam

Maintain & Renew

Maintain certification.

To maintain certification, complete professional development requirements between the start and end dates of your certification, and provide this information on your renewal application.

CALENDAR Your Renewal Date

Certifications are renewed every 5 years. You may submit a renewal application up to 1 year prior to your expiration. You may be ineligible to practice beyond your expiration date.

CREATE an ANCC Account

Track professional development, mail preferences and purchases in one place. Online applications are also stored in your account. Visit Access My Account

UPDATE Contact Information

If you move, change names or acquire a new phone or email, please update contact details in your account. Or email Customer Care or call 1.800.284.2378.

DISPLAY Your Credentials

Learn common questions and answers about displaying your credentials in the proper order. Download How to Display Your Credentials .

TRACK PROFESSIONAL DEVELOPMENT WITH ANCC

Online renewal is simpler when you store professional development activities in your ANCC account immediately upon completion. At renewal, you can transfer stored information to the renewal application, saving time. Note: To renew online, you must store professional development activities before starting the online renewal application.

• After each activity, gather proof of professional development.
• Click Track Professional Development to the right.
• Enter and save professional development activities.
• From account summary, top right column, under Professional Development find links to enter continuing education (contact hours), academic credits, presentations, publications/research, preceptorship and professional service.

Renew Certification

Renewal certification application.

You may submit a renewal application up to 1 year prior to your expiration.

STEP 1: Review Requirements, FAQs, and Pricing

Download renewal requirements     Read renewal FAQs

*Separate discounts may apply.

• Prices above include $140 non-refundable administrative fee. Additional fees for special services may apply. See application for details.
• Discounts may be claimed for up to 5 business days after ANCC receives your application. Discount claims received after this time will not be honored and refunds will not be issued.

STEP 2: Submit Renewal Application

Required: BEFORE starting a renewal application online, proof of professional development must be entered and stored in your ANCC online account. To record professional development activities go to Track Professional Development with ANCC. Then return to renew online.

RENEW ONLINE     TRACK PROFESSIONAL DEVELOPMENT

RENEW BY MAIL

If you would like to renew by mail, please send a request to [email protected] .

Download  General testing & renewal handbook [pdf]

Email us , or call 1.800.284.2378

ANCC Retired Certified Nurse Recognition celebrates achievements for life!

ANCC Study Aids

• Test Content Outline For Exams On or Before August 28, 2024 pdf (0.52MB)
• Test Content Outline For Exams On or After September 10, 2024 pdf (0.76MB)
• Test Reference List For Exams On or Before August 28, 2024 pdf (0.13MB)
• Test Reference List For Exams On or After September 10, 2024 pdf (0.25MB)
• Medical-Surgical Nursing Readiness Test
• Sample Test Questions & Answers
• Role Delineation Study For Exams On or Before August 28, 2024 pdf (0.22MB)
• Role Delineation Study For Exams On or After September 10, 2024 pdf (0.23MB)
• Prometric Test Centers
• General Testing and Renewal Handbook [pdf] pdf (0.53MB)
• Certification Seven Tips pdf (0.90MB)
• Exam Scores & Retesting
• How to Display Your Credentials pdf (0.09MB)

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Medical-Surgical Nursing Review and Resource Manual 4th Edition with 2019 Addendum

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What Does Med-Surg Nursing Mean in Medical Terms?

There are few industries as specialized as healthcare. A prospective nurse just beginning their journey in the field will be greeted by a massive number of diverse and exciting specialties, each with its unique benefits and challenges. Even just deciding which specialty to pursue can be pretty tough for new nurses!

See also: 5 High-Paying Registered Nurse (RN) Jobs in 2023

Of all the nursing specialties within the healthcare system, the largest—and perhaps most broadly defined—specialty is medical-surgical nursing, or “med-surg” for short.

But what does med-surg nursing cover? As a med-surg nurse, which patients will you be working with? What facilities are you likely to work in, and what will your team look like? We’ll be covering all of these questions (and many more) in this article. 

Let’s get started!

What Is Med-Surg Nursing?

At its most fundamental level, med-surg is a medical specialty that focuses on medical care for adult patients suffering from a wide range of conditions. According to the Academy of Medical Surgical Nurses (AMSN) , these patients may have been diagnosed with either acute or chronic health conditions; they may also be preparing for or recovering from surgical interventions. 

But what does that mean? With a definition this broad, med-surg nursing is still fairly difficult to visualize. And there’s a reason for that.

Basically, med-surg is the nursing specialty for adult patients who do not fall into another nursing specialty. As such, the specialty is flexibly defined to accommodate patients dealing with a variety of conditions and needs. 

In many ways, med-surg provides a bridge between the diverse specialties present in a hospital or clinic, and the roles and duties of med-surg nurses are heavily dependent on the types of patients typically visiting that facility.

See also: What Types of Healthcare Facilities Are There?

What types of patients require med-surg care.

Patients who require med-surg care are typically adults dealing with medical conditions that do not require specialized treatment in other areas of the hospital. 

They may be admitted for a variety of reasons, such as post-operative care, management of chronic diseases like diabetes or hypertension, or treatment of acute conditions like urinary tract infections or pneumonia. If a patient is suffering from a fairly common condition and does not require specialized devices, monitoring, or interventional care, they will typically be routed to the med-surg department. 

At the same time, patients will also be cared for by med-surg nurses if they are in the process of recovering from a recent surgery and have been released from the post-anesthesia care unit (PACU) . All in all, med-surg units provide comprehensive care, addressing not only the specific condition but also the patient's overall health and well-being. 

What Does It Take to Be a Med-Surg Nurse?

Med-surg nursing is a challenging and rewarding career path. And despite its generalist image, some very specific personalities with specific skill sets tend to thrive in this field. 

Nurses working in med-surg are responsible for coordinating and managing the care of multiple patients, often with complex medical needs. The fact that the field is so broad means that med-surg nurses must be able to treat patients who are dealing with a wide range of conditions and treatment plans.

As a med-surg nurse, you will assess patients, administer medications, monitor vital signs, educate patients and their families , and collaborate with other healthcare professionals to ensure the best possible outcomes. You’ll need to have a solid foundation in general nursing practices, excellent critical thinking skills, and the ability to multitask in a fast-paced environment.

In addition, effective communication and interpersonal skills are paramount: There is no “typical” patient in med-surg nursing, so providing empathetic and personalized care to every patient—regardless of that patient's unique background, wants, and needs—is a huge part of med-surg nursing.

When it comes to the day-to-day care involved in med-surg nursing, you’ll need proficiency in medication administration and wound care and the ability to prioritize and manage multiple patients simultaneously. Med-surg nurses must be adaptable and flexible, as patient conditions can change rapidly, requiring immediate intervention and rapid and effective decision-making.

What Does a Med-Surg Unit Look Like?

The physical layout and size of a med-surg unit are usually dependent on the specifics of the facility in which that unit is located. Smaller and more specialized facilities will have smaller units equipped to deal with the more generalized needs stemming from the patients and procedures common to that facility. 

The med-surg unit is often the destination for patients transferring from other specialized units of the hospital or facility, and it can see a fairly high volume of patients coming and going as a result.

In larger hospitals, a med-surg unit will be equipped to handle a larger variety of patient care needs, and the team operating that unit will be larger and more diversified. In that same vein, med-surg teams can include med-surg nurses, physicians, surgeons, and surgical specialists, as well as therapeutic nursing specialists and patient advocates. 

What Conditions Are Treated in a Med-Surg Unit?

Med-surg nurses should be prepared to provide a great patient care experience to patients who are facing a variety of common illnesses, conditions, and recovery patterns. Here are some of the most common conditions that a med-surg nurse should be prepared to handle:

• Joint (hip and knee) replacements
• Chronic obstructive pulmonary disease (COPD)
• Dehydration
• Congestive heart failure
• Urinary tract infections (UTIs)
• Fall-related injuries
• Hernia repairs
• Brain injuries

The Future of Med-Surg Nursing

As healthcare needs evolve, the role of med-surg nursing is expected to expand and adapt accordingly. With the U.S. population continuing to age and chronic illness rates trending upwards, it’s unlikely that the need for med-surg nurses will ever diminish. 

In the future, med-surg units may see a greater emphasis on chronic disease management, preventive care, and patient education to promote healthier lifestyles and reduce hospital readmissions as the greater medical industry continues to trend in that direction. 

In addition, new technologies—and in particular, telehealth —may play a more significant role in delivering med-surg care, providing a new level of comfort and convenience for patients, all while maintaining close communication with healthcare professionals.

All in all, med-surg nursing remains the largest nursing specialty in the U.S., and new nurses are always in demand! These nurses play a crucial role in providing comprehensive care, managing complex medical needs, and coordinating interdisciplinary collaboration.

If the med-surg specialty is something that interests you, take a look at our Ultimate Guide to Med-Surg Nursing . In it, we cover everything you need to know about this unique specialty. You can also check out some of the articles in our per-diem nursing blog ; these articles cover a variety of topics in and around the nursing community. 

Thanks for reading!

Read More About this specialty

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What is an “acute care” unit vs a med-surg unit.

There was a hospital I did clinical at that called the unit “acute care” and not med surg but they seemed to get med surg patients.

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is acute rehab considered med/surg?

Nurses General Nursing

Published Jun 3, 2007

I am considering taking a position on an acute rehab unit located in a hospital.

However, the reason I want to work in a hospital is because I want that "med/surg" experience (have 2 years community health experience but no hospital will hire me since i don't have acute care exp.)... is an acute rehab unit considered med/surg? or would 2 years of working on this floor still not count as acute care experience?

thanks for any replies!!

• + Add a Comment

In the facility close to our hospital, a patient is basically med surg and all the patient's they accept have to be able to tolerage at least 3-4 hours of speech, occupational and physical therapy. They can have medical conditions that require medical care, but the rehab portion is meeting criteria to be in that facility, so it should be considered acute care. More rehab oriented though....not sure if it would be as challenging as a med surg floor in and of itself.

hi, I am considering taking a position on an acute rehab unit located in a hospital. However, the reason I want to work in a hospital is because I want that "med/surg" experience (have 2 years community health experience but no hospital will hire me since i don't have acute care exp.)... is an acute rehab unit considered med/surg? or would 2 years of working on this floor still not count as acute care experience? thanks for any replies!!

The answer to your question is no (it is not med/surg).

And although physically located in the same building, acute rehab is still post-acute care.

That said, your circumstance sounds like hospital insanity/nonsense. Med-Surg in my opinion is the real "meat" of nursing. It's the stuff you learned in nursing school after all. (yea yea I'm aware of the Med-Surg is a "specialty" word game some nursing organizations put out there.)

Med-Surg is extremely demanding in every way and the positions are typically very hard to fill; I can't understand why you would have trouble finding a hospital willing to give you a chance in acute care on a Med-Surg floor. They start new grads there, why not you?

TracyB,RN, RN

Hmmmppphhhh...

I guess it would depend on the facility. Our patients were so damn sick, you would wonder how in the hell they "qualified" to be on an acute rehab unit..

I would consider my old unit med/surg with quadruple the work due to all the rehab components thrown in for poops & grins. Maybe we just weren't busy enough suctioning, tele monitoring, plus doing all those damn max assist transfers with slide boards, etc, etc, etc, etc...

We had some of the sickest patients I have ever seen & I've seen LOTS of sickies.

Hmmmppphhhh... I guess it would depend on the facility. Our patients were so damn sick, you would wonder how in the hell they "qualified" to be on an acute rehab unit.. I would consider my old unit med/surg with quadruple the work due to all the rehab components thrown in for poops & grins. Maybe we just weren't busy enough suctioning, tele monitoring, plus doing all those damn max assist transfers with slide boards, etc, etc, etc, etc... We had some of the sickest patients I have ever seen & I've seen LOTS of sickies.

Never said Rehab nursing didn't have challenges or value (I'm certified in rehab Nursing as well as critical care); But you discharge from acute care and admit to rehab, not merely transfer from unit to unit. You eval the patient for rehab prior to admission for appropriateness. Certain specialized rules regarding diagnosis mix and a separate reimbursement structure exists for rehab. Rehab is not Med-surg nor acute care.

hi, thank you all for your replies. i didn't think acute rehab was really med/surg. i guess i was hoping it was considered acute enough so that if later on, i want to go and work on a med/surg floor or in a critical care unit or whatever, i wouldn't have to go in as a "new grad" again but as someone with acute care experience with the requisite 1-2 years experience.

it seems like i would have a harder time in the future marketing myself as someone with hospital experience (rather than rehab experience) than someone who worked on a med/surg floor.

i would rather just work on a med/surg floor but i placed my application to all the area hospitals and none gave me a call back except for this acute rehab unit.

acute rehab is considered acute care. It is billed that way and insurances and Medicare both recognize it as acute care. Where do you get that acute rehab is equal to subacute or snf or tcu?????

RNsRWe, ASN, RN

3 Articles; 10,428 Posts

In our hospital, which has an acute rehab floor, med-surg is med-surg and rehab is rehab. They are not interchangeable, and if one is seeking med-surg experience, the rehab floor is not the recommendation.

The med-surg units are, after all, treating patients for acute conditions, and are either post or pre-surgical most of the time. They are being treated for current cardiac conditions, current respiratory conditions, on an ACUTE basis. These are not the patients who are ready for rehab, acute or otherwise. They need to be discharged from our med-surg units before they can go to either our rehab or someone else's.

How to Become an Aesthetic/Cosmetic Nurse | Salary 2024

• What is an Aesthetic Nurse?
• How to Become
• Specialties
• Tips to Becoming an Aesthetic Nurse

Considering a career in aesthetic nursing? Learn how to become an aesthetic nurse, their salary and education requirements, certifications, and more.

What Is an Aesthetic/Cosmetic Nurse?

An aesthetic nurse, also known as a cosmetic nurse or aesthetic nurse practitioner, specializes in providing cosmetic treatments and procedures to enhance a person's appearance. These nurses typically work in settings such as medical spas, dermatology clinics, plastic surgery offices, or cosmetic surgery centers. 

To note: Some employers use the alternative spelling “esthetic nurse” or “esthetician’s nurse” in job descriptions and job listings. In this guide, we’re using the traditional spelling, “aesthetic nurse.”

Aesthetic nurses may perform various non-surgical cosmetic procedures under the supervision of a licensed physician, such as:

• Injectables: Administering injectable treatments like Botox, dermal fillers, and collagen stimulators to reduce wrinkles, add volume, and rejuvenate the skin.
• Laser treatments: Using lasers for hair removal, skin resurfacing, tattoo removal, and treatment of vascular or pigmented lesions.
• Chemical peels: Applying chemical solutions to exfoliate and improve the texture and appearance of the skin.
• Microneedling: Using a device with fine needles to create controlled micro-injuries in the skin, stimulating collagen production and improving skin texture.
• Skincare consultations: Providing personalized skincare recommendations and advice tailored to individual needs.

What Do Aesthetic Nurses Do?

Aesthetic nurses help plastic surgeons and dermatologists provide cosmetic procedures. These healthcare procedures -- whether invasive or non-invasive -- help improve their patient’s appearance. 

In some cases, patients seek treatment for medical purposes; for others, the procedures can provide a boost of confidence and a more youthful look. 

Whether working full-time or part-time, the job responsibilities that aesthetic/cosmetic nurses perform can include:

• Consulting with patients, including scheduling, interviewing and medical screening prior to services being provided.
• Examination of skin to assess both aging and other health problems.
• Performing pre-operative and post-operative care.
• Assisting the physician with procedures and surgeries.
• Preparation and sterilization of instruments and surgery suites.
• Administering injections of Botox and fillers, performing chemical peels, laser hair removal, dermabrasion, CoolSculpting, removing tattoos, and more.

Aesthetic/cosmetic nurses work in dermatology and plastic surgery offices and medspas, and they may also assist in hospital operating rooms. Occasional emergencies and adverse reactions to treatments can create some schedule unpredictability for surgery nurses , but in most cases, aesthetic nurses work regular hours with no night shifts.  

In addition to working in an environment dedicated to improving patient quality of life, aesthetic nurses can also build long-term relationships with patients who return to maintain existing treatments or investigate additional treatments. 

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How To Become an Aesthetic/Cosmetic Nurse

If you want to become an aesthetic nurse, you’ll need to complete the following steps. 

Step 1. Earn Your Registered Nurse Degree

Becoming an aesthetic/cosmetic nurse begins with a registered nurse degree, which you can earn through either a two-year associate’s degree in nursing (ADN) or a four-year bachelor of science in nursing (BSN) degree. 

Some nurses decide to go beyond the BSN and earn their MSN or DNP in order to become aesthetic nurse practitioners .

Step 2. Pass the NCLEX-RN

Once you've earned your RN degree from an accredited nursing program, you'll then need to pass the NCLEX-RN exam to become licensed by one or more states. 

Step 3. Gain Experience 

As part of your aesthetic nurse training , you must gain experience, spending at least two years working in core competencies with a board-certified physician in plastic/aesthetic/cosmetic surgery, dermatology, facial plastic surgery, or ophthalmology.

Step 4. Earn a Certified Aesthetic/Cosmetic Nurse Specialist Credential 

To position yourself for the best aesthetic/cosmetic nurse jobs , consider earning an aesthetic nurse certification. There are several options to choose from:

• 1. Certified Aesthetic Nurse Specialist (CANS)
• 2. Certified Plastic Surgery Nurse (CPSN)
• 3. Dermatology Nurse Certified (DNC)
• 4. Dermatology Certified Nurse Practitioner (DCNP)

Timeline for Becoming an Aesthetic/Cosmetic Nurse

• Two to five years to earn ADN, BSN, or MSN degree
• Pass NCLEX-RN exam
• Two years working with a board-certified physician in plastic/aesthetic/cosmetic surgery, dermatology, facial plastic surgery, or ophthalmology

Aesthetic Nurse Specialties

One of the best parts of becoming an aesthetic nurse is the many unique opportunities to help patients feel and look their best! Aesthetic nursing is a rapidly expanding field due to the introduction of new treatments and technologies, and there are many exciting specialties to choose from.

Nurse Injector

Nurse injectors specialize in cosmetic treatments designed to improve or enhance the appearance of the face via needle injections. Some types of cosmetic injectables that a nurse may specialize in include:

• Botulinum toxins , such as Botox or Dysport, to temporarily smooth facial muscles to reduce fine lines and wrinkles
• Dermal Fillers such as hyaluronic acid (HA) or calcium hydroxylapatite  to fill or “sculpt” the face
• Fat reduction injections to break down “double chin” fat, such as Kybella.

Laser Facial Nurse

Nurses who perform laser facials can help patients minimize wrinkles, reduce acne scarring, and help improve skin discoloration due to too much sun exposure. Most laser facials remove the skin's outer layers to expose new skin underneath and help promote and stimulate collagen production. 

Nurses who use any type of laser equipment must accurately assess each patient's skin type and determine the most appropriate treatment and level settings. Types of laser facials include:

• CO2 laser treatments
• Intense pulse light (IPL) treatments
• Pulsed-dye laser treatments
• Fractional laser treatments

Tattoo Removal Nurse

This type of aesthetic nurse specializes in removing tattoos using laser technology. There are many different technologies available for tattoo removal, and nurses must understand the different types of laser systems, proper laser settings and removal techniques, and the potential risks of the treatment.

Laser Hair Removal Nurse

As one of the most popular and growing aesthetic procedures today,  laser hair removal is an increasingly popular specialty for aesthetic nurses. A laser hair removal nurse specializes in using laser technology to remove unwanted hair. 

Nurses who perform laser hair removal must provide safe and effective treatment and review aftercare instructions with patients. Most treatments require multiple visits over several months to a year, so many laser hair removal nurses get to know their patients well over time.

Chemical Peel Nurse

A chemical peel is an aesthetic treatment that involves applying a chemical solution to the skin, causing the outer layers of the skin to peel off. Chemical peels typically take several days or even weeks to heal, but the treatment ultimately reveals smoother and more youthful-looking skin underneath. Treatments typically take 1 hour or less.

Non-Surgical Body Treatment Nurse

Many cosmetic nurses enjoy giving non-surgical body treatments because they can help their patients feel better about themselves and maybe even inspire them to improve their health.

Types of non-surgical cosmetic body treatments include:

• Radiofrequency : for cellulite reduction
• Contouring procedures : treatments that induce powerful muscle contractions, such as Emsculpt
• Fat reduction : a procedure that “freezes fat,” such as Coolsculpting

Aesthetic/Cosmetic Nurse Salary

Aesthetic nurse salaries can vary based on education, certification, experience, and geographic location within the country. ZipRecruiter reports that the average annual pay for a cosmetic nurse is $80,321; however, some cosmetic nurses earn as much as $136,000.

As is true in most other patient care professions, cosmetic nurses with higher levels of experience usually receive the highest levels of compensation. Nurses can also increase their overall compensation through other benefits, such as:

• Paid vacation
• health, dental, and vision insurance
• Prescription coverage, and
• Educational reimbursement

5 Tips To Becoming an Aesthetic/Cosmetic Nurse

We talked to Sabrina, an aesthetic nurse injector practicing out of Bellevue, WA. Here are her five tips on how to become an aesthetic nurse:

1: Watch YouTube Videos

Watch as many YouTube videos on the basics of neuromodulators (your Botox, Dysport and Xeomin) and different types of commonly used dermal fillers like Juvederm (Ultra/Ultra Plus, Voluma, Vollure, Volbella, etc.) Restylane (Lyft, Refyne, Defyne etc.), Galderma (Sculptra), and Revanesse (Versa). Look into what they are, how they work, what differentiates them, where on the face they are used, etc.

It seems overwhelming at first, but you’ll get it. It’s also important to know your facial anatomy and how facial muscles work. YouTube also has great videos on technique and depth, so immerse yourself in all of it. This is a great starting point. 

2:  Attend a Botox and Filler Certification Course

There, you’ll learn more about the basics of Botox and filler and get some hands-on experience. You’ll also get a certification, which will enhance your resume for future employers.

Most of you don’t have experience, which is a turn-off to most employers, so it’s important to show initiative! Show that you’re willing to do what it takes and pay the price.

Might I add that most practices want an experienced injector because the training is super expensive—we’re talking thousands upon thousands!

I’ve been told by several practices that nurses are notorious for getting their experience at one practice and then leaving to join another. No bueno for business. Google “Botox and filler certifications course near me” to find a course and make sure that it includes hands-on training. I strongly urge you to attend at least one. 

3. Follow Injectors in Your Area on Social Media

Engage, engage, engage! Like, comment, be their biggest fans. Reach out to them, ask them about their experience as an injector, if their practice is hiring, for shadowing opportunities, if they have any advice for you--establish a connection.

Half of them won’t respond but the other half will! In the case that a practice is hiring, you will have leverage based on your continued support and interactiveness on their social. If they agree to a shadow day, make sure you add that to your resume. Anything and everything helps! 

4. Up Your Social Media Game

LinkedIn is a powerful tool for this industry because you can put a face to a resume. Follow as many practices in your area and all of their employees.

Send personalized messages, sharing your passion for the industry and when they have an opportunity for you to reach out.

Again, also ask for shadowing opportunities. They will remember you for being bold and messaging them (not many people do this, surprisingly. I would also make sure your headshot is professionally done so you look the part. 

5. BE PATIENT AND STAY HUNGRY

It took me almost a year to get into the industry. I applied to numerous practices, had several interviews, and was rejected over and over. But I pressed on every opportunity knowing I would eventually get in, and I did.

It ultimately comes down to how badly you want it at the end of the day. Really ask yourself why you want to get into the industry and use your “why” to motivate you in every circumstance. Don’t give up, babes - you got this!

What Are the Continuing Education Requirements for Aesthetic/Cosmetic Nurses?

Aesthetic/cosmetic nurses who meet the requirements for CANS status must recertify every three years.

Requirements for recertification include accumulating 45 contact hours with at least two hours related specifically to patient safety.

At least 30 contact hours must be in the core specialties: plastic/aesthetic/cosmetic surgery, dermatology, facial plastic surgery, or ophthalmology.

Nurses could also retake the CANS exam every three years to maintain this certification. Once again, there’s no training course required for recertification.

• Aesthetic nurses, also known as cosmetic nurses, are registered nurses who provide aesthetic and cosmetic services and care to their patients. These nurses have specialized training in services ranging from fillers, laser skin treatments, liposuction, tattoo removal, aesthetic surgery, and more.

How Do I Become an Aesthetic/Cosmetic Nurse?

• To become an aesthetic nurse, you must first complete the education required to become a registered nurse, noting that nurses with their four-year BSN degrees are likely to find it easier to find a job in their chosen profession. After getting your degree and licensure as a registered nurse, look for jobs in skincare clinics, cosmetic surgery practices, or similar areas of the medical field. Then you can seek certification from the Plastic Surgical Nursing Nursing Certification Board (PSNCB).

What Does an Aesthetic/Cosmetic Nurse Do?

• Beyond providing inpatient and outpatient cosmetic services such as laser hair removal and skincare treatments, dermabrasion, Botox injections and fillers to provide a more youthful appearance, they also work by the side of physicians such as dermatologists and plastic surgeons as they perform clinical and surgical procedures for patients.

What Are the Educational Requirements to Become an Aesthetic/Cosmetic Nurse?

• The path to becoming an aesthetic/cosmetic nurse starts with completing an ADN or BSN degree and passing the NCLEX-RN exam to be licensed in your state. Though certification with the PSNCB is not required, it is available and preferred by many employers in this healthcare field.

How Much Does an Aesthetic/Cosmetic Make?

• According to ZipRecruiter , the average annual salary for an aesthetic/cosmetic nurse in the United States is just over $89,970. Keep in mind this average reflects advanced practice nurses (APRNs) as well as entry-level nurse salaries.

How Long Does it Take to Become an Aesthetic/Cosmetic Nurse?

• Once a registered nurse has their license, they can apply for jobs as an aesthetic nurse immediately. If you are interested in being certified as an aesthetic/cosmetic nurse by the PSNCB you will need two years of experience, including one year in a related specialty area.  

Aesthetic Nurse Resources

Several organizations support aesthetic/cosmetic nurses within the scope of their practice and as they advance their careers. These organizations provide resources to help nurses’ professional development, education and research. They also promote patient safety and best evidence-based practices.

These organizations include:

• Dermatology Nurses Association
• International Society of Plastic and Cosmetic Nurses
• The American Association of Aesthetic Medicine and Surgery

You can also learn more about aesthetic/cosmetic nursing through Nurse.org! Check out our other related articles:

• 5 Steps to Becoming an Aesthetic Nurse Practitioner
• This is How I Became an Aesthetic Nurse Injector at a Cosmetic Clinic

And lastly, it might also be helpful for you to speak to a medical company that sells botox or fillers to doctors and med spas. Oftentimes, they offer free educational resources and training, as well as guidance for nurses who want to become injectors. 

>> Show Me Online RN-to-BSN Programs

Beyond reading job descriptions, one of the best ways to determine whether medical aesthetics is the career path for you is to speak directly to a cosmetic/aesthetic nurse currently practicing within a private practice or medical spa. You can also reach out to pharmaceutical companies who sell fillers or botox, as some offer free training and resources for nurses as an incentive to sell their product in medspas, etc. where those RNs will go on to work. 

Nurses trained in cosmetic and aesthetic procedures can raise the level of care for patients who seek improvements in their appearance. These nurses can also earn competitive pay while enhancing the quality of life for their patients.

Whether helping a patient to look younger, removing a regretted tattoo, or smoothing away old acne scars, cosmetic nurses provide their patients with a sense of possibility and self-confidence, unlike any other type of nursing specialty. 

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