Medical Surgical (Med Surg) RN
A Med Surg nurse provides direct care to patients suffering from a variety of illnesses and diseases. Patients can range from being acutely ill, needing help managing an exacerbation of a disease and/or preparing for/recovering from surgery.
An additional skillset of a Med Surg RN could be basic interpretation of dysrhythmias and treatments. These Med Surg nurse could work on a Med/Surg Tele unit, with basic Telemetry monitoring, not that of a step-down unit.
Types of Med Surg Units: Surgical, General, Ortho, Oncology, Cardiac
Patient Diagnosis: Pneumonia, Diabetes, GI bleed, Post-op, COPD exacerbation, Bowel Resection, Ileus, Congestive Heart Failure (CHF) Kidney disease, Dialysis, Cellulitis, Asthma.
Certifications: BLS (requirements may vary based on facility preference)
Ratios: 1:5 (Day shift) 1:8 (Night shift)
Floating: Depending on experience and certification- could potentially float to a Tele unit.
Screening Questions: What’s their comfort level in caring for post-surgical patients, more specifically orthopedics. Determine if they have floated to a higher level of care and what their comfort level is. Can you interpret EKG strips?
Pediatric RN
The general pediatric care unit provides nursing care to children with a wide range of acute and chronic medical and surgical conditions. Pediatric nurses are very knowledgeable about growth and development as they adapt their interactions and care to the individual child’s developmental level. In addition, they acknowledge the expertise of the family and collaborate with them to provide care for the child.
Types of Units: Med Surg, Oncology, Cardiac, Emergency, Operating Room, PACU
Patient Diagnosis: General medical, post-surgical, Diabetes, Orthopedic, Oncology, Transplant, pneumonia, Asthma, Respiratory issues.
Certifications: BLS, PALS (requirements may vary based on facility preference)
Ratios: 1:3-5
Floating: Depending on experience and units at the facility
Screening Questions: Have you worked at a Children’s hospital or a hospital with a pediatric floor? What pediatric units have you worked on? Do you have experience with adults? What age group do you have the most experience caring for? What patient population are most comfortable caring for?
Intensive Care Unit RN (ICU/CCU)
Intensive care unit nurses use an advanced skill set to care for patients with severe and life-threating illnesses and injuries, which require continuous, close monitoring and support from highly trained professionals, specialized equipment, and medications to sustain life.
Types of Units:
- Burn Intensive Care Unit (Burn ICU)
- Medical Intensive Care Unit (MICU)
- Neonatal Intensive Care Unit (NICU)
- Pediatric Intensive Care Unit (PICU)
- Coronary Care Unit/Cardiovascular Intensive Care Unit (CCU) or CVICU
- Neurological Intensive Care Unit (Neuro ICU)
- Surgical Intensive Care Unit (SICU)
- Trauma Intensive Care Unit (Trauma ICU)
Patient Diagnosis: This patient population has severe, life-threatening illnesses and injuries that require constant, close monitoring, support from specialist, and specific equipment and medications to sustain life.
Certifications: (Requirements may vary based on facility preference)
- BLS (Basic Life Support)
- ACLS (Advanced Cardiac Life Support)
- PALS (Pediatric Advanced Life Support)
- IABP (Intra-Aortic Balloon Pump)
- ENPC (Emergency Nurse Pediatric Course)
- NIHSS (National Institutes of Health Stroke Scale)
- TNCC (Trauma Nurse Core Course)
- ATCN (Advanced Trauma Care for Nurses)
Ratios: 2 patients to 1 nurse but can be a 1:1 depending on the patient’s condition
Floating: PCU, ER
Common equipment:
- Mechanical ventilators to assist with breathing through an endotracheal tube or tracheostomy.
- Cardiac monitors with telemetry
- External pacemakers
- Defibrillators
- Dialysis equipment
- Arterial Lines/CVP monitoring
Screening Questions: What has been your experience floating to a telemetry or stepdown unit? Do you have your CCRN certification? Adult ECMO experience? What is the highest acuity patient you have cared for?
*ECMO- In extracorporeal membrane oxygenation (ECMO), blood is pumped outside of your body to a heart-lung machine that removes carbon dioxide and sends oxygen-filled blood back to tissues in the body. Blood flows from the right side of the heart to the membrane oxygenator in the heart-lung machine, and then is rewarmed and sent back to the body. This method allows the blood to “bypass” the heart and lungs, allowing these organs to rest and heal.
Neonatal Intensive Care RN (NICU)
NICU nurses care for premature and critically ill newborns, with a variety of problems ranging from prematurity, birth defects, infection, cardiac malformations, and surgical problems.
Type of Unit: Neonatal Intensive Care Unit
Levels of NICU
- Level I: Basic newborn care- Healthy, full-term babies, stabilization of newborns near term to get them ready to transfer to facilities that provide advanced care.
- Level II: Advanced newborn care- newborns greater than 32 weeks gestation or who are recovering from more serious condition requiring closer monitoring.
- Level III: Subspecialty newborn care- newborns less than 32 weeks gestations as well as newborns born with critical illness, at all gestational ages. These facilities offer prompt and readily available access to a full range of pediatric medical subspecialties. Additionally, they offer a full range of respiratory support and advance imaging.
- Level IV: Highest Level of neonatal care- providing the highest level, most acute care. Level IV NICUs can provide surgical repair to complex congenital or acquired conditions. These facilities have a full range of pediatric medical and surgical subspecialties as well as pediatric anesthesiologists on site. This level of NICU takes care of neonates as early as 22 weeks gestation.
Patient Diagnosis: Depending on the level of NICU, the diagnosis will vary. For example, a level 2 NICU may care for and infant with jaundice requiring phototherapy for treatment or a newborn having difficulty keeping their temperature regulated. A level 3 NICU would care of a newborn requiring mechanical ventilation to breath, surgical intervention such as a cardiac or neuro defect. Level 4 NICU will be you most critical newborns.
Certifications: BLS, NRP, STABLE may be required. (Requirements may vary based on facility preference)
Ratios: Feeder/growers 1:3 otherwise typically 1:2 or 1:1 depending on acuity.
Floating: may float to PICU if prior experience
Screening Questions: Determine what level of NICU RN has worked in. Do they have experience with ECMO? Have they floated to PICU? Ask what the highest acuity of newborns they have cared for.
*ECMO- In extracorporeal membrane oxygenation (ECMO), blood is pumped outside of your body to a heart-lung machine that removes carbon dioxide and sends oxygen-filled blood back to tissues in the body. Blood flows from the right side of the heart to the membrane oxygenator in the heart-lung machine, and then is rewarmed and sent back to the body. This method allows the blood to “bypass” the heart and lungs, allowing these organs to rest and heal.
Pediatric Intensive Care Unit (PICU RN)
The PICU RN provide care for severely ill or injured children and adolescents who need constant monitoring and interventions. PICU units normally do not provide care to patients over the age of 18.
Patient Diagnosis: Invasive surgery, Congenital anomalies, Immunological disorders, Severe infection, Poisoning, Drug overdose, Physical trauma
Certifications: BLS, PALS (requirement may vary based on facility.
Ratios: 1:3 otherwise typically 1:2 or 1:1 depending on acuity.
Floating: may float to NICU if prior experience
Screening Questions: Is your experience at a Children’s Hospital or a hospital that has a Pediatric Unit? Do they have experience with ECMO? Have they floated to NICU? What is the highest acuity of a child/adolescent they have cared for? Have you worked in an adult ICU, if so, what is the highest acuity adult have you cared for?
*ECMO- In extracorporeal membrane oxygenation (ECMO), blood is pumped outside of your body to a heart-lung machine that removes carbon dioxide and sends oxygen-filled blood back to tissues in the body. Blood flows from the right side of the heart to the membrane oxygenator in the heart-lung machine, and then is rewarmed and sent back to the body. This method allows the blood to “bypass” the heart and lungs, allowing these organs to rest and heal.
Stepdown, Progressive Care, Interediate Care,
Telemetry RN
Step-down/PCU jobs for Registered Nurses involve the care of patients who require close monitoring and frequent assessment but are moderately stable with less complexity than ICU patients. Telemetry (Tele) RN falls under this category of nursing specialty – These nurses are highly trained in using the latest electrocardiogram (EKG/ECG) and telemedicine technology. They are experts at identifying potentially dangerous heart rhythms.
Patient Diagnosis: Management of these patients includes: BIPAP/CPAP, conscious sedation, peritoneal dialysis, cardioversion, defibrillator/pacemakers, pre/post-surgical care, tracheostomy care, chest tubes, tube feedings, ostomy care, wound care, IV therapy, and central line care. These patients have a high potential for becoming unstable, requiring a higher level of care such as the ICU.
Ratio: 1:3 or 1:5
Float: Med Surg
Certifications: BLS (Basic Life Support)
ACLS (Advanced Cardiac Life Support)
NIHSS (National Institutes of Health Stroke Scale)
CCRN (Critical Care Nurses Certification)
(Requirements may vary based on facility preference)
Common Equipment:
- Mechanical ventilators to assist with breathing through an endotracheal tube or tracheostomy
- Cardiac monitors with telemetry
- External pacemakers
- Defibrillators
- Dialysis equipment.
Questions: Do you have experience with titrating drips? What is your Cardiac experience in terms of monitoring techniques and dysrhythmia interpretation and treatment? Have you pulled pacer wires?
Emergency Room Nurse
ER nurses specialize in rapid response to medical emergencies. They treat patients who are suffering from trauma, injury or severe medical conditions that require urgent treatment. Since these specialists work in crisis situations, they must be able to quickly identify the best way to stabilize patients and minimize pain.
Levels of ER:
- Level I-Provides the highest level of care for the most serious and life-threatening injuries for both children and adults. A level 1 trauma center has in-house trauma surgeons and on-call specialist available.
- Level II: Can initiate definitive care for all injured patients. Level II has 24-hour immediate coverage by general surgeons, as well as coverage by the specialties of orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, and critical care.
- Level III-: can provide prompt assessment, resuscitation, surgery, intensive care and stabilization of injured patients and emergency operations.
- Level IV: Can provide advanced trauma life support (ATLS) prior to transfer of patients to a higher-level trauma center. It provides evaluation, stabilization, and diagnostic capabilities for injured patients.
Patient Diagnosis: Trauma (MVA’s, gunshot wounds, stabbing), respiratory failure, Chest Pain, Stroke, Heart Attack, COPD exacerbation, Metal illness, Overdose, Alcohol withdrawal, fractures, pregnancy related issues.
Certifications: BLS, ACLS, PALS, TNCC, CPI (requirements may vary based on facility preference
Ratios: 1:4/5 (depending on severity and acuity of patients)
Floating: usually will not float
Screening Questions: What trauma level have you worked in? Are you comfortable working with children or adults? What is your critical access experience?
Labor and Delivery (L&D) RN
L&D nurses care for women during labor and while giving birth. They monitor and assess the mom and baby during this time. They coach the mom through labor and the delivery of their newborn, while assisting the doctor in the process. An L&D nurse can have a background in working with “High-Risk” patients.
This grouping of patients can range from different disease process, some examples include Diabetes, Preeclampsia (high blood pressure) and multiple gestation (multiple fetus). Depending on the facility an hour or two after the baby is delivered, the mom and newborn may go to the Postpartum unit. This is the unit they will remain on until they are discharged.
The focus of this type of nursing is on recovering mom after delivery and ensuring the newborn is having appropriate input and output given their age, and that their assessment and labs are stable to be discharged to home. If the mother chooses to breastfeed, these nurse’s assistant new moms with breastfeeding. Some facilities will have lactation specialist on staff.
Some facilities have these two units combined; this is referred to as LDRP (labor delivery recovery postpartum) If a patient needs to have a Cesarean Section (C-Section) they are taken to the operating room. The nurse could act as a circulator or scrub depending on the expectation of the facility.
Type of Unit: Obstetrics Unit
Patient Diagnosis: prenatal, perinatal, postpartum
Certifications: BLS, NRP, ACLS, AWHONN- EFM (Electronic Fetal Monitoring), STABLE (requirements may vary based on facility preference)
Ratios: Determined based of phase of labor. Usually it is a 1:2 or 1, Postpartum is usually 1:4 or 1:5
Floating: L&D can float to postpartum, but Postpartum cannot float to L&D, both can float to Newborn Nursery
Screening Questions: Do you have experience working primarily in Labor and Delivery? What about working primarily in postpartum? Have you assisted with C-Sections? Do you have experience working in the newborn nursery? Are you EMF certified? What is your experience when caring for a patient who is in for an induction? What is your experience when caring for the high-risk OB population?
Oncology RN
Type of Unit: Oncology
Patient Diagnosis: The oncology nursing specialty seeks to reduce the risks, incidence, and burden of cancer by encouraging healthy lifestyles, promoting early detection, improving the management of cancer symptoms and side effects throughout the disease trajectory, and leading the coordination of complex care needs.
Oncology nurses advocate for people at risk for or with a diagnosis of cancer, deliver education throughout treatment decision making and planning with attention to individual health literacy levels, coordinate care delivery across the cancer continuum, ensure safe delivery of cancer treatments, assess for complications of therapy, help manage symptoms, optimize quality of life, support patients with cancer and their caregivers, advocate for the unique needs of patients with cancer, and collaborate with an inter-professional team to improve outcomes and reduce the impact of cancer on patients, families, communities, and populations.
Certifications: BLS, OCN (Oncology certified nurse), Chemotherapy Immunotherapy Certification (RN must have this certification to administer Chemotherapy) (requirements may vary based on facility preference)
Ratios: 1:4
Floating: Med Surg
Screening Questions: What patient population of Oncology are most experienced in caring for? Do you have your OCN and/or Chemotherapy Immunotherapy Certification? Do you have experience administering Chemotherapy? Have you worked on an oncology unit that is mixed with Med Surg patients?
Operating Room RN (OR RN)
The RN in the Operating Room circulates and coordinates the surgical team in all aspects of O.R. activities, providing for optimum perioperative nursing care to patients. Functions as the patients’ advocate. The circulating nurse assists anesthesia while they are intubating the patient, retrieve’s any extra supplies needed during the case, assisting with equipment, verifying consents, and ensure that the right patient and right procedure is going to be done.
Additionally, they can function as a scrub nurse. A scrub nurse scrubs in to help with cases, setting up the OR for the operation that will be performed, and ensure sterile technique is followed. A scrub nurse assists the surgical team with gowning and gloving prior to procedure.
An RNFA (RN first assist) uses medical devices and instruments, providing exposure to the surgical site, and the handling or cutting of tissues. Additionally, a registered nurse first assistant can provide hemostasis, suturing, and wound management.
If circulating or scrubbing, a nurse is usually assigned to an OR suite and works the cases in that room. They are only in one case a time.
Depending on the procedure performed the patient may stay overnight in the hospital or go home the same day.
Ambulatory Surgery Centers/Outpatient surgery Center will perform procedures that are outpatient- meaning the patient will go home the same day.
GI Lab preforms endoscopies and colonoscopies (scopes)
Type of Unit: OR- operating Room
Patient Diagnosis: Orthopedic, Neuro, Cardiac, General surgery, GYN (women’s health), GI, Head and Neck, Plastics, Transplant, Ophthalmology, ENT.
Certifications: BLS, ACLS (requirements may vary based on facility preference)
Ratios: Surgeries per month
Floating: N/A- if they have experience with pre-op or PACU
Screening Questions: What types of cases are you most familiar with? Do you have experience with scrubbing into a case? Do have experience with circulating? Have you worked in the GI Lab? Do you have experience with robotic surgeries? Do you have experience with Neuro, cardiac, or plastics surgeries? Do you have experience working in pre and/or post- op? How much call are you comfortable taking?
Surgical Tech
Assists the surgeon during operative procedures by providing appropriate and adequate sterile instrumentation and other supplies. They pass instrument, sponges, and sutures to the surgeon during surgery. Maintains the surgical field through aseptic practices. Ensures the operating suite is adequately prepared for the procedure. Ensuring counts are correct, anticipates what the surgeon is going to need before they ask. Have a good understanding of the equipment used during surgery. A surgical tech assists the surgical team with gowning and gloving prior to procedure.
Type of Unit: Operating Room
Patient Diagnosis: Orthopedic, Neuro, Cardiac, General surgery, GYN (women’s health), GI, Head and Neck, Plastics, Transplant, Ophthalmology, ENT.
Certifications: BLS, Surgical Technologist Certification (requirement may vary based on facility)
Ratios: Surgeries per month
Floating: N/A
Screening Questions: What types of cases are you most familiar with? How many cases have you scrubbed into? Have you worked in the GI Lab? Do you have experience with robotic surgeries? Do you have experience with Neuro, cardiac, plastics and ortho surgeries? What shifts do you prefer? Will you float to sterile processing? How much call are you comfortable taking?
Post Anesthesia Care Unit (PACU RN)
A post-anesthesia care unit, often abbreviated PACU, provide care for patients recovering from anesthesia, Cares for these patients include vital sign monitoring, pain management, watching for signs of hemorrhage, airway management, and treating postoperative nausea/vomiting,
The length of stay in a PACU will vary from patient to patient. The pace of a PACU in an outpatient center could be higher because the cases are not typically as complicated so more can be performed in a day.
Phase I has monitoring and staffing ratios equivalent to the ICU. Phase II ensures the patient fully recovers from anesthesia and return of vital signs to near baseline. Phase II is a transitional period between intensive observation, and either being admitted to the surgical unit or discharge to home.
Patient Diagnosis: All patients who are recovering from anesthesia, general, regional, or local.
Certifications: BLS, ACLS, PALS Certification (requirement may vary based on facility)
Ratios: Surgeries per month
Floating: could float to Pre-op if they have experience in it. Some facility their Pre-op and PACU are one and nurses are expected to float between both.
Screening Questions: What is the highest acuity of post-surgical patients you have cared for? Do you have experience working with post-surgical patient who will go to the ICU once out of PACU? Do you have experience with Phase I and Phase II PACU? What types of patients are you most comfortable with recovering? Do you have experience with adults? Do you have experience with Pediatric patients? Are you willing to take call?
Sterile Processing Technician
The Sterile Processing Technician is assigned duties performing decontamination, preparation, sterilization and distribution of surgical instruments and medical equipment throughout the surgery center, utilizing infection control and safety practices during all phases of the process.
Patient Types: Orthopedic, Neuro, Cardiac, General, GYN, Endo
Certifications: CRCST- requires that SPT passes an exam and complete 400 hours of hands-on experience. These hours can be completed before testing or within 6 months of passing the exam. Most jobs require the CRCST, depending on the facility they might accept a CBSPD, but most prefer a CRCST.
CRCST (Certified Registered Central Service Technician) is offered through- The International Association of Healthcare Central Service Materiel Management (IAHCSMM)
CBSPD is Certification Board for Sterile Processing and Distribution
Ratios: Surgeries per month
Floating: N/A
Questions: Are you certified, if so, what certification do you hold? What size of OR have you worked in? Which areas are you specialized in? How much call are you willing to take? Do you have experience in being a supervisor?
Behavior Health RN/Psych RN
Behavior Health RN promotes the well-being of their patients through prevention and education, in addition to the assessment, diagnosis, care, and treatment of mental health and substance use disorders.
Type of Unit:
- Outpatient or Day Treatment Facility – These types of mental health facilities offer day programs where a person may visit the facility for treatment. Treatment at these facilities often includes medication management, group therapy, individual therapy and classes that teach skills to be used in dealing with a mental illness. Day treatment facilities, as the name implies, do not have patients stay overnight and so are suitable for people who have already stabilized their mental health condition. A day treatment program may be what a person enters after leaving an inpatient psychiatric facility.
- Inpatient Units- These are inpatient units where mental health emergenciesare handled – such as a person who is floridly psychotic. Patient stays are typically short-term and are used to stabilize a mental health condition
Patient Diagnosis: Patient with mental illness (Geriatric, Adult, or Children)
- Alcohol or Substance Abuse
- Mood Disorders
- Dementia
- Suicidal
Certifications: BLS (Requirements may vary based on facility preference)
Ratios: 1:4/6
Floating: N/A
Screening Questions: Do you have a specific patient population you work with (example: Pediatric, Adult, Geriatric)? Where is most of your experience at (Outpatient or inpatient)? Do you have general med surg experience?
