The Medical-Surgical (Med-Surg) Nurse provides general inpatient nursing care across a broad spectrum of diagnoses in the hospital's largest and highest-volume clinical setting, reporting to the Med-Surg Charge Nurse or Nurse Manager. Med-surg nursing is often underestimated in complexity, but here is the reality: a med-surg nurse managing five to eight patients on a typical shift is executing a cognitive workload that rivals any specialty, because the patients are diverse, the acuity shifts unpredictably, and the nurse must prioritize and reprioritize continuously throughout the shift. The best med-surg nurses are the ones who know how to identify the patient who is quietly deteriorating beneath the noise of a busy unit. Success is measured by early warning score utilization, rapid response activation rates, patient satisfaction scores, and length-of-stay benchmarks.
Conduct thorough head-to-toe assessments on all assigned patients at the beginning of each shift and document findings in the EHR within required timeframes.
Administer medications accurately using the five rights of medication administration, scanning barcodes at every administration per facility protocol.
Monitor patients for clinical deterioration using National Early Warning Score (NEWS) or Modified Early Warning Score (MEWS) and escalate per rapid response criteria.
Manage post-operative patients following surgical procedures, monitoring for pain control, wound integrity, bowel and bladder function, and ambulation milestones.
Perform and document wound assessments, dressing changes, and surgical incision care using evidence-based wound management techniques.
Insert and manage urinary catheters, peripheral IVs, and nasogastric tubes following facility protocols, applying CAUTI and CLABSI prevention bundles.
Collaborate with physical therapy, occupational therapy, and case management to advance discharge readiness and prevent avoidable readmissions.
Manage patient education sessions on new diagnoses, medications, and self-care skills required for safe discharge and recovery at home.
Communicate clinical status changes to providers using SBAR format, documenting notifications and responses accurately in the medical record.
Respond to rapid response activations on the unit, providing initial assessment and interventions pending the response team's arrival.
Complete discharge teaching and coordinate with case management and social work for post-discharge support arrangements.
Contribute to unit safety culture through accurate incident reporting, participation in bedside shift report, and engagement in unit quality improvement initiatives.
Active, unrestricted RN license in the state of practice; BSN preferred, ADN accepted with demonstrated competency.
Current BLS certification; ACLS preferred, required at some facilities.
0-3 years of nursing experience; new graduates with strong clinical rotations accepted at facilities with structured residency programs.
Basic proficiency in medical-surgical patient assessment across common diagnosis categories (cardiac, pulmonary, orthopedic, GI, renal, neurological).
Demonstrated competency in IV medication administration, wound care, and urinary catheter insertion and management.
Familiarity with early warning scoring systems and rapid response escalation protocols.
Proficiency with hospital EHR systems; Epic, Cerner, or Meditech experience preferred.
CMSRN (Certified Medical-Surgical Registered Nurse) from AMSN, or commitment to sit for exam within 2 years of hire eligibility.
1-3 years of experience in an acute care inpatient hospital setting.
Experience in a high-acuity med-surg or step-down unit with 5-8 patient assignments.
Wound care certification or advanced wound management training.
Bilingual capability in languages spoken by the patient population served.
Head-to-toe systematic assessment across multiple diagnostic categories
Medication administration including high-alert medications and IV push drugs
NEWS/MEWS early warning scoring and rapid response escalation
Post-operative monitoring and surgical wound care
CAUTI and CLABSI prevention bundle implementation
IV access, urinary catheter, and NG tube insertion and management
EHR documentation (Epic, Cerner, Meditech)
Prioritization under high patient volume and unpredictable acuity shifts
Concise, accurate handoff communication and SBAR notification
Patient and family education across varied health literacy levels
Team coordination with ancillary services, case management, and physicians
Resilience and composure during multi-patient deterioration events
Med-surg nurses earn $72,000 to $92,000 annually across most U.S. markets, consistent with the national RN median of $86,070 (BLS, May 2023). While med-surg traditionally sits at the lower end of nursing specialty compensation, CMSRN certification, years of experience, and night shift differentials meaningfully increase total earnings. Hospitals in competitive markets offer signing bonuses of $5,000 to $20,000 to attract experienced med-surg nurses given the specialty's persistent shortage. Source: U.S. Bureau of Labor Statistics, May 2023; PayScale, 2025.
San Francisco Bay Area, CA ($100,000 - $122,000)
Seattle, WA ($93,000 - $112,000)
New York Metro, NY ($91,000 - $110,000)
Los Angeles, CA ($89,000 - $108,000)
Boston, MA ($87,000 - $106,000)
Med-surg nursing positions typically include medical, dental, and vision coverage, 401(k) with employer matching (3-5%), 3-4 weeks PTO, and shift differentials for nights, weekends, and holidays. Most facilities offer CMSRN exam reimbursement, tuition assistance for BSN and MSN programs, and structured new graduate residency programs. Signing bonuses are increasingly common at facilities with persistent vacancies.
Cannot prioritize a scenario with two deteriorating patients simultaneously: Multi-patient prioritization is the core cognitive demand of med-surg nursing. Candidates who cannot articulate a structured approach to this scenario reveal an organizational thinking gap that will surface daily.
Views med-surg as a stepping stone they are eager to leave: This attitude predicts short tenure and low engagement. Med-surg needs nurses who respect the complexity of the work, not nurses who treat it as an entry-level inconvenience.
Cannot explain how they prevent medication errors with a high patient load: Med-surg nurses are responsible for the highest volume of medication administrations of any inpatient unit type. Candidates without explicit error-prevention habits are a risk.
No experience identifying early clinical deterioration: Subtle deterioration on med-surg floors is a leading cause of preventable ICU transfers. Candidates who cannot describe their early warning approach represent a gap in one of the unit's most critical safety functions.
Unfamiliarity with CAUTI and CLABSI prevention bundles: These hospital-acquired infection metrics are tied directly to reimbursement. Candidates who don't know the basics of these bundles require education on compliance expectations before practicing independently.
Q: What does a med-surg nurse do?
A: A med-surg nurse provides general inpatient nursing care to patients across a broad range of medical and surgical diagnoses. Responsibilities include systematic assessment, medication administration, post-operative monitoring, wound care, patient and family education, discharge planning, and early warning monitoring for clinical deterioration across a 5-8 patient assignment.
Q: What qualifications do you need to be a med-surg nurse?
A: You need an active RN license and current BLS certification. New graduates are accepted at facilities with structured nurse residency programs. BSN is preferred but ADN is accepted. The CMSRN credential from AMSN is the recognized specialty certification and becomes eligible after 2 years of med-surg experience.
Q: How much does a med-surg nurse make?
A: Med-surg nurses earn $72,000 to $92,000 annually across most U.S. markets, consistent with the national RN median of $86,070 (BLS, May 2023). CMSRN certification and night shift differentials increase total compensation. Signing bonuses of $5,000 to $20,000 are increasingly common at facilities facing persistent vacancies.
Q: What skills are required for a med-surg nurse?
A: Med-surg nurses need systematic patient assessment, high-volume medication administration, early warning scoring, post-operative monitoring, wound care, infection prevention bundle compliance, and EHR documentation. Prioritization across multiple simultaneously deteriorating patients, SBAR communication, and structured patient education are equally critical soft skills.
Q: What is the career path for a med-surg nurse?
A: Med-surg nursing builds one of the broadest clinical foundations in nursing. Nurses advance to charge nurse, preceptor, or clinical educator. They commonly transition to specialty units including telemetry, ICU, and emergency nursing with additional training. Management tracks include unit manager and director of medical-surgical services roles.
Q: What are the biggest challenges facing med-surg nurses today?
A: Patient acuity on med-surg floors has risen sharply over the past decade as ICU and step-down capacity limits push more complex patients to general floors. Staffing ratios of 6-8 patients per nurse are increasingly unsafe but persist at many facilities. The specialty also faces a reputation problem: it is perceived as entry-level when the reality demands sophisticated clinical judgment at volume.