New RN Pay, Hiring, Psych.

!~New~! · Aug 22, 2009

Hi PSYCHEE, thanks for your questions.

Your questions made me have to think a little, here... (scratches head...) lol.

1. Well, finding jobs is getting harder for everyone, I think, not just new grads. nursing in general is getting cut (surprise, surprise!) But don't lose heart. Keep looking, there are jobs out there, you just may have to be a little creative to find them. (Psst-- Look beyond Monster and Careerbuilder!)

You may need to relocate. That's what I ended up doing to get into psych, and once I had some experience under my belt I was able to move back to FL to get a position out here. There are facilities that will accept new grads but keep in mind that right now psych jobs are getting harder to come by, period. I think that will change in the future... the stimulus bill was passed on the back of a mental health parity bill and the text of at least one of the health reform bills include a parity provision. But right now just keep looking. The door will open when the time is right, and keep in mind that you want to make sure where you work has safe staffing policies in place. Whether a facility has an opening will make no difference if you are in a facility where there aren't enough staff to keep the place safe and you get hurt or killed.

2. No, I don't find your question about salary intrusive at all. I wish nurses in general would be open about it so we can finally negotiate to get paid what we are really worth. We need to stick together so we'll finally stop getting walked on. Remember- according to the census Bureau there are 819,000 doctors/surgeons in the US and 2.4 MILLION RNs. Guess who sticks together, and guess who gets paid better? Hint-- it isn't nurses!

Anyway, this is what I recall: my rate for my first job was approximately $17/hr (pitiful for someone responsible for lives!). This was in med-surg, and was an RN rate, not GN. Keep in mind that it is better to hold out for your first job until after you pass your boards and get your actual license, as some places pay less for a GN than an RN.

I actually had to leave FL to get into psych. I moved to CA, where my pay bumped up to approximately $32/hr immediately upon arrival, lol. Viva la difference! But then so are the costs of living. Once I got some experience I moved back for family reasons and ended up taking a pay cut to come back. Now I'm making just over $26. I was per diem in CA, so that was really nice, I could make my own schedule to a certain extent b/c they just asked for your availiablity and put you on the schedule around when you say you can work. The only drawbacks were no insurance coverage and no guaranteed hours. But they pretty much worked me 32/hrs a week, so the money was fairly steady. The nicest thing was I arranged my availability so that every two months I gave myself a week's vacation (which I used to visit family here in FL.) Ahh, those were the days!!! No sick or vacation pay, though, but that's standard for per diem. If I am ever in a situation where I can reliably swing per diem work again, I am SO going back to it!

Psych generally is based on 8 hr days rather than twelves, so expect a 5 day workweek. Rotating days are standard and you should expect to work every other weekend. Baylor shifts (weekend only worker) have largely been phased out, unfortunately, but some of them still do exist. We get standard health, dental ins, disability ins, etc and PTO (Which is really sick/vacation personal time all lumped together in one pool of time off, so if you call out sick, you lose a vacation day). Patient ratios are usually 8-9 during daytime, but watch out, some facilities staff the night shift really really thin and you could wind up responsible for 16 or 30 patients to one nurse (plus admissions), depending on where you go. You will likely get one tech to help, maybe two if you are lucky. It's not safe, but in FL we don't have statutory limits on what we can be expected to be responsible for and nurses don;t stick together to demand otherwise. So this is what we are stuck with until that changes. Just pick your facility very carefully so you stay safe and protect the license you've worked so hard to earn.

Anyway, sorry to be so long-winded, but you asked some great questions that I felt deserved thorough answers.

Good luck to you on your job search!

WB~

!~New~! · Aug 22, 2009

Oops, I cut off the answer about the graduate nurse program, sorry.

3. Graduate nurse programs are like extended orientation programs. The facility you sign on with will make you sign a contract to work specified shifts and hours, and usually incorporate financial penalties for breaking the contract and quitting before the contract expires. In return, they offer additional training classes and a "preceptorship" where you work with a more experienced nurse to really learn how to handle a set of patients. The first year of nursing is stressful and is nothing like what you get in school. You will learn, but it takes time. Try not to be too hard on yourself. We all have to start somewhere. And yes, you may come home crying from the stress sometimes. But it does get better and you will find a way to learn to manage. The GN programs are varied, with most of them focused on medical areas, critical care or ER. The one I was in was rather disorganized; I never had the same preceptor for more than a week at a time and I never did get any additional classes. However, one of the techs I worked with recently just graduated with her RN and had an excellent experience with a critical care/ neuro program, which she did full time while also working part time as a new grad in psych. So YMMV.

Yes, graduate nurse programs are generally paid. I have not heard of one that isn't. However, if you take a position before your have your license, thwy will pay you less than if you have passed your boards and gotten licensed.

Good luck.

WB~

PSYCHEE · Aug 23, 2009

Wow! Thanks so much for answering all of my questions in such great detail. You've really given me hope in a lot of aspects.

How long did you work in Cali? If need be that I need to get a job somewhere where the pay is greater for a while [and I could actually get into psych] I would definitely do it. I don't want to stay away from FL too long [does a year or two sound okay to you?], even if I do work out my schedule like yours [genius!] so I can come visit frequently. Just to clear things up, you worked in psych in California, correct?

I'm confused about the whole GN/RN thing. The program I'm looking into is for strictly certified RN's. It's a GN program... good to know that they get paid, but why would a GN get paid less than an RN if a GN has more schooling/training? :0

Thank you for all of your help and advice again. :)

!~New~! · Aug 27, 2009

Hello PSYCHEE,

Glad to be of help.

Working in CA for a year or two should be fine. By then you will have some experience and have an easier time finding a new job. It worked for me ok, and yes I worked psych in CA. Although, once you go to CA you may decide you don't want to come back! LOL

It's so beautiful out there and CA is the only states with mandated staffing ratios. (FYI the ratios laws only apply to hospitals, not freestanding psych facilities, so watch out). Patient ratios in CA are 1:6 for psych, and the hospitals out there HAVE to abide by the ratios or get hit with fines. FL is more of a free for all. Some places you are responsible for 8-9, 16 or up to 30 patients, depending on where you work. Yeah, you'll probably have a tech to help you but even with that the workload can get crazy, possibly even dangerous. Ultimately you are the one held responsible for what happens, even if you do have the help of a tech. If something goes down, it will be the nurse who is blamed for it. So pick your facility carefully.

On the GN / RN thing... maybe this will help you understand a bit.

A Graduate Nurse = a nurse who has graduated from nursing school but has not yet gotten their license. Hence, you are not a "full-fledged" nurse yet.

A Graduate Nurse PROGRAM = an extended orientation program, usually yearlong, that attempts to bridge the (very large) gap between what you learn in school and the practical knowledge you will need to survive as a practicing RN. Note the word I use: SURVIVE. There is a HUGE adjustment period for first year nurses; in reality nursing school only gives you a fraction of what you are going to have to learn to manage working the floor once you take on a job. 1 in 5 nurses quits their first year It can be done; these programs try to help and millions of nurses do manage. :wink2: The GN program is strictly for nurses in their first year out of school.

As for the pay scale, well, that's a dose of reality for you. Hospital administrators sometimes like to play games, and the #1 game is called "Pay the Employee A Little As We Can Get Away With." Which actually goes for pretty much all of corporate America, to be fair. Welcome to the Real World, I guess. Even though it would seem that a GN has "more" training, in reality the GN program is geared to get you "up to speed" to the supposed proficiency of an RN with experience. So they rationalize and pay accordingly for that difference in knowledge.

Of course, under the current hospital staffing models, NOBODY can realistically do everything that is expected of nurses. It's simply impossible to provide adeqaute, safe care to that number of patients. You can't divide yourself that many times. Hospitals know this, but use their corporate lawyers and Risk Management departments to wrangle out of liability issues and push the blame on someone else. It's all a big numbers game to them... and it's a terribly dangerous situation for the patients.

Nurses are the watchdog for the patient. In fact, that's a mandated responsibility from the board of nursing: to be the ADVOCATE for your patient. And sometimes that will mean running counter to administration / the hospital.

That's why the California nurses went to bat to get the ratios mandated. Do yourself a favor and educate yourself: California Nurses Association Yes, that is a union organization, but don't let the label "union" scare you. In reality that organization is just nurses sticking together to PROTECT THE PATIENTS, and they have some darn good information on their site.

Direct care nurses sticking together is VITAL. Nursing administration really represents the interests of the hospital, not you. Now, a lot of the DONs do genuinely care about their nursing staff, the patients and are good people. And hospital staff do have to be mindful of the bottom line too, because if the hospital is not solvent, then guess who's out of a job?

But ultimately, the responsibility for protecting the patient lies mainly with the direct care nurse and we have a duty to uphold that. We have been granted INDEPENDENT nursing judgment by the nursing board. Which means standing up for the safety and well being of the patient, and standing up against administration, doctors or politicans if need be. If that sounds scary, it should. It's an awesome, sacred responsibility. We hold lives in our hands. Nurses need to stand up, quit bickering with each other and stand united to protect our patients' interests, just like doctors do with the AMA. Both patients and nurses will be better off for it.

Well, there I go again, long winded. Guess there's just a lot to say. LOL

Good luck to you in your new career. I hope it is everything you hope it to be, and more.

Take care.