Removed from Nurse Residency Program-Should I Try Psych?

  1. Sadly, I became a member of the club no one wants to join two days ago. "Removed from Nurse Residency Program" club.

    I'm an older nurse, graduated from an accelerated (16 mnths) BSN program in December of '17. Took NCLEX and passed on first try in March. Accepted spot in a pilot Nurse Residency program in June. Hospital is Level 1 Trauma unit in a large city. My position was in SICU. I really loved critical care and I was learning in leaps and bounds. Unfortunately, I was told on my eighth day on the floor that my basic nursing skills were not sufficient for the fast pace of an ICU. Shadowed in Stepdown/Tele and was told the same thing. Also told there was nothing available in general med/surg. Oddly, even though I was told there was no place for me within the facility, the ICU director wanted me to work the following day and one day the following week. Went home, thought about it, checked out many threads on this site and decided that it would be best to resign, rather than be terminated.

    I was surprised at how supportive the ICU director was at this meeting. She gave some suggestions for new employment and said she will give me a good letter of recommendation. She also had high praise for my energy, personality and leadership abilities. She emphasized that it is my basic skills that are lacking and encouraged me to contact my school to see if I can get some remediation. I knew throughout nursing school that I wasn't getting the experience I needed to solidify my basic skills. I made this clear to many instructors and administrators and always got the same reply: "you'll learn those skills on the floor." Not so. I did much continuing education on my own. I got in 45 minutes before my shift every day in order to read my patient's history and familiarize myself with the (pretty antiquated) charting system, I asked many, many questions, I lived, ate and breathed nursing at home. Nurse Sarah RN became my new best friend. YouTube nursing videos became my only form of entertainment. I wrote education articles on disease processes for future use in new nurse orientation. I acted out processes such as blood draws just to build muscle memory. Unfortunately, this wasn't enough.

    All of that to ask this question: I've seen some openings for psych and will apply for them. I entered nursing school originally with the goal of becoming a psych NP, but I wanted to get a year of general nursing experience to solidify my skills before considering that route. If I do get an offer (the facility where I did my psych rotation would probably hire me), should I take it? Some nurses have told me that if I make that jump, I won't be able to reenter general nursing. I loved my psych rotation as a student; most of it just consisted of talking to the patients and I really enjoyed it. However, it looked to me like the nurses mostly passed meds and had very little interaction with the patients.

    In the meantime, I am looking into nursing skills refresher courses in order to further my basic skills and definitely plan to see what my school can offer me in the way of remediation. I would really like to try psych nursing, but worried it will lock me into that role permanently if I do it now. Any input would be much appreciated.
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    About dbabz

    Joined: Feb '16; Posts: 129; Likes: 208


  3. by   Aunt Slappy
    Exactly which "basic nursing skills" did they say you were deficient in?
  4. by   dbabz
    Quote from Aunt Slappy
    Exactly which "basic nursing skills" did they say you were deficient in?
    2 big ones: I had never drawn blood or started an IV in school. I did each of those things once on the floor--and got the IV on the first try. School tried to tell us that no nursing schools teach blood draws or IV insertion any more due to liability issues, but as threads on this site have indicated, that's not true.

    IV line priming: Preceptor said I always had "a **** ton" of air in the line. I spent much time on YouTube trying to figure out how to perfect my technique and I think I improved a lot. Secret is in filling the tube before letting the roller clamp out slowly.

    Bed-making: Never really got much practice at this b/c at clinicals, CNAs usually did it.

    Also had a lot of trouble with the charting system.
    Last edit by dianah on Oct 1 : Reason: Terms of Service re: posting profanity
  5. by   Aunt Slappy
    I'm sorry to tell you that whoever dismissed you is lying to you. Those are skills that you could've been instructed in once or twice and given practice opportunities in the course of your floor work. They're not anything challenging, except maybe IV placement and that's going to be a patient-driven issue not necessarily related to skill.

    But yeah, your school is FOS. We learned and practiced all those things even in my LPN program, where everyone graduates IV certified.

    I think they wanted to get rid of you for some other reason and used this as an excuse.

    What were your issues with the charting system, and what system was it?
  6. by   hppygr8ful
    Granted you will not be starting IV's or making beds in Psych. (well maybe making beds) You still need a very good base training in assessment skills. Still if you have good people skills and a calm nature (Which I have found to be extremely important) you can always try Psych. My only concern is that when new nurses go into Psych they often forget the bedside skills they don't use so much which limits their job opportunities in the future. I have done Psych for almost 20 years now but occasionally do per diem at an Out-patient surgery to keep assessment skills and IV skills current.

    Good luck to you

  7. by   111th
    I went through an LPN program and an LPN-RN bridge program and I never once learned how to draw blood and I frankly don't even remember it being covered. We did practice IV skills on fake arms in both programs but I never had the opportunity to insert one in clinical. Luckily my first job as an LPN was through a major hospital and they offered a day of shadowing/working with the outpatient phlebotomists and I was able to get major practice. I truly learned IV skills on the job as an RN. You truly learn on the job, in my opinion. I think those skills should have been (nearly) perfected with your preceptor in my opinion. You can always learn skills, but ability to work well with coworkers/patients, and common sense can't be learned imo. Most managers I've interacted with would rather train the right person than hire someone who can't get along with people but can hit the floor running.... anyway...

    If psych is where you want to be, I say go for it. Don't kill yourself doing something you aren't loving just because you think it's what you're supposed to do. I'm sort of going through something similar.

    Best at of luck!
  8. by   Lil Nel
    I had a similar experience as yours in CVICU, as a new grad.

    Resigned my position after five shifts, and went to work at psych facility where I did clinicals.

    Loved my patients, and would have stayed at the job more than eight months, if the facility was safe for staff and patients.

    Sadly, it wasn't, and I left for a med-surge position.

    I now work in a physical rehabilitation facility, and frequently use the skills I acquired in psych.

    From my experience, it has been easy to go back and forth.

    But I don't know where you live, or what job market is like.
  9. by   Orion81RN
    Hmm Those "skills" sound like BS. One only gets good at them with time, AFTER nursing school. You stated this was a pilot program. They probably don't have a very good residency for new grads. Maybe after time when they realize all new grads lack those skills...
    I say go for psych! Heck, my mom was out of bedside for 25 years. She got back into more hands on care doing private duty and home health where there are vents, trachs, wound care, central lines...etc...They do in-service in office then orientation in the home. It's working out great for both of us!
  10. by   Aunt Slappy
    Quote from 111th
    I went through an LPN program and an LPN-RN bridge program and I never once learned how to draw blood and I frankly don't even remember it being covered.
    I'm wondering how all these schools keep operating without even covering basic clinical skills.
  11. by   LovingLife123
    There has to be something else. Heck, I still suck at IVs. We don't start that many in the ICU. And tube priming? There's a skill to that? Lol.

    They were making excuses to you. We did I'V starts one time in nursing school on mannequins that had very large, visible veins.

    Bed making? Are you kidding? We don't even put sheets on our beds. A lift and a chux.

    Something is off.
  12. by   RNNPICU
    For starters, Starting an IV is not really a part of nursing. I have been a nurse for over 12 years and have never successfully started an IV. I just don't have it in my skill set. I don't even feel bad. I have good assessment skills though, which is absolutely a nursing skill. I know plenty of people who are not a Nurse who start IVs. Second, priming tubing without getting air in it takes practice. Blood draws, mostly in my hospital it is done by phlebotomists. If a patient has a PICC, central line, Arterial line, or Broviak, yes, it is nursing responsibility, but that takes several times of practice to get it just right and learning what to do when it is sluggish.
  13. by   JKL33
    These are the same people who had one person doing compressions for nearly 30 minutes; that's how they work a code.

    Sounds like they fly by the seat of their pants. And aren't familiar with new grads.

  14. by   LibraNurse27
    I don't know how a hospital can expect a brand new nurse to start an IV... maybe on a young, healthy, well-hydrated man in his 30s with huge veins... aka no one you will ever find in the ICU! It takes time and practice (and many failed IV attempts!) to become proficient. Even after years of starting IVs on sick, dehydrated IV drug users I have days (and weeks) were I can't seem to find a vein and have to call for help. As stated above lab draws are usually done by phlebotomists unless it's from a CVC. And I don't know how you can make a bed wrong unless they still believe in hospital corners or something. The point of a new grad program is to train new nurses. You sound very diligent and hard working and passionate about being a nurse. Sounds like they made a mistake letting you go or they don't understand how a new grad program works. If you are truly interested in psych give it a shot! Don't let people tell you every new nurse has to try Med/Surg, ICU, etc. If your long-term interest is in psych start learning the skills necessary to succeed in psych... why stress over IVs and bed making if your goal is Psych NP? just my 2 cents and good luck! You sound really nice