New grad - best place to start?

[Rionoir, ADN, RN]

I'm graduating in a few weeks and am interested in working towards being a psychiatric NP. Most of the hospitals behavioral health nursing positions seem to require at least a year of "clinical experience". There is a behavioral health hospital that does hire new grads though, and I have an interview with them next week for a residential adolescent OCD/Anxiety program. I am already a nurse extern at a hospital on a med-tele floor and they are more than willing to hire me on when I graduate.

My question: Is there any reason to do a year of med-surg (or some other medical type experience) before going into behavioral health? Also is the adolescent OCD/Anxiety program too specific of a place to be starting out?

[Neo Soldier, BSN, RN]

If being a psych NP is ultimately what you want, then you may benefit from getting a psych job at least to gain the one year psych experience so that you can be eligible for the np programs. Most people tell new grads to get their year of med surg which is not bad advice if you intend to stay in the medical side of nursing. You could start off in med surg and have a part time psych job. For new grads, hospitals may likely hire you as a full time staff. Congrats on almost graduating.

[Lurkndmurk, ADN, RN]

There is no reason IMO to do medsurg IF psych is where you want to be. When I was a new grad, i went straight into psych. No regrets.. A lot of my co-workers NEVER went to medsurg, & if they floated there because of necessity-- they absolutely hated it lol. If you want, you could always do a year of medsurg because apparently it can only be beneficial.. but personally, if you know where you want to be, i dont see why you should delay going there.

[Rionoir, ADN, RN]

5 hours ago, Lurkndmurk said:

There is no reason IMO to do medsurg IF psych is where you want to be. When I was a new grad, i went straight into psych. No regrets.. A lot of my co-workers NEVER went to medsurg, & if they floated there because of necessity-- they absolutely hated it lol. If you want, you could always do a year of medsurg because apparently it can only be beneficial.. but personally, if you know where you want to be, i dont see why you should delay going there.

I actually enjoy med surg (all my clinical rotations for that matter) but it’s just not where I see myself... my psych rotation was amazing and we couldn’t even do that much as students. I have this feeling like I’m going to lose so much of what I learned the last couple years by going into psych right away though - did you guys ever have that feeling?

[penelopelp]

There is no reason to do a med surg rotation. I would just be careful with getting a job at an RTC. I would make sure that it is a good one. I know some people who had trouble at RTCs due to poor staffing ratios and unsafe conditions.

[Rionoir, ADN, RN]

4 hours ago, penelopelp said:

There is no reason to do a med surg rotation. I would just be careful with getting a job at an RTC. I would make sure that it is a good one. I know some people who had trouble at RTCs due to poor staffing ratios and unsafe conditions.

The RTC facility is amazing but you are absolutely right too I have heard they have trouble staying staffed - but I also have a couple classmates that work there and both absolutely love it and it doesn’t seem like it’s to the point of being unsafe. I applied for a position at the psychiatric hospital run by the org I am externing at though and they gave me an interview next week so I am excited about that, wasn’t sure I’d qualify.

[penelopelp]

I’m glad to hear it is a good RTC. Congrats on the interview. That’s exciting!!

[Lurkndmurk, ADN, RN]

On 11/7/2019 at 8:11 PM, Rionoir said:

I actually enjoy med surg (all my clinical rotations for that matter) but it’s just not where I see myself... my psych rotation was amazing and we couldn’t even do that much as students. I have this feeling like I’m going to lose so much of what I learned the last couple years by going into psych right away though - did you guys ever have that feeling?

nope because we knew what we wanted psych. There's not reason to worry about "what you will lose" when you don't need it anyway in the area you want to pursue.

[Rionoir, ADN, RN]

Ok so I had some interviews and they all went great, but now I’m wondering if these inpatient facilities are all 80% detox and only 20% or so actual psych patients or? I mean learning withdrawal protocols is good experience and all but I felt a little meh I guess. Loved the facilities and the staff though. Maybe it was just hard to get a good feel for it with a short shadow experience?

[penelopelp]

Detox units are different because of the medical treatment. I work on an inpatient psych unit and we don’t have detox patients. Yea, we have patients who could be having withdrawals and they are on COWS or CIWA protocol. However, for medical detox, they would need to go somewhere else. Detox would be good experience, but it’s not somewhere I’d want to work for any length of time. Maybe that’s just where the new grad jobs are in your area? I think those units often have high turnover, so they might be more willing to take new grads.

[Rionoir, ADN, RN]

This is the actual psychiatric hospital that my organization runs - they don't even have medical at that location. Anyone who gets to the point they need medical gets shipped off to the main hospital. Like I said though they just have all the patients combined on the adult unit. The main hospital (which is where I work now) apparently used to have inpatient psych but doesn't anymore. That's just within my organization though - I've got an interview with the county facility and with one other inpatient facility later in the week that I know has things more separated. I'm interviewing for an adolescent OCD/anxiety residential unit, which I'm kind of excited about. I was just curious if that was normal or not, so apparently not. lol

All the psych places around here are hurting for RNs I've realized - the county facility has a $7500 sign-on bonus. It's just going to be a matter of choosing the best route for me at this point.

[penelopelp]

I’ve only had experience in a couple of states so I can only speak to what I’ve seen. Of course substance abuse and psychiatric illnesses goes hand in hand. We have a lot of patients with substance abuse disorders. We’re just not considered a detox unit, if that makes sense. Out patients have been admitted because they are a danger to themselves or others. So generally they are suicidal or homicidal or they have increased aggression. Once they are stabilized, some of them do go to substance abuse treatment.

I personally enjoy working with adolescents. They are very challenging, but they can also be a lot of fun. You definitely have to have a sense of humor!