New Grad RN Going Into Psych

Davey Do · Nov 26, 2010

AngeloRN:

Congratulations on your new position.

As a "new grad RN" I am going to assume that you are okay with not using a lot of your Medical skills. (Unless you'll be working Gero-Psych.) If you are okay with that, then know that your job will test your ability to: Stay Awake. Deal with Sleep Deprivation. Perform Routine and Mundane Tasks.(e.g. MARS Reconcilliation, Chart Stuffing, etc.) Administer Some Medications. Do Admissions. Exprience Long Spells of Inactivity. Followed by More of the Same. Then, when everything seems calm, you will experience A Psychotic Acting Out Client with Insomnia.

The Status is usually Famine. But sometimes, you Feast.

A working knowledge of: Dopamine Antagonist Antipsychotics, Antianxieties (both Contolled and Non-Controlled Substances), other Benzodiazepines, Relaxation Techniques, Comfort Measures, and Sundowners Syndrome is good to have.

Pursuing An Interest (e.g. Nursing) is sometimes possible on the MN Shift. AN.com is a good place to Visit, Gain Information, and Communicate With Like Souls.

Actually, I love my Current Position. I work MN's EVERY Weekend and EVERY Holiday. I live in the Woodwork. However, for years I worked in the Cutting Edge Mainstream. Been There. Did That. Bought the T-Shirt. Will Return PRN.

Oh yeah- make sure Rounds are made. Especially if your Unit has Video Monitoring. And your Boss has nothing better to do than sit at home watching you on her home tap-in.

The best to you in your new position, AngeloRN!

Dave

elkpark · Nov 26, 2010

I have to say that a psych facility hiring a new grad to charge on nights is a really bad sign, IMO. Esp. with such minimal orientation. I realize jobs are hard to find these days, but this organization is not doing you any favor. A place that will put a new grad in this position will not hesitate to leave you to dangle in the wind the first time anything goes wrong.

Are there going to be other, more experienced RNs in the building and available to you for questions, etc., when you're working?

I hope that you have your own professional liability (malpractice) insurance. I would certainly recommend it if you don't carry it already. Best wishes --

Davey Do · Nov 27, 2010

I have to say that a psych facility hiring a new grad to charge on nights is a really bad sign, IMO. Esp. with such minimal orientation... A place that will put a new grad in this position will not hesitate to leave you to dangle in the wind the first time anything goes wrong.-

With all due respect, elkpark (and I do respect your opinion, noting your tenure and having read several of your posts), but I have to beg to differ.

Beiing an RN in charge on a Psych Unit on MNs is not the same thing as being First Scrub on a Lumbar Laminectomy. (I wanted to compare it to an experience in Nursing rather than Astrophysics: Rocket Science.)

Point in Fact: The Institution I work for recently hired a New Grad RN , as THE RN on MN'S for the Adult Psych Unit. Now, this is a high acuity/admissions unit. EVERYONE, including me, believed she was going to fall flat on her face and leave her assigned post, screaming and crying, incotinent of urine.

Not so! She has excelled at her position and has gained the respect of her Co-workers and Peers. Not to mention Patients.

You do make a very good point, however, elkpark: As the book Meditations for Managers noted, "Contacts are gold". Yes! To have Seasoned Ones as Guides is very important. At the Institution I work at, the MN shift is VERY tight, and we constantly communicate with each other. Having Resources can result in a feeling of needed security.

I do not wish to over-ride your areas of concerns, elkpark. You made some valid statements.

But, with that said, my vote goes to you experiencing an opportunity to hit the ground running and to shine, AngeloRN. Good luck to you!

Dave

elkpark · Nov 28, 2010

Point in Fact: The Institution I work for recently hired a New Grad RN , as THE RN on MN'S for the Adult Psych Unit. Now, this is a high acuity/admissions unit. EVERYONE, including me, believed she was going to fall flat on her face and leave her assigned post, screaming and crying, incotinent of urine.
Not so! She has excelled at her position and has gained the respect of her Co-workers and Peers. Not to mention Patients.

I'm v. glad that things worked out well for the one RN you describe. However, I have seen many new grad RNs hired into psych positions by administrators who didn't know better or didn't care, those same RNs put into situations where they were being set up to fail, and then being blamed and scapegoated by the adminstration when something turned out badly (entirely predictable). A really crummy way to start out a new career ...

I'm not sure what the point of the comparison to "first scrub on a lumbar laminectomy" is -- you're right, though, the two roles are entirely different. The first scrub on a lumbar laminectomy would never be in the position of having to make solo life-or-death decisions, which can be the case at any time for a night shift charge nurse in psych, if s/he is the only RN there.

A new grad hired to be charge on nights with only six days of orientation is a BIG red flag for me. OP, I'm v. serious when I say that I hope you have your own liability coverage. Best wishes.

macfar28 · Nov 28, 2010

I completely agree with elkpark. I am suspicious of any facility that provides such little orientation for any nurse joining its organization, especially a new grad.

Davey Do · Nov 28, 2010

The proof will be, as they say, in the pudding.

GooeyRN, ADN, BSN, CNA, LPN, RN · Nov 28, 2010

I think a new grad requires more orientation than 4 days on the floor. :eek: I started out psych right away and being "charge" on nights (only nurse on the unit- had a tech with me) It was doable- there was a supervisor I could call if I had a problem. BUT I also had a full 2 weeks orientation. (10 days)

Jules A, MSN · Dec 3, 2010

I also started as a new grad as the only nurse on the unit in psych after 2 weeks orietation. It was ok for me. There were nurses on other units if I really needed input. Frankly I'm a bit skeptical of the trend lately for 6 month orientations with more time if the person doesn't "feel ready" and imo have worked with a few very ill prepared new grads.

Meriwhen, ASN, BSN, MSN, RN · Dec 3, 2010

I started as a new grad in psych but I had a month of orientation. I won't deny it was a steep learning curve, but I survived and flourished. I always kept in mind what my limitations were and learned to not try to be "SuperNewGrad" and instead ask for help if I needed it. And help was always there when I asked...it didn't always arrive as quickly as I liked but it was there.

I'm also a little wary of your short orientation time, Angelo. If you'll be the only nurse in the building from 11p-7a, run and don't look back. But if you have other nurses there to help you and if you feel comfortable taking this job on, then go for it. Ask for help as much and as often as you need to. Do outside reading to brush up on psych and the skills you'll need. And definitely keep your own malpractice insurance: if anything happens, you'll be the first one thrown under the bus.

Good luck.

sarmedic70 · Dec 18, 2010

I, too, have to agree with Elkpark. When I read that new grad's post, I shuttered. Having worked psych for quite awhile, in a major psych hospital, and on one of the most violent and active units of the hospital........and being an experienced RN (med-surg, et al) and also currently still working EMS (medic/RN), that reading from the newly grad RN.............I am still somewhat shuttering.........I would seriously question that facility as well..........not to say anything against the newly graduated RN...........but to put somebody into that position in the first place as a newbie.............regardless...........Our facility puts all of our NEOs through an extensive orientation, and then orient them additionally on the units once nearly through the classroom portion (be they RNs/LPNs or psych techs. At our facility, due to the fact the jobs are very scare for newly graduated RNs, we have TONS of newly graduated RNs.........one of the differences is that many were either psych techs or LPNs working our facility prior to becoming RNs to they had a "leg up" overall. However, in some cases, some new RNs were hired right off the street, and it's been scary.............it's one thing to have to deal with psychiatric issues, but one really does need to be relatively strong in med-surg skills in that patients with psychiatric illness, due to medications or just poor individual care, will have medical issues. And one needs to be alert and able to discern between what is an actual medical issue or patient is simply being somatic. I have seen serious issues to where a patient, with a history of being very somatic, did not get the proper assessment for a possible medical issue and had a VERY serious medical issue as a result. I personally would not advocate (and I am no doubt going to get some angry respones on this) going into psych straight out of nursing school unless have already had experience working in psych as a psych tech or LPN, et al. Just saying...............Best of luck to you, AngeloRN. I do wish you well.............

MariaE_RN · Apr 22, 2011

I agree with ElkPark.

At the same time whenever I orient new RN's I always recommend that they get an acute setting experience so that they can polish their assessment and critical thinking skills... it's kinda scary to start Psych if you have no acute setting background -- I mean for the patients...

I wish you all the best...