New Grad RN Going Into Psych

CAguyinMO · Apr 30, 2011

I have greatly enjoyed reading this thread. I can relate, in many respects, with the original poster. I am a *relatively* new-grad RN. I went straight from nursing school into an extremely high-acuity ER/trauma center. The experience I have gained over the last months has been incredible and invaluable. In many ways, I love the ER.

Still, I always knew in nursing school that I would likely end up working in psych (it was the only class in school where I read the entire textbook cover to cover). It just fascinates me. The great news is that last week I was offered a staff RN position on an acute-adult psych unit at a sister hospital within my company (a very large hospital chain based in St. Louis). What's got me posting here is that 2 days after I was offered the acute psych job I mentioned above, I was called back by the internal recruiter and asked if I would consider a day charge-nurse position on the intermediate psych unit of this hospital. While I am a relatively new RN, I have extensive management and leadership experience, prior to nursing school, at Disney and General Motors. The psych leadership at this hospital felt like I could succeed as a new charge nurse, without any psych background, because of my experience prior to nursing school.

Thus far, my reaction has been very tentative and non-committal. I am pretty leery of going into a charge nurse position with no experience in that particular area. My question here is simple: Am I being foolish to not seriously consider this opportunity?

Whispera, MSN, RN · Apr 30, 2011

To CAGuyinMO and anyone else inclined to read all these following words:

Charge nurse already....That is a bit of a setup for trouble or at least some bigtime stress, in my opinion.

First, you have no experience with the chaos that can develop on an acute-adult unit, and staff will be coming to you for decisions on what to do. Would you know what to do? You would be expected to know what to do. Higher-ups than you would expect it, and you might not have anyone to ask for help in such situations, depending on what THEY know about such things.

You might have management experience, but that doesn't necessarily mean you would succeed NOW as charge nurse. What is their definition of charge nurse? Is it someone who is first-nurse on the shift he works or is it nurse manager? Big difference!

Second, those who have been there awhile could have the feeling, "why him and not me...I've been here 99 years and they hire a STRANGER??" That could be difficult to overcome. You could be frozen out a bit. It takes time to get into the clique and I think at times it's more difficult in psych than other specialties. In psych we depend on our co-workers to protect our lives sometimes, not just the lives of our patients. We develop strong bonds with our peers. Would you have peers if you're the charge nurse right away without having time to become part of the clique?

I'd wonder why they aren't offering the job to someone who already works there. Is this an indication that there's something going on that's troublesome? It's a red flag to me.

Can you job shadow a bit and see what happens there before you say yes to the charge nurse position? How ample an orientation would you be given, both to psych nursing and to the charge nurse position?

When I graduated from nursing school, I worked full time evenings on an intermediate care adult psych unit in a hospital that had that unit, an ICU-psych unit, and a chemical dependency unit. I had been a behavioral health tech for 2 years on this unit before graduating, so I had some experience. I was charge nurse most of the time. I was the ONLY nurse and the only staff person if there were 8 or fewer patients. Higher-ups and social services went home at 5. Everything was my responsibility. Sure, there were staff people on the other two units, but they were past locked doors, and busy with their own work and chaos.

Here are a couple of things that happened on my watch. One time two patients tried to kill themselves at one time. Another time patients TP'd the nursing station while one of them had me occupied in a conversation in the day room (they had it planned before doing it). The first happening was TERRIBLE even though both patients weren't able to complete their plan. The second was both funny and frustratingly irritating. Both happenings were signs that there needed to be more staff there.

So, let's say I had been charge nurse and other staff had been around. It wouldn't have been quite so bad for me, but I'm sure other staff would have wanted me in the mix of things, and would have counted on me to do what needed to be done, and to tell them what to do...not everyone of course, since many just jump into effective action automatically, but the newbies and those who weren't quite "there" yet would need someone to take "charge."

I faced the attitude of others when I was charge nurse right out of nursing school. It was probably easier because they knew me, but it was still there. It actually never went away totally. You know how you hear the gossip about things? I heard about it through the grapevine quite often.

Will you know what to do? Will you be able to be leader of the team because the others accept you as part of the team? Will it be an uphill battle? Are you willing to do the hard march uphill?

All that being said, it's doable. I did it. I'm generally a wimp too, so if I can do it, many can. You just have to get used to some things as you get through the learning curve and get into the clique.

Best wishes to you. Feel free to PM me if you want.

gnursjr2 · Apr 30, 2011

My first job was on a Psych Unit, with one week orientation, with a preceptor who was angry because they gave me a day position that she had wanted, so she made my orientation and un-orientation. I don't know how I made it, but I ended up being very well respected by my peers and the Psychiatrists. I also discovered how much I truly love working in Psych, it's really my thing, and I've been told I'm great at it by my co-workers and the managment. These days many private hospitals give you very minimal so-called orientation. You just have to give it your all, show up to work early, be polite, be open to learning anything they throw at you. Please, document everything in your notes, regarding anything that happens with a patient, because you will learn that your co-workers, and managment will throw you under the bus fast, it anything goes down. Don't ever think they will back you up! Good Luck.

CAguyinMO · Apr 30, 2011

Whispera and Gnursjr2......I greatly appreciate your insight and comments. Whispera,you've kind of confirmed and supported what I've been thinking.

I should add a couple of things. First, my ER has an incredibly high number of very acute (mostly suicidal) psych patients passing through it. For the first 4 months I was in the ER, I worked the psych hall about a third of my shifts, because I liked it so much and because most of my ER colleagues don't like it. For the last month, since I've decided to move into psych nursing, I've worked the psych hall exclusively while I'm on duty in the ER. So I do have *some* experience working with psych patients in a highly acute crisis....but still, it's not the same as working on a psych unit, and I realize that. In addition, the unit I've been offered the charge nurse position on would be a 22-bed intermediate/geriatric psych unit....acuity's not quite as high. It doesn't mean it would necessarily be any easier (in fact, in some ways it could be just as difficult), but it may be a little more stable in terms of what goes down. If I decided not to take the charge nurse position and instead went to the acute adult unit, it would be on the same floor....just another part of the floor.

I'm due to go back to the unit on Tuesday and meet with the clinical director and nurse manager of the unit, as well as with some of the charge nurses for both the intermediate and adult sides. I'm not ruling anything out, but at this point it's hard for me to envision stepping into this role right now. For one thing, after 7 months in the ER as a new nurse, I could NEVER, EVER envision or being anywhere near ready to step into a charge nurse role. There's just so much clinical knowledge needed, and I have maybe 25-30% of that knowledge, at most. How, I think to myself, could it really be any different, despite being in a psych setting?

The only thing left to add is that the clinical director and the nurse manager of the psych unit at this hospital are both new to their roles. They both are extremely well regarded within my company, and I immediately clicked with them when I met them last week. I trust their judgment. I still have a lot of doubts about whether a charge nurse role is right for me at this time. I'll let you all know how it shakes out in the next week.

Thanks again for your input and insight. So appreciated!

Don

almost entirely now, I work the psych hall in our ER because I like it so much and because (now) I'm moving into psych and I want the experien

mustangmona · Jun 20, 2011

AngeloRN where are you located? What you described sounds exactly like the place I am currently working out and let me tell you, there is no 4 days of shadowing a nurse unless your are working during the week. I work the weekends and shadowed a nurse for 2 days and I'm still trying to figure things out.

I wish you the best!

Whispera, MSN, RN · Jun 20, 2011

I see I already posted on this, but the thread only went so far when I just read it. Since I took the time to write, here are today's thoughts. Silly me!

Hi Angelo, and welcome to psych nursing!

Dave pretty much described night shift psych nursing as I've seen it. I've worked it a few places, along with working the other two shifts. It's definitely a feast or famine job. If only the two could be blended!

I have trouble with a new grad being hired as charge nurse on a psych unit, unless there are other people around who can QUICKLY come help the charge nurse. Will there be such people near you? Shoot, I have trouble with anyone being charge nurse on a psych unit unless there are other people nearby who can come quickly!

Sometimes on night psych, the RN is the only staff person on the unit, depending on how many patients there are. Sometimes there are other people nearby, on another unit, but they can't come quickly, or you have no way of letting them know you need help. This is not safe. I hope you're not in that situation.

Please don't take this personally, because I don't know you or how much you know or what other life experience and personality you'll bring to the job: I've taught psych clinicals for almost 2 decades at 2 big 10 schools. I am also familiar with the course of study for psych clinicals at 3 other schools. There's not a single student I've met who would be capable of being charge nurse on a psych unit directly out of school. That includes me, and I did it. It was not a good idea. School just doesn't teach you what you need to know on psych any more than it teaches you what you need to know in any other specialty. The orientation you're being given doesn't seem like enough to me.

Night shifts on psych are quieter, yes, but when they're not quiet, their noise is blaring. It wouldn't be as big a learning curve on nights as it would be on days or evenings, to be charge nurse, but it would still have its moments. The amount and/or type of blare can be tied to what kind of unit you're working on, as well. Gero-psych is different than forensic is different than addictions is different that ICU-psych, is different than child/adolescent.

Pick the brains of those you'll be following. Find out if there's a reason why the person before you left, that you should know about. Watch how they interact with patients. Ask questions, questions, questions. I think it would be really valuable for you to have a few days of orientation on both days and evenings, as well as on the night shift. You'd see more action and learn how things happen and where things are! Your four days of orientation could be extremely quiet and you might not learn a thing about what to do in crisis.

Bring food. Bring caffeine (or know where to get them). Wear comfy shoes. Keep an open mind. Bring your psych text with you and in down time read up on the disorders and treatments. Remember that your patients are people just like all of us, only they have an illness. Treat them with honor and respect. And, as I always tell my students, have fun. It can really be awesomely interesting.

We're here for you. Lots of us have been there and can identify with what you're thinking and feeling.

By the way, I survived being thrown into being evening charge nurse after graduation. It wasn't always a walk in the park, but I made it and enjoyed lots of it immensely. If I can do it, lots of people can, even if my words made it seem like I was a doubtful-Whispera.

Whispera, MSN, RN · Jun 20, 2011

Angelo, since it's been awhile since you started this thread, how's it going?

Chaser, BSN, RN · Jun 23, 2011

I also was hired into an inpatient psych unit as a new grad. My situation is fairly similar, short orientation and then hit the ground runnning. I don't start for a couple weeks. I'm excited for it. I've got about 200 hours psych and my internship was in the icu. I also have 4 years as a security guard/bouncer manager. Our staff mix is 1 RN, 1 LPN, 2 uap for days and evening. Nights are 1 RN and 3 uap. I'll relate my experience once I start.

Chaser, BSN, RN · Jun 23, 2011

We also won't take anybody with medical comorbids except for DM, withdrawl, and well controlled chronic conditions.

cleback · Jun 30, 2011

OP:

I'd be cautious for several reasons:

1) That's a short orientation for any nursing position. Besides learning the basic unit routine, as a new grad, you'll be making that transition from student to RN. That's pretty big.

2) Night shift. You'll probably have a skeletal crew. I hope you'll have more seasoned RNs there to help you if there's an emergency (pts' BP tank, pts desat, become unresponsive, etc, beside become violent... and then you cant get an IV in, security refuses to come up, etc). Also remember, you'll probably be playing other professional roles like social worker, unit coordinator...

3) Charge nurses do a lot that isn't taught in nursing school... managing intake, handling staffing concerns, etc. A lot of extra administrative stuff.

That said, I know finding a job is tough right now. As long as you wouldn't be the only one there, I'd still go for it. Make sure you know basic procedures and resources for emergencies so you don't lose your license. Call the doc if you're on the fence about a pt. And don't beat yourself up if it doesn't work out.

PS I was a new grad, had two months' orientation, and then a week after orientation, was made charge nurse. It was stressful but I had help if only a phone call away. Today I feel I am stronger in my skills than some of the new grads that started on other shifts, without the responsibility of charge.

morecoffeepls, BSN, RN · Jul 7, 2011

This was a very informative and entertaining thread. My situation is similar to that of the original poster, but the circumstances seem fairly disparate. I was hired as the lone/charge nurse on a 14-bed inpatient psychiatric unit right out of school. However, I would have to admit that being a large adult male and having been on the unit as a student for a clinical rotation may have made their decision to hire me a little easier. I oriented on all shifts forever (4 months maybe?), and although it seemed to be too long and they would have continued my orientation if I hadn't asked them politely to end it, I am positive in reflection that I benefited from it. Also, my employers and co-workers may have gained some insight into my character and work ethic and ability to be left alone with a single Mental Health Worker overnight. I love my unit, and enjoy the advantages of working nights. There are times when I miss interacting with the collective patient population in certain regards, but there are also instances when I can communicate with a patient overnight on a one-to-one basis which other nurses may not have the opportunity to do, and these moments of being an "authentic presence" are invaluable. The down-time is great, and has enabled me to pursue my BSN and work full-time while raising a family. The nights when I get 3 admissions and the entire current population is awake and needy and I don't have time to eat lunch make me feel less guilty about taking advantage of slow nights. I love my unit and my job, and I actually bought out a tuition contract in order to work here. In retrospect, I feel I made a very good decision. Also, I didn't realize I wanted to not be a nurse anesthetist but be a psych nurse instead until I had done a few psych rotations. Once I suspected that this was my calling, going straight into psych and forgoing the suggested 2 years in med-surg was something that I don't regret at all. Finally, the charge and shift differentials don't hurt one bit.

flaper · Jul 19, 2011

does anyone in this thread have feeling regarding getting "stuck" in psyche nurse position? I have been working in an intermediate-psyche(we do IVs, caths, and some minor wound care) floor ever since i graduated from nursing school in may 2010. I love the floor and my manager but i really want to try other types of nursing. does anyone feel this just a hopeless cause? Sorry if this post deviates from the original question posted but i just really wanted to get the pulse of the people who posted here. Thanks DW!