Psych nurse for 5 mos...need advice

[Strwbrywne]

I accepted my first job on an inpatient psych unit about 5 months ago. Psychiatric nursing interests me and I am eager to learn. When I took this position, the hospital had just announced that it was just purchased by a larger hospital system. I was confident that this hospital would have opportunity and I could grow with an organization for many years to come. I was also confident that I would still be exposed to medical patients and utilize my clinical skills. (As told in my interview)

Right from the gates there were disappointments. I was told I would get 90 days of training/orientation, and was put on the schedule as a regular staff nurse 3 weeks later. I feel that I was just thrown in the position and hit the ground running. I guess this is pretty normal. We do have some medical patients on the floor, but honestly, we barely have an opportunity to do a psych assessment on the patients, let alone a nursing assessment. Sadly, most medical concerns are ignored. They are usually only addressed to "save your butt", so to speak. I don't agree with it and feel like I don't get support from other staff when I do have a medical concern.

Here are my concerns: I only work 2 days per week and 5 months later I still feel like I am struggling. I know that I am still a novice and it will take time to feel comfortable...BUT, my biggest complaint is not feeling as though I am getting mentored or support from the other nurses. Some nights I may have 12-17 patients ON MY OWN. This scares the crap out of me. I addressed this concern with my clinical manager and it was brushed off. I can assure you that most of the seasoned nurses don't know what's going on with their patients either. It's a mess on the unit and extremely unsafe. We have adolescents with geriatric patients, and throw a few sex offenders in there as well. There is no organization on our shift either. A new admission comes and it is just tossed to the nurse that happens to be in the nursing station...no rhyme or reason to assigning patient load. I feel like only working 2 nights a week is not enough to get comfortable and feel like I am learning and growing. Being in a disorganized, low morale floor doesn't help either.

So, here we are 5 months later and I feel like I haven't learned enough in that time frame, but am responsible. It's a scary and unsettling feeling. I continue to ask questions, but it is to the point that they look at me like, "You should know".

I'm not sure what I should do. I thought maybe I could throw my scenario out there for you all to read and provide feedback. Is this normal? Should I be feeling this way? I want to stick it out and I try to learn and absorb as much as I can. I also constantly read psychiatric nursing books for help/education. Although, I don't see any of our staff nurses utilizing these skills. (I'm just saying) Perhaps I should post for another position on a different floor. I don't want to lose my clinical skills, so maybe that would be an option. I also want to stick it out with the new "take over" because I think working for a larger hospital system has its advantages and I don't want to leave and not be able to come back. I don't want to make an rash decisions and not think them through.

I hope you all can provide some perspective. Thank You!

[elkpark]

Are you saying you have adolescents and geriatric clients on the same unit? Everywhere I've worked over the years (5 states), that's been illegal (mixing adults and minors on a unit).

Working part-time means you are not getting the experience and acclimation that you would if you were working full-time. So you don't really have "5 months" experience, you have around half that.

Unfortunately, like any other kind of healthcare setting, there are good and bad (and average :)) psych facilities, and good, bad, and average psychiatric nurses. I've worked (briefly) in some bad places, and I got out of them as quickly as possible. There are good psych facilities and lots of good psychiatric nurses "out there" -- but it sounds like you are in one of the not-so-good facilities. What happens in those places, in my experience, is that the good staff leave quickly and the people who stay are those who either can't get a job anywhere better or just don't care. Unfortunately, it's rare that one "good" nurse is able to elevate the standards of the nurses who don't care.

Do you have any other opportunities within the larger system of your new employer? If I were in the situation you describe, I would be looking hard for something else, and I would start with transferring within the system you're already in.

[Strwbrywne]

Thank you for your response. Yes, geriatric patients and adolescents are on the same floor. I know it is illegal and it surprises me that they are getting away with it. When I questioned it, I was told the adolescents are not allowed to be in the halls and must remain in their rooms. They are to come out for group and meals only. (How are the groups helping when the population is combined?- I have asked myself this question as well. And, they don't stay in their rooms, either. It's more of a formality.)

I see what you are saying about my experience and thank you for acknowledging that. That was precisely my point, but I guess I didn't explain it very well. My concern is I KNOW I don't have enough training, but just because I have been employed for 5 months, the staff thinks I SHOULD know....there is my frustration. They don't seem to take into consideration I am only there 2 days a week and there is still a huge learning curve. There is no mentoring or support.

I would like to stay with this hospital and post for another floor...but I need to wait a year before doing so.

Are you saying you have adolescents and geriatric clients on the same unit? Everywhere I've worked over the years (5 states), that's been illegal (mixing adults and minors on a unit).

Working part-time means you are not getting the experience and acclimation that you would if you were working full-time. So you don't really have "5 months" experience, you have around half that.

Unfortunately, like any other kind of healthcare setting, there are good and bad (and average :)) psych facilities, and good, bad, and average psychiatric nurses. I've worked (briefly) in some bad places, and I got out of them as quickly as possible. There are good psych facilities and lots of good psychiatric nurses "out there" -- but it sounds like you are in one of the not-so-good facilities. What happens in those places, in my experience, is that the good staff leave quickly and the people who stay are those who either can't get a job anywhere better or just don't care. Unfortunately, it's rare that one "good" nurse is able to elevate the standards of the nurses who don't care.

Do you have any other opportunities within the larger system of your new employer? If I were in the situation you describe, I would be looking hard for something else, and I would start with transferring within the system you're already in.

[marshmallowstar, BSN, RN]

Policy that states pts must stay in their rooms sounds very close to unwarranted seclusion to me. yikes. Can you speak with your manager that you don't feel comfortable with this and ask her to allow you to apply to another unit? Sometimes mangers can give HR the go ahead to wave those types of rules. Is the medical hospital better run than the psych unit? It would suck to bounce to another unit and want to leave there for mismanagement too. I would be very careful with a hospital that walks the tightrope with pt's rights.

[Strwbrywne]

I agree and it surprises me the hospital can get away with it. Thank you for the advice regarding talking to my manager. I'll be honest and tell you that I just want to lay low. I have already voiced my opinion about some of the safety concerns I have and other policies that I question. The senior nurses don't like to be questioned. I am not trying to ruffle feathers...I am trying to LEARN. It's more of wanting to do the right thing for the patients - and keep my license! I try hard to be very respectful when I communicate. Snide comments are made to my face and when the unit census is low, guess who is the first one who gets cut? I have come to the conclusion that I need to keep my mouth shut, keep patients safe, and make the best of it. I'm afraid if I go to my manager, I will just be looked at as a whistle blower. Sad, but true.

As far as the rest of the hospital, I have had the opportunity to float to some other floors just this past week (talk about perfect timing!). I have witnessed some pretty amazing team work and that gives me hope that I have better things in store for me.

Thanks for your response.

Policy that states pts must stay in their rooms sounds very close to unwarranted seclusion to me. yikes. Can you speak with your manager that you don't feel comfortable with this and ask her to allow you to apply to another unit? Sometimes mangers can give HR the go ahead to wave those types of rules. Is the medical hospital better run than the psych unit? It would suck to bounce to another unit and want to leave there for mismanagement too. I would be very careful with a hospital that walks the tightrope with pt's rights.

[Orca, ADN, ASN, RN]

First off, that patient load seems excessive if you are indeed working alone - not to mention unsafe. Mixing broadly different ages of patients is not a good idea either, and like others I have serious concerns about the legality of mixing adolescents and adults. Keeping the adolescents in their rooms except for meals seems more like jail than mental health treatment, and I believe that if they were sued over it they would be paying a very large settlement.

If I were in your spot, I would get out. If this facility is operating with that little regard for legality, proper orientation and safe levels of staffing, they aren't going to change just because you suggest it or express concerns. This place is a house of cards, and you don't want to be standing in it when it collapses.

[TerpGal02, ASN]

Um, I would RUN! It sounds like you've seen some good in other areas of the system, I would see if you can transfer. Are you saying the adults and adolescents are housed AND in group together? Just.......wow. My hospital does overflow older adolescents onto the adult unit (which I def have some qualms about), but they are overflowed to sleep there ONLY. We have a seperate adolescent hall with it's own dayroom and pretty much all day programming with the exception of sleeping time and quiet time and during those times the pts are expected to he in their rooms with doors shut (regardless of what hall their bed is on).

It just sounds totally disorganized and unsafe, not to mention that I really don't think it's possible for a new grad to develop any kind of proficiency working so few shifts. Go with your gut on this.

[mon00707]

I would try to find a different place to work if I were you because it does not sound like employer cares about the staff. I work in a private behavioral health setting and they are wonderful to work for and i have been here for 3 months and it was my first job out of nursing school. The director, other nurses, therapists here really try to work hard for the patients. Its a small unit and i only have 8 patients but there is only me and an aid on duty so I am basically a charge nurse. I had about 6 weeks of training then I was on my own. It was a bit of learning curve but the company really cares about the empoyees. You should be happy where you work and find some place who can treat the employees appropriately.