Removed from Nurse Residency Program-Should I Try Psych?

Nurses New Nurse

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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.

Specializes in Community Health, Med/Surg, ICU Stepdown.

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

Specializes in NICU.

See you can deduct there is more than one way to skin a cat.Many different experiences here from school programs.In my day IV certification took place on the job,but you really had to already know how to maintain an iv and monitor the site.Not everyone puts ivs in.I love it and the harder the better.So it is not a job requirement.As for priming tubing it depends on the brand being used,learn to read the insert with the mfg instructions,very helpful,and you would be doing it correctly.

Charting,why did that become a problem?

If you are an NP you take a course on deep lines ,insertion but you better know how to monitor them because no one is around to do that but you.

Bed making, how silly,your school should have made sure you knew how to do it and keep patient comfortable especially in ICUs where they are RN only units.

Your ex employer is not making sense.

If you are leaning toward psych then go that way ,why are you worrying about needing to go back on the hospital floors?Only the future will tell.Tomorrow is promised to no one.

Specializes in M/S, LTC, home care, corrections and psych.

LPN courses give much better floor training than BSN programs. When someone enters an accelerated BSN program, it's usually to get OFF the floor not ON.

Specializes in M/S, LTC, home care, corrections and psych.

Good question. I learned so much more in my LPN program than I did in the LPN-RN program. The bridge program didn't even have a pharm course "because they didn't have time to fit it it"!!!

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?

I've thought of that as well. The position I was supposed to fill is not posted on the website and I noticed that there's a new nurse on that shift--someone who returned from medical leave. Poor business move on their part, though. They put a lot of resources into me--just in the training program.

You touched on my biggest fear--that maybe I'm just not cut out to be a nurse. If that's the case, $50K down the drain. In life in general, I make connections pretty quickly and have good critical thinking skills; however, on the floor, I had many experiences in which, I didn't know what I didn't know. This was the impetus for all of my self-study. When I came back to the floor to report the things I had learned, my preceptor actually said that I should stop studying and work on basics.

Which brings me to another point, preceptor could be difficult. While a great nurse, she didn't seem to like me (or anyone on the floor) very much. She was bitter in general. At my last meeting, floor manager said she wished I had come to her earlier with my concerns. I wish I had as well. I was raised to believe that you keep your head down, do your work, and don't complain. I may have to rethink that.

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

Hppy

My concern as well. That was the reason that I didn't consider going into psych right out of school.

Thanks. That's encouraging. In psych, did you get to interact with the patients, or was it just passing meds most of the time?

Many thanks to all of you for your thoughts.

I want to believe that everything happens for a reason and there's something better around the next corner, but I can't get rid of this feeling that I've failed and maybe nursing just isn't for me. Very humbling experience. The reality is that I've invested much into this career and I have to just move forward, for my family as well as myself.

I'll take all of your suggestions into consideration and try to formulate a plan for the immediate future.

Specializes in Surgical, Home Infusions, HVU, PCU, Neuro.
Many thanks to all of you for your thoughts.

I want to believe that everything happens for a reason and there's something better around the next corner, but I can't get rid of this feeling that I've failed and maybe nursing just isn't for me. Very humbling experience. The reality is that I've invested much into this career and I have to just move forward, for my family as well as myself.

I'll take all of your suggestions into consideration and try to formulate a plan for the immediate future.

Oh my heart hurts for you! *HUGS* Please do not think for one instant that you are not meant to be a nurse because a new grad residency program FAILED YOU, not the other way around, do not forget that! Perhaps it has been a while that those in charge of teaching and training a new nurse has somehow forgotten their first stent at being a new nurse, because I can almost bet they was all not stellar at IV starts, priming tubing and making a dad gum bed (seriously??). IV 's take time to master and some don't get it done to be an IV bad A@@, and that's ok. Nursing is a team effort and most places will be more than happy to assist you with your areas and you assist with theirs.

Don't give up, your next preceptor, if things are not meshing, speak up if you need to. If you get on in another hospital, ask if you can work a couple shifts in same day surgery to get IV practice if you need too. Most places I have experienced are more than willing to help you learn and grow. My residency let me go in on an open heart because I told them I always had wanted to see one. ( coolest thing ever, the surgeon, perfusionist and CRNA was amazing all showing and explaining things to me as they went)

Best wishes on your job hunt, everything happens for a reason, make this detour lead you to a path your heart guides you too and make the most of every moment!

Specializes in orthopedic/trauma, Informatics, diabetes.

I work in a large level 1 teaching hosp. I don't start IVs or do phlebotomy. Ortho floor

Oh my heart hurts for you! *HUGS* Please do not think for one instant that you are not meant to be a nurse because a new grad residency program FAILED YOU, not the other way around, do not forget that! Perhaps it has been a while that those in charge of teaching and training a new nurse has somehow forgotten their first stent at being a new nurse, because I can almost bet they was all not stellar at IV starts, priming tubing and making a dad gum bed (seriously??). IV 's take time to master and some don't get it done to be an IV bad A@@, and that's ok. Nursing is a team effort and most places will be more than happy to assist you with your areas and you assist with theirs.

Don't give up, your next preceptor, if things are not meshing, speak up if you need to. If you get on in another hospital, ask if you can work a couple shifts in same day surgery to get IV practice if you need too. Most places I have experienced are more than willing to help you learn and grow. My residency let me go in on an open heart because I told them I always had wanted to see one. ( coolest thing ever, the surgeon, perfusionist and CRNA was amazing all showing and explaining things to me as they went)

Best wishes on your job hunt, everything happens for a reason, make this detour lead you to a path your heart guides you too and make the most of every moment!

Wow! Thanks so much. Admittedly, my confidence is shaken. I'm going to live your words today.

Thanks. That's encouraging. In psych, did you get to interact with the patients, or was it just passing meds most of the time?

I interacted with patients all the time.

Some nights, it was just me and a tech on the locked unit, so that I did all assessments and passed medications, and did admissions.

But I worked for a UHS facility, which isn't something I would recommend.

They aren't safe.

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