Removed from Nurse Residency Program-Should I Try Psych?

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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.

I tend to agree with you. I got a two-degrees-below-lukewarm reception from the beginning and it just went downhill from there. I tried being friendly, offering my help to other nurses (almost always turned down), joining in general conversations (which often was met with "just focus on what you're doing.") so I just gave up, kept my mouth shut and kept to myself. There were a few people who were very helpful and supportive, but the atmosphere wasn't great.

I will say, though, that the main issue anyone ever pointed out to me was my basic lack of skills. It seems I was always choosing between doing a task right or doing it fast. All this while trying to focus on my patient as a human being. I always chose to do the task right and got many complaints about my lack of speed.

In the long run, you may find out that they were doing you favor by letting you go early. They just gave some bs answer because they did not want to be sued. I have seen it played out myself in real life where they give some politically correct answer in order to avoid backlash. Sometimes the facility had genuine concerns about the employee skills and some it was because the employee could not get accustomed to the unit culture aka fit in.

I'm wondering how all these schools keep operating without even covering basic clinical skills.

They're all about the NCLEX pass rate. In retrospect, that is a big red flag.

Specializes in Critical care.
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.

No, that's not true. The whole point on ABSN program is for a non-nurse to earn their nursing degree. I attended an ABSN program and I'm working on the floor. Working on the floor was always my plan. I'm starting to plan for working off the floor, but that has nothing to do with my attending an ABSN program instead of a traditional ASN or BSN program. I know plenty who went the traditional route and applied to grad programs sooner than me. I haven't applied to any grad programs yet and my original plan was to work on the floor for many many years before going back to school. I love working at the bedside, but unfortunately I was hurt in an accident and have a lot of pain from that some days.

OP: I agree with others that they just made up an excuse. I'm in the ICU and I'm ok with blood draws and really stink with IVs. My nursing school didn't allow anyone to do blood draws or IVs. I attended an ABSN program, but my university has a very well respected traditional BSN program too. My first nursing job had dedicated staff for labs and IVs. The type of IV tubing my first facility used took me awhile to get the hang of- it was totally different from the tubing we practiced with in school and that I saw/used in clinical.

Don't let this one facility get to you. Go where you want to. Best of luck!

Once you go psych, you won't WANT to go back.

I used to work on a medical floor for 12 years or so and now so work in psych. My stress level is almost zero. I leave on time. I get paid the same as I used to. I have never needed a mental health day off. Maybe it's just the place I work at is unusually awesome, I don't know. But this was my experience.

BTW when I graduated we weren't taught hands on skills either. We watched a video on how to start IV's. We practiced foley insertion on a mannequin. And this was no problem with my first nursing job on a medical floor.

I tend to agree with you. I got a two-degrees-below-lukewarm reception from the beginning and it just went downhill from there. I tried being friendly, offering my help to other nurses (almost always turned down), joining in general conversations (which often was met with "just focus on what you're doing.") so I just gave up, kept my mouth shut and kept to myself. There were a few people who were very helpful and supportive, but the atmosphere wasn't great.

I just want you to know that I looked up this thread today, while on my break at work. A coworker saw the headline, and that started a discussion. Thank you for that.

This is the same old psych nurses "are not real nurses" debate that has gone on...forever.

You may have strong nursing skills for the psychiatric population. Apply and see what happens?

Specializes in Addictions, psych, corrections, transfers.

My goodness, I'm so sorry this was your experience because what it sounds like is that you were doing everything you could to improve yourself. As a lead nurse I would have never fired you knowing that you were trying this hard, I would had you shadow some more and just given you more support. It sounds like it was their loss because they just let go of a passionate, dedicated nurse. You sound like a very good nurse, you just needed some practice, and don't we all when we are new. Psych would be great for you, especially if they do blood draws, because it will give you some practice without so much pressure. Have you tried looking into shadowing in a phlebotomy department. I had a nurse friend who did this and it helped her immensely. Also sorry about your the subpar education you received.

A trauma SICU is a difficult jump for nurses with experience, so I wouldn't be hard on yourself for it not working out. They knew you were brand new, so I'm wondering what they expected, especially in such a short period of time. Kind of ridiculous if you ask me. If they wanted someone to run out the gate they shouldn't have hired a new grad. At least the manager is being decent to you during this process and will write a letter of recommendation.

Anyhow, in the past I would have said go to the floor somewhere to get basic nursing skills first, but after years of misery I say if you want to do psych then do what you want to do and see how it goes.

Best of luck in what you decide.

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.

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.

your first comment was In line with what I was thinking. and I wonder if your preceptor is friends with the that nurse? I think you were the units back up plan if the nurse did not come back.

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.

perhaps you should mention this to your school. just to give them a heads up. and,, placing IVs and drawing blood are not basic nursing functions, and are commonly not taught in school.

Specializes in Nephrology, Cardiology, ER, ICU.

Moved to first year after nursing licensure

Specializes in Med-Tele; ED; ICU.
When someone enters an accelerated BSN program, it's usually to get OFF the floor not ON.

In my experience, it generally to get ON to the floor more quickly...

I graduated valedictorian yet had never drawn blood or started an IV. I didn't even know how to hang a piggyback lol. Thankfully my new grad program gave us 10 weeks with a preceptor so I was able to develop some skills. The only way a new grad learns is by doing the skill over and over. If your unit wanted someone who already knew basic skills, they shouldn't have hired a new grad. I wouldn't be hard on yourself at all, you seem like a dedicated nurse with great potential. Just my opinion obviously, but I don't think the ICU is a good place for a new grad. I wouldn't have made it either.

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