To accept or not accept offer?

[songbird_RN]

Hello Everybody! I recently graduated, passed NCLEX, and am now on the job hunt. I had my first interview with a psychiatric hospital and received a job offer on the spot. It is a night PRN position, no benefits or insurance. The nurse-to-patient ratio is 1:16 and I would be charge nurse (the only nurse unless we have over 16 patients) with 1 psych tech. Orientation would be 4 days along with 4 shifts of training. What concerns me is the high patient ratio and what seems like a rather short orientation/training. Is this the norm for psych? I also don't feel comfortable with the idea of being charge nurse so soon, especially as a new graduate with no other experience besides clinicals. Any feedback would be much appreciated!

[Jules A, MSN]

I'm no wuss and worked some hardcore units with poor staffing but this sounds ridiculous especially a new grad as the only nurse. My opinion would be if you really want psych keep looking there are better places out there.

[theRNJedi]

as a rule I generally encourage new grads to accept any nursing job they get offered; but there are exceptions, and your description of that specific job environment and responsibilities sounds like a red flag. Particularly in light of the fact that you are a new grad with no formal nursing experience. With no experienced RNs to work alongside and glean from, I would be concerned at how effective you would develop your skills and build your knowledge base. The employer sounds desperate and it sounds like a license risk. I would proceed with caution.

-theRNJedi

[ThePrincessBride, MSN, RN, NP]

That sounds like a disaster in the making...

New grads almost never start off in a PRN position. Usually, FT hours are needed in order to hone and master those RN skills, and they should never start off as charge. And four shifts of orientation?

There are just so many red flags, but if that is all you are being offered, you may want to take it. But...I don't know.

[Davey Do]

I am a "wuss", songbird RN. But I'm also a Naysayer and a Hatchetman. And I'm leaning toward agreeing with Jules.

Red Flags: New Grad, Four Shifts of Orientation, High Patient/Staff Ratio.

But you could check it out. You know- gain Empirical Knowledge and get Paid for Four Shifts of Orientation.

Who knows? You might just like the Place.

Good Luck to you, songbird RN.

Let us know how it all Turns Out.

[TheCommuter, BSN, RN]

Can you afford to turn your nose up at this offer?

I have worked psych in Texas (the OP's location), and have contended with nurse/patient ratios higher than 16. It is the norm in some areas.

[Jules A, MSN]

Can you afford to turn your nose up at this offer?

I have worked psych in Texas (the OP's location), and have contended with nurse/patient ratios higher than 16. It is the norm in some areas.

I have to ask: with a separate med nurse or without? I just can't imagine it as when I got above 12 on an inner city inpatient acute unit I was ready to be EPd.

[elkpark]

I've done 16:1 and even higher as the only nurse on nights in inpatient psych, but with more than one tech, and as an experienced psych RN, not a new grad.

As already noted, I think it is a really bad idea in general, regardless of ratios, acuity, specialty, etc., for new grads to start off on night shift as the only RN. New grads need to be working around other, experienced RNs to learn and grow professionally. Day or evening shift is better -- night shift can work, but not (IMO) if you're the only nurse.

Four days of orientation for a new grad is crazy, as is the facility offering you the job on the spot (I always consider that a big red flag that the facility is desperate). Intentionally or not, they are setting you up to fail. If you crash and burn in this position, they will just hire another warm body with a license and keep chugging along, but you only have you, and you need to be savvy about protecting your interests and future. Trust your instincts on this; it is a bad situation for you. My advice would be to keep looking for something better if you are not yet completely desperate for a job. Best wishes!

[Jules A, MSN]

Are there other psych units at that hospital that will have RNs you could consult with? What I can share just anecdotally is the three patients who passed away on units where I worked all died on night shift. We also had 2 babies born overnight.

[RatchedAfterMidnight, MSN, APRN]

I have been working psych in Texas (started in psych as a new grad). 1:16 nurse to patient ratio is not unheard of, but with that kind of ratio more techs are working the unit to make it manageable. Think about it, in the mental health community if there is a code/aggressive patient it throws off the balance of the whole unit. A code would be difficult for two staff members to manage, add in managing the cascading effect and it is impossible for two people to manage. For your safety (and your license), I would not put myself in that position as a new grad. There are many other psych facilities you can apply to that require new grads to work alongside an experienced nurse for at least 4-6 months before managing a unit alone. Good luck!

[ceebeejay]

Do the orientation and see how it flows.

[michlynn, BSN, RN]

This sounds like a recipe for disaster. Let's be honest here, you're a new grad, and no offense, but you're pretty much clueless because you don't learn how to take care of 16 patients in nursing school. This sounds similar to my first job offer, LTC assignment, nurse to patient ratio was 26-1 and they wanted me to be the supervisor because I was the only employee with an RN degree. I immediately said no to the supervisor part. Clearly I don't know what I'm doing so I'm definitely not telling anyone else what to do. I accepted the job because I needed a starting point and then I happily left 2 months later. Very unsafe environment for everyone involved.

Let us know what you decide!