Where to Start as a New Grad

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Hi!

I am in the final stretch of nursing school (Sacramento region of California, though will eventually be in the LA area), and trying to decide where to start my career. My goal is to work with underserved/vulnerable populations (especially loving my time working with the unhoused), specifically with a psych, and possibly forensics, emphasis. This is why I went to nursing school, and my passion for it has only grown. I am just not sure where the best place to begin is.

I am considering a new grad position in an ER, in order to get some traditional medical experience. I have enjoyed my rotations in the ER, but, in all honesty, I would only be doing this after being told I am basically worthless and unmarketable as a nurse if I don't have at least a year of bedside to work on my "skills". It drives me insane how psych, community health, all non-traditional nursing areas, etc are looked down upon and undervalued.

I do have a lot of support and encouragement from my mental health professor to jump in to psych, but I would love to hear more from people who have been in similar dilemmas as mine. Where did your journey start? Would you change anything about your path thus far?

I am grateful for any thoughts, feelings and advice! Thank you! 

Specializes in Psych, Substance Abuse.

Hello! Nursing is a second career for me. I previously worked as a newspaper journalist. When the newspaper industry crashed I went to LPN school and got a job in a drug rehab facility. When I became an RN I worked on the psych floor at two hospitals and then I moved down to the psych ER. When I earned an MSN I started working as a mental health intensive case manager for a VA hospital. I always knew I wanted psych, and nothing else, so I have no regrets. 

 

 

B52 said:

Hello! Nursing is a second career for me. I previously worked as a newspaper journalist. When the newspaper industry crashed I went to LPN school and got a job in a drug rehab facility. When I became an RN I worked on the psych floor at two hospitals and then I moved down to the psych ER. When I earned an MSN I started working as a mental health intensive case manager for a VA hospital. I always knew I wanted psych, and nothing else, so I have no regrets. 

 

 

Hello! Thank you for sharing your experience! Your path is one I could see myself on. Nursing is also my second career, which I think has some benefits. I have had one person say they are a better psych nurse due to having extensive med/surg experience, as they were able to better assess and identify medical issues in psych patients. Do you feel at a disadvantage or that you have struggled without that experience? 

Specializes in Psych, Substance Abuse.

I do not feel at a disadvantage. On the psych floor I've had patients with feeding tubes, gunshot wounds, cathethers, etc. I consider myself a lifeling learner. I'm psych certified and I read journals on psych and med/surg issues.

What you are hearing is the stigma of mental health not being valued. It is a myth that you need "medical experience" as a nurse. They will hired anyone for med sug these days anyway. If you want to do psych then do it. I did 3 years acute psych as a new grad, started teaching CPR for the facility, did gero psych for a year, then VA psych for 3, then outpatient addictions, precetped nursing students for a year, now I'm a workplace violence prevention program manager and a facility nurse educator for the VA. Your experience is what you make it and you can use it to find your niche.

If I could do it again, I-as someone who was a BHT for 12 years-would have gone into medical once I graduated.  In my area, the myth is real and I am having a horrible time trying to get out of psych.  I've interviewed for med surg positions and anythin that seems lower acuity at all the different hospital organizations in my small city, and I mostly have not gotten any offers.  A couple have offered, but the pay is 3-4 dollars less and inflation has made rent go up.

This is NOT saying you'd have the same issues.  Not at all, it just depends on where you are and what your goals are professionally.  If you know you want psych, go for it.  I did it because it was all I knew...and now I want more experiences and I'm just not having an easy time getting them.

Arr-tistRN said:

What you are hearing is the stigma of mental health not being valued. It is a myth that you need "medical experience" as a nurse. They will hired anyone for med sug these days anyway. If you want to do psych then do it. I did 3 years acute psych as a new grad, started teaching CPR for the facility, did gero psych for a year, then VA psych for 3, then outpatient addictions, precetped nursing students for a year, now I'm a workplace violence prevention program manager and a facility nurse educator for the VA. Your experience is what you make it and you can use it to find your niche.

sadly no....it isn't accurate in all areas that you can get into med surg easily.  too many new grads, and the stigma is real in some areas (mine, namely, I do not speak for all by far.  It's just not really valued where I am).  Been trying to get out, and I just don't have enough medical experience to be valued by medical jobs.

ftbalgirl79 said:

If I could do it again, I-as someone who was a BHT for 12 years-would have gone into medical once I graduated.  In my area, the myth is real and I am having a horrible time trying to get out of psych.  I've interviewed for med surg positions and anythin that seems lower acuity at all the different hospital organizations in my small city, and I mostly have not gotten any offers.  A couple have offered, but the pay is 3-4 dollars less and inflation has made rent go up.

This is NOT saying you'd have the same issues.  Not at all, it just depends on where you are and what your goals are professionally.  If you know you want psych, go for it.  I did it because it was all I knew...and now I want more experiences and I'm just not having an easy time getting them.

sadly no....it isn't accurate in all areas that you can get into med surg easily.  too many new grads, and the stigma is real in some areas (mine, namely, I do not speak for all by far.  It's just not really valued where I am).  Been trying to get out, and I just don't have enough medical experience to be valued by medical jobs.

What I have found is that the way your write your resume and how you interview makes all the difference. It could be one of those factors holding you back. 

Specializes in Dialysis.
BuzzyAllyBee said:

Hi!

I am in the final stretch of nursing school (Sacramento region of California, though will eventually be in the LA area), and trying to decide where to start my career. My goal is to work with underserved/vulnerable populations (especially loving my time working with the unhoused), specifically with a psych, and possibly forensics, emphasis. This is why I went to nursing school, and my passion for it has only grown. I am just not sure where the best place to begin is.

I am considering a new grad position in an ER, in order to get some traditional medical experience. I have enjoyed my rotations in the ER, but, in all honesty, I would only be doing this after being told I am basically worthless and unmarketable as a nurse if I don't have at least a year of bedside to work on my "skills". It drives me insane how psych, community health, all non-traditional nursing areas, etc are looked down upon and undervalued.

I do have a lot of support and encouragement from my mental health professor to jump in to psych, but I would love to hear more from people who have been in similar dilemmas as mine. Where did your journey start? Would you change anything about your path thus far?

I am grateful for any thoughts, feelings and advice! Thank you! 

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Understand that CA has an abundance of nurses, new grads are pumped out continuously, as evidenced by the many posts of new grads can't find jobs. Just look and keep applying, with the understanding that you may not land your dream job out of the gate

Specializes in Psych NP.

I never did the "2 yr of med surg" everyone talked about.  But the weird bit was I did a hybrid program, so I was starting out as a Pedi NP who wound up working in psych as an RN.  I also did School Nursing, and Camp Nursing, and was a nursing instructor (clinicals in OB and Psych, lectured in Psych and Peds), all the while always doing psych.  More recently I designed and implemented a program to support schools nurses (and other school staff) with consultation and educational programs about psych, and finally got the PMHNP (since Pedi NP plus psych nurse does not an official Psych NP make, though the second Masters was two years of them adamantly never telling me anything I didn't already know), and now also have a private Psych NP practice.

Every so often I would suddenly think "Oh, no -- with this job history I could NEVER get a job on a regular med-surg floor!"  But then I remind myself that I don't actually want a job on a med surg floor, and that I also can't be a banker or an astronaut at this point, and it's okay.  

The main issue has been others' attitudes.  I had a new School Nurse Leader who made it quite clear that she thought I had no business in the job without those 2 yrs of med-surg experience (having been the strongest nurse in the district for three years, being an NP and all).  When I was a camp nurse, I had nurses one Summer who would not take any instruction from me even though I'd been at the camp for five summers, since I was "just a psych nurse." 

I've been pretty all done with that attitude for a few decades now, and have long since stop apologizing for being "just a psych nurse."  When I was teaching psych clinicals to RN students, I told them I wasn't interested in making them want to be psych nurses.  (If they did, great, let's play -- and it's really fun to see someone discover an unrealized affinity for psych.)  I want to make them med-surg (or whatever) nurses who understand that psych is real, it is important, and it's a hell of a lot harder than anything else they're studying.  Because my clients all die 10-15 yrs younger than the average, not due to their psych symptoms but due to their diabetes, or heart disease, or asthma, or renal failure -- because med-surg folks treat them like crap.  So they need to understand psych and give it the respect it deserves.  And then I'd proceed to show them that if they thought nothing was going on, it was because they lacked the skills and knowledge to recognize it.  I wrote the hardest test questions, pointed out details on their clinical patients they'd missed (when they'd been with them all day and I just walked by), did a mock med pass to show them why they don't get to do real meds in psych (they had to pour them accurately, and then get me to take them), and basically weirded them out by knowing way too much about what everyone was thinking most of the time.

Of course, it also helped that I simply retained the med-surg training from nursing school (despite going to a "blink-and-you-miss-it" hybrid program).  We had a patient on the psych unit needing suctioning, so the respiratory nurse came with the dummy to check our skills on it.  When I finished, she said I clearly had done that a lot, and I told her that was my third time in my life, and the first two were 17 yrs ago in nursing school.

But mostly it comes down to, if you will ever want to do anything outside psych, you might want to go put in those two magical years of new-grad hazing hell, or just be ready to still work outside psych but face a lot of people assuming you don't know what you're doing.  Gets tedious proving them wrong, but is entertaining at times.  Or you can just stay in psych -- it's not like there aren't a huge number of different types of psych jobs to be had if you get bored in your first one -- inpatient, PACT team, residentials, rehab, methadone clinics, state hospitals, outpatient, teaching, psych NP, etc.

Julie Love said:

I never did the "2 yr of med surg" everyone talked about.  But the weird bit was I did a hybrid program, so I was starting out as a Pedi NP who wound up working in psych as an RN.  I also did School Nursing, and Camp Nursing, and was a nursing instructor (clinicals in OB and Psych, lectured in Psych and Peds), all the while always doing psych.  More recently I designed and implemented a program to support schools nurses (and other school staff) with consultation and educational programs about psych, and finally got the PMHNP (since Pedi NP plus psych nurse does not an official Psych NP make, though the second Masters was two years of them adamantly never telling me anything I didn't already know), and now also have a private Psych NP practice.

Every so often I would suddenly think "Oh, no -- with this job history I could NEVER get a job on a regular med-surg floor!"  But then I remind myself that I don't actually want a job on a med surg floor, and that I also can't be a banker or an astronaut at this point, and it's okay.  

The main issue has been others' attitudes.  I had a new School Nurse Leader who made it quite clear that she thought I had no business in the job without those 2 yrs of med-surg experience (having been the strongest nurse in the district for three years, being an NP and all).  When I was a camp nurse, I had nurses one Summer who would not take any instruction from me even though I'd been at the camp for five summers, since I was "just a psych nurse." 

I've been pretty all done with that attitude for a few decades now, and have long since stop apologizing for being "just a psych nurse."  When I was teaching psych clinicals to RN students, I told them I wasn't interested in making them want to be psych nurses.  (If they did, great, let's play -- and it's really fun to see someone discover an unrealized affinity for psych.)  I want to make them med-surg (or whatever) nurses who understand that psych is real, it is important, and it's a hell of a lot harder than anything else they're studying.  Because my clients all die 10-15 yrs younger than the average, not due to their psych symptoms but due to their diabetes, or heart disease, or asthma, or renal failure -- because med-surg folks treat them like crap.  So they need to understand psych and give it the respect it deserves.  And then I'd proceed to show them that if they thought nothing was going on, it was because they lacked the skills and knowledge to recognize it.  I wrote the hardest test questions, pointed out details on their clinical patients they'd missed (when they'd been with them all day and I just walked by), did a mock med pass to show them why they don't get to do real meds in psych (they had to pour them accurately, and then get me to take them), and basically weirded them out by knowing way too much about what everyone was thinking most of the time.

Of course, it also helped that I simply retained the med-surg training from nursing school (despite going to a "blink-and-you-miss-it" hybrid program).  We had a patient on the psych unit needing suctioning, so the respiratory nurse came with the dummy to check our skills on it.  When I finished, she said I clearly had done that a lot, and I told her that was my third time in my life, and the first two were 17 yrs ago in nursing school.

But mostly it comes down to, if you will ever want to do anything outside psych, you might want to go put in those two magical years of new-grad hazing hell, or just be ready to still work outside psych but face a lot of people assuming you don't know what you're doing.  Gets tedious proving them wrong, but is entertaining at times.  Or you can just stay in psych -- it's not like there aren't a huge number of different types of psych jobs to be had if you get bored in your first one -- inpatient, PACT team, residentials, rehab, methadone clinics, state hospitals, outpatient, teaching, psych NP, etc.

Thank you for this thorough and thoughtful response! I love hearing about your experiences and journey, especially the different areas within psych. The more time I've spent in the ER, the more I am realizing I think I just needed to know I *could* do it. I am learning a lot, and gaining confidence, which I needed more than anything. However, I am still drawn to the true psych patients we encounter, and everything continues to pull me that direction as I head towards graduation. I've received a lot of wonderful insight on here and other forums, where 99% of people have encouraged me to pursue what I know I want. Of course my own insecurities surrounding what is "expected" or seen as "traditional" take hold at times, but, overall, I am filled with excitement about the prospect of entering this area. I find myself consuming all I can about the nursing and patient experiences, and look forward to the challenge and fulfillment of this specialty. Now to figure out where to start...

 

 

Specializes in Mental Health.

You'll get plenty of psych experience in the ED. Detox, OD, first breaks, suicide attempts, anyone the police pick up - they all go through the ED. Sometimes psych facilities use local hospitals for medical clearance - at one psych facility I worked at, all of our patients went through the same ED for med clearance. This all varies depending on where you live of course, but if you want to do ED and are interested in psych long term, I'd just find one that gets a lot of psych patients. 

Also, medical experience is GREAT to have on a psych floor and psych experience is GREAT to have on a medical floor. I use my med surg knowledge daily working in psych - the medical providers at psych facilities appreciate it very much when a psych nurse knows when something can wait until morning and when a patient needs to be sent to the hospital tonight.

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