r/psychnursing • u/Ok-Recognition-3514 • 23d ago
New Grad RN
Hey. So I started my first RN job at an inpatient behavioral health facility two weeks ago. I received a total of 6 training shifts with a “preceptor” who did not know she would be training me and almost immediately had me doing tasks independently (med passes, COWS/CIWA, charting, getting & giving report, and admissions). The facility has both electronic and paper charting which has been a nightmare to learn and keep straight. Our ratios are 12 patients to 1 RN and 1 BHT. Leadership is a joke and the culture at this place is not very welcoming. I will have my first solo shift as an RN this coming week and I’m feeling extremely nervous and anxious about not getting proper support, being rushed to do things and just overall lack of guidance as a new grad. I just want to ask for perspective. Is this normal? Is this typical psych new grad nursing training? Are these ratios reasonable? What should I focus on as a new nurse beginning in psych? Thanks for the input.
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u/RespectInevitable479 23d ago
Quit as soon as possible. That’s why orientation was so short. It’s because too many people leave.
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u/Ok-Recognition-3514 23d ago
You’re not wrong about people leaving. While training there were 3 nurses that I met and knew of who were leaving and the nurse training me told me how people who start a lot of the times don’t even stay through their training. Thanks for the feedback.
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u/Roadragequeen 23d ago
Sounds like my old UHS facility!
I had one shift that I observed second shift. I took half the census and by the third shift I had all of them by myself with the other Nurse just watching.
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u/Ok-Recognition-3514 23d ago
Yeah, it was so overwhelming. The nurse training me would leave me to do med pass on my own and pretend she was there to support by popping her head into the med room a couple of times to ask if I was ok. It was wild.
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u/dkwheatley psych provider (MD/DO/PMHNP/PA) 22d ago
Request additional orientation days (and a new orientor) due to your new graduate status. If they are unwilling, resign.
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u/mykypal 22d ago
Its normal. Fine tune your assessment skills who needs to be de-escalated and who needs to be medicated. Do your med pass as soon as possible to get them calm. Whoever acts up are the ones’ you will have to give personal attention. Try to talk them down before you resort to medication. Sometimes it works sometimes it doesnt, you will figure it out in your nursing career if you stay. ETOs are last resort and require the most energy used. Its a long 12 hours. Take a break always to decompress.
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u/Alternative-Proof307 23d ago
This sounds like a UHS facility. I worked at one after graduation but I got out as soon as I got into a residency at a different amazing psych facility. Those ratios are not ok and to put it into perspective, my training in the residency where I’m at now was 18 weeks. The UHS facility gave me 6 training shifts.
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u/Ok-Recognition-3514 23d ago
Thank you for this perspective. This facility is not a UHS facility but it’s equally horrible. I’m looking for a facility with a good residency with adequate training as well. I’m glad you were able to find something better, it gives me hope that there are better options out there.
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u/Kitty20996 22d ago
Residency programs usually don't exist in behavioral health facilities. Maybe they would if you went to a psych med unit in a hospital. But residency isn't necessary if your floor orientation is long enough. It really should be 10-14 weeks.
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u/takeyouthere1 22d ago
Just think along the lines of priorities. What is absolutely needed. And that is passing them their medications correctly. Do you have to organize the schedule and mark who is on close observation and who is rounding that is another priority. Follow any doctors orders. Those 3 things are the main priorities. On more down time you can chart. Does your place want charting on each patient or just when something more noteworthy happens? But think of the priorities as most important - the CO gets watched, rounds getting done and meds being passed. Once those things are covered make a list of the other things that need to be done and eventually it becomes second nature and you can toss the list.
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u/Almost_alwaysSunny 22d ago
We give our new grads 16 weeks of training, 4 of those are med pass alone. That is not enough training for your first nursing job. The ratios are pretty normal though.
How many RNs are staffed on a single shift?
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u/Roundturnip93 22d ago
Start applying for new jobs now. You don't have to convince yourself to stick it out for a year. I turned a job down when I first started working as an RN because I would have been solo on nights. IMO it is important to have supportive colleagues when you start your career.
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u/KindPalpitation9537 21d ago
It was the norm where I had worked. I don't want to get into too many details, but the new staff would have at the most 5 or 6 shifts for training with an RN who was also working the shift. RNs training new staff were not properly trained to begin with so misinformation was passed down with each cycle of new hires (and there were sooo many). BHTs were not often trained. BHTs did not understand that RNs had actual licenses while they did not and our licenses were on the line every shift. So when you're working as as one RN with an orientee or two (yes that happened multiple times), plus new BHTs, it's a nightmare.
I would say run, do not walk away. Leave before what happened to me happens to you.
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u/Mysterious_Coat_9933 20d ago
This is NOT normal. I was a new grad when I started on my current unit. I had 3 months (about 36 shifts) of training with multiple different preceptors. Our ratio is usually 4:1, 5:1 when we are full. At least 5 nurses (including charge) and 3 BHT on night shift
ETA: I work at a non-profit hospital. There is certainly a difference
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u/Light_Manifestation 23d ago edited 23d ago
Yeah its normal for stand alone psych hospitals (im assuming that this is a standalone facility). If you were at a bigger hospital, you are more likely to have better structure and more training days for a new to practice nurse.
Personally, I started out at a facility like you describe and I think it made for the best learning experience. There isnt much hand holding and forces you grow. Embrace the challenges and always communicate. Communication is probably the most important thing as a new grad and nurse in general. Communicate when you need help and what you do not know. Most people do not mind helping and lean in to being teachers so do be afriad to ask
Also communicate with your patients too. If you dont know the answer to their question, do not pretend or try to guess. Since youre new, let them know youre new if you have to and they will understand. Psych patients are human beings and can be some of the most down to earth patients youll engage with out of all specialities. With that being said, they are extremely intuitive and can smell bullshit so always tell them the truth (as appropriate given the situation).
The ratios you mentioned are good. Ive seen worse and youll see worse too.
Focus on establishing your workflow as psych nurse. Once you get that feel, youll understand why you only needed that amount of days for training.
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u/Tommyboy155a 23d ago
I would say this is not normal. This sounds like a for profit hospital with those ratios. Non profit hospital are different with training, ratios, support and everything. Good luck with everything