u/Comfortable_Coat_285

Hi everyone,

I’m looking for some real, honest input because I feel like I’ve hit a wall.

I’m a registered nurse with 16 years of experience in psychiatry. I graduated with my medical degree in 2024, but due to financial issues, I wasn’t able to enter residency in my home country.

I attempted USMLE Step 1 and Step 2 and failed both. I didn’t go for a second attempt because people around me basically told me it would be pointless, that matching in the US with failed attempts is extremely unlikely.

I’ve since moved to the US. To be blunt, I don’t really like it here, but I’ve been grinding hard with lots of overtime and I’m making about $200K/year as an RN because I work 6 days of week - 12 hour shifts.

Recently, I enrolled in a Nurse Practitioner program (PMHNP track). But honestly, I have serious doubts. From what I’ve seen so far, the training feels very shallow, mostly online, and clinicals are with other NPs. I don’t feel like I’m getting the depth, structure, or medical rigor I actually want. I became a doctor to practice as a doctor, not halfway.

On the other hand:

• I passed MCCQE1 and NAC (Canada)
• But I keep hearing matching as an IMG in Canada (especially psychiatry) is very difficult
• Some seniors suggested doing MRCPsych exams in the UK and then trying to pivot to Canada later

My core issue is that I feel frustrated working as an RN with limited autonomy, but I also don’t want to settle for something (PMHNP) that I don’t fully respect or feel confident in long-term.

I’m 42 and single. No liabilities.

So I’m stuck between:

1. Stay in the US, finish PMHNP, make good money, accept the ceiling
2. Push for psychiatry properly (Canada or UK route), knowing it may take years and is uncertain

What would you do in my position?

Would really appreciate advice from people who’ve gone through similar paths or understand the system realistically.

Thanks in advance.

Hi everyone,

While working on the behavioral health unit, I observed multiple things over time that genuinely concerned me from a patient safety standpoint. These weren’t one-off issues they felt like patterns. Some examples:

• A nurse reportedly sleeping during shifts (and this being known among staff)
• No clear Code Blue preparedness - staff seemed unsure of roles during emergencies, and no drills (to my knowledge)
• Vital signs not consistently taken or escalated, with abnormal values sometimes missed
• Pain meds being withheld at times due to reluctance to complete documentation
• BHTs avoiding basic care like hygiene/diaper changes, requiring RN intervention
• Staff (including charge nurses) using personal phones during patient care, including scolding patients while distracted
• A charge nurse allegedly doing a TikTok live during a shift
• Staff being criticized openly in front of others (including my student), creating an unprofessional environment
• A situation where a tech was pressured to perform a blood glucose check without gloves
• Patients being reprimanded for asking questions while staff were on their phones
• Staff leaving the unit without sign-out or accountability
• Float staff roles (nurses and techs) being unclear and inconsistently applied
• Assignment distribution sometimes appearing based on favoritism rather than patient needs
• General lack of ownership for basic tasks like restocking meds

Because of all this, I decided to send a formal email to my nurse manager documenting these concerns. I tried to keep it professional and framed around patient safety and system issues not attacking individuals. I also stated that I was submitting it in good faith and referenced whistleblower protections, asking for no retaliation.

After I sent it, I panicked.

I started worrying:

• Did I go too far?
• Will this be seen as attacking the unit?
• Am I putting my PRN position at risk?

So I attempted to recall the email… but my nurse manager had already read it.

Now I feel like I’ve put myself in a very exposed position:

• I still rely on this job for extra shifts/income
• I don’t know how management will interpret this (helpful vs disruptive)
• I’m worried about subtle retaliation (reduced shifts, being labeled difficult, etc.)

To make things more confusing, earlier that same day I had emailed the same manager asking about a shift because the unit looked overstaffed and mentioned I was trying to pick up more shifts due to “teething issues” at my new job. So now I’m worried I’ve sent mixed signals (asking for shifts + raising serious concerns).

At this point:

• The email is already read
• I can’t undo it
• I haven’t sent any follow-up
• I haven’t been contacted yet

I genuinely wasn’t trying to start a fight, I just felt uncomfortable ignoring what I saw. But I also recognize this may have been a big move, especially since I’m not a full-time staff member there.

So I’m asking:

• Did I completely mis-handle this?
• Should I send a follow-up to clarify, or stay quiet unless approached?
• How do situations like this usually play out in nursing/hospital systems?
• What should I do now to protect myself professionally?

I’d really appreciate honest input, especially from those in nursing leadership or who’ve dealt with similar situations.

Thanks.