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Psychiatric-Mental Health Nurses in the Emergency Department

By APNA Bloggers posted 05-23-2016 01:09 PM

  

APNA News: The Psychiatric Nursing Voice  |  May 2016 Members' Corner Edition

An APNA Institute for Safe Environments workgroup set out to explore the role of psychiatric-mental health nurses in emergency departments...

As patients with psychiatric and substance use issues increasingly use emergency departments to meet their acute and chronic health care needs, emergency departments are grappling with how to best provide care to this population. During the Institute for Safe Environments’ Interactive Panel at the 2013 APNA Annual Conference in Pittsburgh, a group of nurses expressed an interest in discussing the issues related to caring for psychiatric patients in hospital emergency departments. Following the conference, these twenty five members came together regularly, through an online community on APNA Member Bridge and conference calls, for discussion. Their collaboration ultimately resulted in a survey of the membership in April of 2015. A column in this month’s issue of the Journal of the American Psychiatric Nurses Association (JAPNA) outlines their work and the survey results.

The workgroup, which sought to determine the role of the psychiatric-mental health nurse in the Emergency Department, used APNA organizational channels to bring their needs to the attention of the Board of Directors. In January of 2014, the group submitted a briefing paper to the APNA Board of Directors asking for approval to survey the membership. “This grassroots group has identified the need to define the role of the psychiatric nurse in emergency rooms and to develop competencies for nurses that practice in these settings,” they stated in the briefing paper. “The group would like to begin by surveying APNA members in an effort to discover how psychiatric nurses who work in emergency room settings define their roles.” The Board supported the project and approved the final 25-question survey in April 2015. Workgroup members Michele Heyland and Gale Sullivan summarized the 519 responses. (Scroll down for select summaries.)

More than half of the respondents identified themselves as psychiatric-mental health nurses, while one third identified themselves as emergency department nurses. Demographic data showed the majority of respondents to be highly educated and experienced, practicing in mostly urban settings, and trained in and comfortable with providing care to individuals with psychiatric-mental health needs. Consensus was shown around a title of psychiatric emergency department nurse with a primary role of crisis management, for psychiatric-mental health nurses providing care in the Emergency Department.

“We thought that we might find that there was a need to develop competencies for nurses caring for psychiatric patients in emergency rooms, but the results did not confirm that,” says Diane Allen, who chaired the workgroup. (More than half of respondents indicated that their hospitals provided key training and education for caring for patients with behavioral health needs.) “We were encouraged by what we considered to be a large response,” continues Allen, “but realize that given that there are 10,000 APNA members, this was a relatively small sample of mostly experienced psychiatric nurses.” While these results show the difficulties inherent in crafting a member survey that will elicit scientifically useful data, they do provide an interesting snapshot of a contingent of APNA membership. Plus, according to Allen, there was another positive outcome: “Our experience may have paved the way for other APNA work groups to publish the results of their work in JAPNA.” You can view the full article in the May/June issue of JAPNA here.


Special thanks to the members of the ISE Emergency Departments Workgroup: 
Diane Allen MN, RN-BC, NEA-BC; Brittany Bower RN, BSN; Vania Brown-Small DNP, RN, PMHCNS, BC; Jean Christoffersen PMHCNS-BC; Clare Conner DNP, APRN; Lori Dakin APRN, MS, CNS; Suzanne Goetz PhD, MSN, RN, CCS-P; Teresita Gonzales MSN Ed. RN-BC; Michelle Heyland MSN, APN, PMHNP-BC; Camille Kennedy; Jeannine Loucks MSN, RN-BC PMH; Marlene Nadler-Moodie MSN, APRN, PMHCNS-BC; Janet Nickolaus CNS, ARNP; Nora Perez-Camargo BSN, RN; Michael Polacek MSN, RN-BC; Beth Reiley CRNP; Michael Rice PhD, APRN, BC, FAAN; Colleen Robinson RNC; April Schwartz RN, MHA; Kelly Southard; Gale Sullivan MSN, RN-BC; Christine Tebaldi MS, PMHNP-BC; Victoria Weiss; Babette Wieland MSN, BSN; Suzane Wilbur PMHCNS-BC

 

Select Survey Response Summaries:

   
   
   
   
   
   
   
   

 
 
   
   
   


 

 

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05-28-2016 07:11 AM

I work in the Psychiatric Evaluation Services (PES) unit in an large urban hospital emergency department. It is a 10-chair unit. Patients admitted to this unit are supposed to be triaged by ED nurses to determine appropriateness for this unit. The confrontational (and sometimes hostile) dialogue directed towards the PES nursing staff from the main ED is very disheartening.
If a patient presents to triage intoxicated, this patient must need a psych evaluation. Any patient presenting as an Emergency Petition is automatically assumed to be a mental health problem. Nursing home patients with changes in mental status (or already diagnosed with Alzheimer's disease) must be a psych patient. The constant push-back from my unit because of the obvious inappropriatness of attempted admissions from the ED is an ongoing battle. Admission appropriateness to PES includes +SI, active psychosis: it is not wanting a medication change or being homeless.
My coworkers and I often wonder how the ED nurses have obviously 'forgotten' their psych rotation in nursing school. There is no support for 're-education'.
When I start my shift tonight, I can guarantee an ED triage nurse will call me and say, "I have one of yours out here"; and it's almost a given, no triage, i.e. vital signs, etc. has happened..