The ER is in total chaos today. All 23 rooms are full, the behavioral health suite is full, the waiting room is full, and even the hallway is full. Full of sick patients. The nurses are frazzled, working as hard as they can delivering treatments, hanging IV medications, soothing fears, charting and carrying out each order on every patient. There are 23 rooms in our ER. The waiting room has 12 triaged patients waiting for a room, the hallway holds 5 stretchers with sick patients on them and the behavioral suite has 5 patients in there (3 counted for in the room number). We are currently in a crisis situation~ we have 2 doctors, a PA and 6 nurses. Its only 9am.
At this point another behavioral health patient is brought into our ER by the state police. He is psychotic and half-dressed and screaming at unseen people. He was found in the park yelling at a tree. As the charge nurse I go out to assess him (the triage nurse is busy). I find him to be completely in need of psychiatric help and not suitable to be allowed to stay in the waiting room, (as you can imagine the other patients and their families were getting an eye full!!) BUT where can I put him to him safe and to keep the staff and other patients safe??? Shuffling of patients begins…
Our ER, like every ER across the country is facing these situations every day. The budget cuts to the mental health programs have resulted in catastrophic cuts in the community resources that our patients need to stay healthy and out of crisis situations. The ER has become the place to send all of these patients. Once with us, the truly ill might be kept in our ER for days while waiting for a bed to open up in a psych hospital.
Behavioral health/mental health patients are especially frustrating for us ER nurses for a few reasons. We are not psych nurses, so many times we feel overwhelmed with how to help them, they are hard to manage both medically and emotionally and at times they have multiple outbursts that are unsafe and scary, they take up many of our limited resources (staff and beds) so we again feel overwhelmed, and the frustration level rises every time we present their situation to another hospital hoping they can be seen and helped in the fashion they need~~~ and they get declined due to “that patient just doesn’t fit our milieu.”
With all of that said, how can we as nurses see these patients through a new lense??? Since we have no control over the red tape of the Psych world maybe there is something we can do to see the patient as we do the chest pain, the trauma and the septic patient; we might have less frustration and feel less overwhelmed. I decided to try something…and it was an exercise in compassion.
I decided to be a mental health patient to walk a mile in their shoes, to see how it feels on some small level. With the ok from my supervisor and the help of the staff, I came into the ER and “signed in.” At first it was silly and giggles erupted from myself and the triage nurse…but then as I was asked the multiple intrusive questions, and brought to a room to change out of my clothes and given the blue paper scrubs to change into, things were not so funny. Out of respect for me the nurse didn’t stay in the room and watch me change, BUT if I were truly in crisis she would have had to do that! Once changed, all of my belongings were taken from me, bagged and locked up. I had to be without my bra and undies – NOT COOL – and I couldn’t keep my cell phone either. I was then moved into the behavioral health suite, scary. I wanted the full experience so I was then put into 4 point restraints for “an unsafe outburst that put myself and the staff at risk of harm.” At that point I was scared… something happened.
I always knew that putting someone in restraints made me sick to my stomach. I knew on some guttural level how awful it must feel for that person. Now, I know why we do it and I’m not saying we do anything wrong, I am just saying that it is WORSE than I ever imagined it to be. I stayed in them for 15 minutes, and I was with people I trust… and at one point I had to tell myself to not freak out! My nose itched and I couldn’t scratch it. I didn’t like the way the shirt was slipping up off of my stomach… I felt so out of control… when I was released from the restraints I felt like crying. I had the luxury of saying, “OK, this little experiment is OVER!! I honestly can tell you that it was a good experience, in the fact that I got just a little taste of how the patient must feel…and it opened my heart as well as my eyes.
There may not be anything I can do to get the mental health patient to a psych bed any quicker…BUT I can have a better understanding of their situation and a bit more compassion.