Tuesday, October 11, 2011

Just venting a frustration today

Soooo how long is it humane to keep a human being in a behavioral health room that is 10x10, with no windows and no fresh air????
 Let me set the stage for you… Our Hospital is a small rural, critical care access site and our ER is a 22 bed~ highly functioning machine that can take care of every person and every diagnosis that walks through our doors, (or comes in via ambulance.)  except for the psych patient that has real psych interventions…. Now, I don’t mean that our ER cannot take care of that person…by keeping them safe, giving them shelter, meals, a hot shower, meds and interaction….what I mean is the “system” cannot take care of them.  This person comes to us for help…they are suicidal or psychotic…or manic…whatever the situation, we get them to a place that they are unable to harm themselves or others…they are watched and cared for as we and our “crisis” team search for a hospital bed in a psych facility that can properly house and treat them accordingly.  It sounds like this should be so easy…so cut and dry.  It is not.  This system, our mental health system, is broken!! 
We have had many behavioral / psych patients that have been “housed” in our ER for up to a week at a time as we have worked daily, for many hours, searching for a hospital bed that could meet their needs. There are only 4 hospitals in our state that take these types of patients and it seems they are always full…or they cannot take our patient because “they are too high risk for the rest of our patient population”   What this means is…the patient can stay in the ER where they get their physical needs met (except sunshine and fresh air because we cannot risk elopement) BUT not their mental health needs!!  Most ER's, including ours, does not have a psychiatrist or mental health trained nurses to tend to the needs of this population. We try to follow their med regimes but typically they need med adjustments and therapy...both of which ER docs are not trained to do.  The ER docs, nurses and mental health patient end up being frustrated as we search for the trained professionals in mental health hospitals that have the ability to properly care for these patients AND are willing to accept them.
 Now call me stupid but I cannot understand why the psych hospitals can reject a patient when they have open beds because the patient does not meet their criteria….BUT we take every patient that walks through our doors…NO matter if we are down staff, if our patient population is at full capacity or if this new patient doesn’t fit well with others…. These patients can stay in our ER for days…a week…like a caged animal...or a prisoner…waiting for the care they need!!  It is very frustrating as a provider… and I cannot even imagine what it is like to be that patient.
I wish there was an easy solution to this problem… it is a huge problem…seems so overwhelming…
The one thing for us all to keep in mind is that this patient is a human being.  They need care and concern, a healing touch and an open mind. I admit that this patient population isn’t the one that usually gets my mothering juices flowing but yesterday I had a moment with just such a patient that made me remember just how human they are…. Something that we all could use a reminder in.
I went into the behavioral health area to answer this patient’s call bell and the patient told me her back hurt and that she wanted an ice bag.  I filled an ice bag and went back to her… she was crying and lying on her bed.  I placed the ice bag onto her low back and asked her if I could help her in any other way (I feel so useless in this area when I have no mental health training…and I just don’t want to say the wrong thing!) She asked me to rub her back.  I did.  She began to sob…and said, “that feels so good… no one has touched me or rubbed my back in so long.”   This touched my heart so deeply.  As I rubbed her back and listened to her cry I was so thankful that I could fill this one need for her and maybe help calm her. 
Sadly this patient is still with us…in our small area…with no windows and no fresh air because none of the mental health facilities in our state can “take her level of care.”  


  1. I agree- it seems like a form of neglect when we have these mental health pts for extended periods of time cause they don't fit the milieu of the other units. We aren't able to help them to the full compassity that they need... All we can do is listen to them, offer them food/drinks/blankets and hope some psych unit will accept them. It's rediculous, we don't keep hip fractures for 3 days til an ortho doc will take them... Or a chest pain til the cardiologist can see them. The system in this case is sadly broken... But I don't know what the solution is either...

  2. I know that this is happening all across the country and all the ER nurses are frustrated...I wonder what would happen if the ER nurses across the country stood up and acted...emailed senators and congress men/women every time a situation like this arose and asked them "what are you going to do about your states mental health issue" I bet if the emailed began piling up every day they just might listen~~