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.
