She answers to the name Erin, but you can feel free to call her Wonder Woman. Not only does she sport scrubs with the logo of her favorite superhero, she has a heart of gold to match.
As a nurse on the behavioral health unit at Akron Children’s Hospital, Erin Shipley provides mental health support and reassurance to kids in need of emotional stabilization after a crisis situation. Although she’s worked at Akron Children’s for less than a year, she has 7 years of experience working in adult mental health.
It was back in her nursing school days at Walsh University that Erin found herself inspired by the field of mental health.
“Psychiatry was my favorite clinical rotation during school,” she said. “After I completed it I was sold.”
For Norris Nguyen, a night nurse on the unit, his path to a career in behavioral health nursing was personal.
“I had depression issues as a teenager and went through some crisis stabilization programs myself,” he said. “Family and people who worked in this field helped get me through that time in my life and it motivated me to want to help kids who are going through what I went through.”
Destigmatizing mental health care
Both Erin and Norris admit their field comes with a lot of preconceived ideas and stigmas.
“Our unit isn’t as scary as it sounds,” Norris said. “If you think about it, every aspect of nursing deals with the behaviors and emotions of our patients. We’re just dealing with it on a more focused level. While medical floors have a standardized set of treatment protocols, we have to be able to adjust our care to different situations.”
Akron Children’s is renovating and expanding the 14-bed unit to 24 beds. The patient population is mainly teens, but we also accept kids as young as 5 years old. The unit is locked for the safety of the patients who may not be in a cooperative frame of mind about being there in the first place.
Everything − from patient room doors that don’t lock to doors that swing both ways to make it impossible to barricade inside − is designed with patient safety in mind.
“We have a quiet room we can use to seclude our patients when they’re actively aggressive or need to diffuse, but we always try to use the least restrictive means possible first,” Erin said.
Caring for patients
Today the unit is at capacity with patients who have been deemed a danger to themselves or others. Some of the reasons kids reach this low point include bullying, a bad breakup, a death of someone close or divorce, and sometimes those feelings manifest into thoughts of suicide or self-harming behaviors like cutting.
Kids who have overdosed or experienced medical trauma are admitted through the ER and may need to spend a few days in another area of the hospital being medically stabilized. Typically patients spend 3 to 5 days in the behavioral health unit.
Erin has 5 patients under her care today. She gets a report from the night nurse and assesses her patients’ moods, administers medications and talks to them about their goals for the day.
Certified in “street yoga,” otherwise known as trauma-informed yoga, Erin sometimes leads one of the daily exercise groups. In addition to dedicated time for school, patients attend other therapeutic group sessions that vary between goal setting, spirituality, cooking, poetry, music, drama and expressive arts.
“The purpose of group therapy is ultimately to help them find and develop healthy coping skills to manage their stress, anxiety or sadness,” said Norris.
While strolling down the hall Erin stops to help one of the mental health technicians with a patient who is visibly agitated.
“His body language told me he was struggling,” she said. “He was just admitted late last night.”
Erin decides that instead of making her patient go back to class, he should rest in his room and listen to music to help him calm down.
“When you think about behavioral health, there’s no black-and-white way to take care of mental illness,” she said. “Sometimes you have to be able to adapt and think on your feet.”
Tonight Erin is handing off her day patients to Norris, and they discuss how each patient’s day went. Oftentimes the shift change causes anxiety for patients, so the nurses try to care for the same patients when they work back-to-back shifts.
“I have a patient who is starting an antidepressant tonight,” he said. “I’ll be watching for any side effects like an increase in intense moods. Before he’s discharged our providers will coordinate treatment with his providers to ensure continuity of care.”
The hospital offers an outpatient partial day hospitalization program for patients who need more support after leaving the inpatient unit.
Patient safety is the #1 priority
While his patients are in their last group session of the evening, Norris conducts room searches. He’s looking for handwritten notes and other items that could compromise their safety.
Over the years the kids have become creative with their hiding spots so he’s had to step up his game by looking under mattresses, desks, trash cans, inside pillows and toilet paper holders and even in between the individual paper towels in the bathroom.
“The main purpose of the room search is to ensure patient/staff safety and privacy protection,” he said. “Our safety policies sound intense, but they’re necessary interventions during this crisis stage. Sometimes kids want to stay in touch after discharge so they’ll try and share personal information like phone numbers. We discourage that because while they think they know each other after 3 days − they really don’t.”
Norris and Erin agree that most parents whose kids land on the unit didn’t see it coming.
“Part of what our social workers do in family therapy is go over the issues that led to the hospitalization and help them to set up short-term goals,” Erin said. “They work on developing a safety plan for home that includes taking away unsafe items, locking up medications, and staying away from peers who are a bad influence.”
After showering, patients are in bed by 9:30 p.m. Norris will do rounds every 15 minutes to check on them.
“During the evening, when patients aren’t busy or distracted, their moods sometimes drop so we need to make sure they’re safe throughout the night,” he said.
Patients can be admitted any time, day or night, and it’s the job of the nurses to do the initial first examination and assessment. Norris said from Monday through Thursday he does anywhere from 2 to 4 admissions a night.
While many people would find this kind of work heart-wrenching − to see young kids and teens at their lowest point− Erin and Norris have a different take.
“I try to connect with my patients and present new ideas to help them change their thought patterns,” Norris said. “I’ve been where they are and it’s helpful for them to know they aren’t alone.”
“What we do is important and necessary,” Erin added. “I’m thankful to work for a hospital that sees a need for what I do and appreciates me. The culture here is truly phenomenal.”
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