A day in the life of a mental health nurse

The CHOC Children’s Mental Health Inpatient Center is an inpatient psychiatric center exclusively dedicated to the treatment of children ages 3-17 with mental illness who are in immediate risk of hurting themselves or others. It is the only inpatient facility in Orange County that can treat patients younger than 12. Our doctors and care team are all specially trained to treat children and provide the very best patient- and family-centered care 24 hours a day, seven days a week.

During a child’s stay, he or she engages in daily multidisciplinary therapeutic groups and receives individual therapy, family therapy, brief psychological testing and psychiatric care.

In observance of Mental Health Month, follow along for a day in the life of Madeline, a clinical nurse in CHOC’s Mental Health Inpatient Center.

5:15 a.m. – After fighting my snooze button, I wake up, shower, and drink some much-needed coffee.

6:30 a.m. – My cat yells his goodbyes to me as I give him a treat and leave for work. On the way, I vibe out to music to get pumped up for the day. I’ve worked at CHOC for over a year now. Last year, I was accepted into CHOC’s Registered Nurse Residency program. As a new nurse, I felt called to work in a mental health setting. I am beyond proud to stand alongside the brilliant CHOC team on the frontlines of mental healthcare.  

7:00 a.m. – I join my team in our conference room for a daily briefing report. Together, we review any newly admitted patients, our current population of patients, and any safety concerns. One of the ways we keep kids safe is through trauma-informed care. Upon admission, we work with patients and their families to determine any triggering situations or actions the patients may have, and then learn how strong emotions may manifest outwardly; such as pacing, shaking, or becoming very quiet. This information helps us to rapidly identify when patients are struggling and may need extra support or encouragement to utilize their coping skills. One of my favorite environmental adaptations we can provide for patients is our sensory room. It helps stimulate a few of our five senses to help kids cope and be more present in the moment. Sometimes, just hearing the rhythmic movements of the bubbles can be soothing and have a great calming effect.

7:30 a.m. – Once I have an understanding of our environment, I walk the unit to check on the patients. Most are still asleep, so I then look up my patient’s medications, while verifying medication consents. All pediatric psychiatric medications need parental consent obtained by the patient’s psychiatrist.

8:15 a.m. — Our medication room has a barn door, so I can efficiently and safely administer patients’ morning medications, preform a quick mental status check-in, and obtain vitals.

9:30 a.m. — One of my patients is currently taking a new medication. In order to better understand her body’s acceptance and tolerance of the drug, we need to run labs. Before drawing her blood, I numb a small area of her skin using a J-Tip®. During the blood draw, a child life specialist and I help the patient cope by offering her modeling clay and a hide-and-seek activity book.

10:00 a.m. — Throughout the day, our patients are divided into groups based on age to attend group sessions. This creates a structured environment that promotes the development of coping and social skills they can utilize when they go home. The sessions focus on our various themes of the day that can range from problem solving or emotional regulation to nutrition and wellness. These sessions are led by our team of nurses, social workers, child life specialists, plus and art and music therapists. This morning’s group session is focused on gross motor skills. Our group leaders soak up some sunshine in our beautiful outdoor area while supervising patients socializing and joining in on a game of handball.

11:00 a.m. — I sit down with one of my patients to discuss their day so far and check in on any thoughts of self-harm that we can work through together. Afterwards, as part of the patient care team, I meet with that patient’s psychiatrist Dr. Lavanya Wusirika, and social worker Gaby, to discuss the patient’s care plan.

12:30 p.m. – It’s time for the patients to have lunch. Our patients eat together, so I assist with passing out lunch trays and pouring drinks. One of our licensed vocational nurses, Brenda, has become our unofficial DJ, and she plays music during lunch to help create a fun, therapeutic environment.

1:00 p.m. – I receive a call from a patient’s parent. After addressing their questions, I update them on their child’s plan of care, medications and current temperament.

2:00 p.m. – I use my own lunch break to catch up with my coworkers. We spend a lot of time together, and I’m lucky to have such an amazing work family.

3:00 p.m. – It’s time for one of our patients to head home. Upon admission to the unit, our team begins organizing outside resources and planning ways to increase safety and support at home. This information is built upon throughout their stay and is incorporated into an individualized safety and coping plan. After our social workers discuss the plan for home with the patient and their parent, I review current medication information and additional discharge instructions. Staff members and fellow patients send off their peer with warm wishes and words of encouragement.

4:30 p.m. –As a nurse, it’s my turn to lead one of our nursing groups. After the patients participate in a discussion about favorite coping skills and we do a check-in of their current emotions, we follow a painting tutorial to practice our theme of the day, mindfulness.

6:00 p.m. – I spend time updating my patients’ charts, including their mental status assessments and treatment plans. This way our whole team can see the patient’s progress and any concerns.

6:45 p.m. – During daily community meetings, all of our patients join together, and our staff leads a check-in to summarize what has been learned from our theme of the day. Patients take turns sharing their high and low of the day and how we can build on these experiences for tomorrow.

7:00 p.m. – As our night shift nurses arrive, we take turns giving a report of their patient’s day and mental status. We share new triggers that we have learned from the patients as well as new coping skills that were helpful. Knowing how we can best care for patients before, during and after a crisis or stressful situation is fundamental for trauma-informed care. By caring for every patient as a whole, not as a diagnosis or as someone defined by their trauma or maladaptive behaviors, we are able to better understand and care for them.

8:00 p.m. ― Get home and share a delicious meal with my husband. A long hug and many kisses are bestowed unto my cat Boots. The three of us will cuddle up and watch a show before we head to sleep and start again.

Stay Informed about Mental Health

CHOC Children’s has made the commitment to take a leadership role in meeting the need for more mental health services in Orange County. Sign up today to keep informed about this important initiative.

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What one NICU nurse learned from her patients

By Marina Birch, registered nurse, neonatal intensive care unit, and graduate of CHOC Children’s RN Residency in Pediatrics program

Marina Birch, NICU nurse and graduate of the CHOC Children’s RN Residency program.

Nursing school taught me many things, but nothing compares to what I have learned during the CHOC Children’s RN Residency program. Experiencing uplifting days and watching your patients heal helps you see the difference you make in patients’ lives. I hadn’t realized how one amazing day will inspire you to come back to work after you have a rough day.

My patients and their families have taught me lessons I would never have learned by myself. During one shift, I had the privilege of caring for a sweet baby girl who was admitted to the NICU a few hours after she was born. Her mother had barely been able to hold her before the baby began having trouble breathing and was intubated. During my day with her we were able to pull out her umbilical vessel catheter, something that allows blood to be drawn for the baby without repeated needle sticks. In addition to this making the baby more comfortable, this allowed her parents to dress her in a onesie for the very first time. I still remember the pastel onesie that read “Little Miss Sunshine.” We then were able to allow her loving parents to hold her without an IV pole attached to her or a machine breathing on her behalf. Her parents had been waiting for this moment for a long time.

That is one of my all-time favorite days at work because the look on her parents’ faces is something I will always remember. They had wide eyes and massive smiles while holding and looking down at their little one. Something so simple as holding and dressing their child was a huge event they had been waiting for since she was born. Giving parents opportunities to hold their child and emphasizing these moments are what they will remember about their time at CHOC.

Have you been inspired by a nurse at CHOC? Nominate them for the Daisy Award

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The surprising thing I learned in the RN Residency program

By Andrea Flinn, registered nurse, medical/surgical unit, and graduate of CHOC Children’s RN Residency in Pediatrics program

The RN Residency Program at CHOC Children’s taught me more than I had ever imagined. The magnitude of my learning experience has made it nearly impossible to pinpoint one standout or breakthrough moment. However, reflecting upon my journey, one of my greatest takeaways is the fact that the smallest moments create the greatest impact. Here are a few of my favorites.

  • I have learned to really focus when playing your
    patient in Connect Four so they do not beat you in less than five moves.
  • I have learned that letting a parent help take
    their three-year-old’s temperature often times goes much smoother than when you
    try to do it yourself.
  • I have learned that the playroom and its
    volunteers are some of my greatest resources.
  • I have learned that bedazzling your
    five-year-old patient’s oxygen mask is not only awesome but will lead to them
    wanting to take it home.
  • I have learned to love education printouts for
    our patients and their families.
  • I have learned that taking the time to explain
    as much as you can to patients and parents goes a long way.
  • I have learned that receiving a drawing from a
    patient can turn your whole day around.
  • I have learned that crying is okay because
    sometimes your patient’s family just needs someone to cry with them.
  • I have learned to treasure each smile shared.
  • I have learned that fellow nurses are truly the
    best support system.
  • I have learned how the value of family greatly
    impacts our patient care experiences.
  • Most importantly, I have learned that each child
    is special and what we do here as pediatric nurses is much more than a job;
    it’s a blessing.

Have you been inspired by a nurse at CHOC? Nominate them for the Daisy Award

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CHOC chief nursing officer reflects on another year of nursing excellence

In honor of National Nurses Week (May 6-12), Melanie
Patterson, vice president, patient care services and chief nursing officer of
CHOC Children’s Hospital, shared a few nursing highlights from the past year. CHOC
nurses work in a variety of roles, from direct patient care to informatics. They
partner with our pediatricians and pediatric specialists, as well as other
staff, to advance care and safety for our patients and their families. Learn
more about their most recent contributions in this Q & A with Melanie.

CHOC received
numerous accolades for patient care and safety; among them Magnet® recognition.
What does this honor really mean?

This is our third time achieving Magnet recognition, reflecting our commitment to high-quality nursing practice. This is truly an honor and places us in an elite group of healthcare organizations; fewer than 500 (out of more than 6,300) hospitals in the country have achieved Magnet recognition.

To earn this distinction, we passed a rigorous and lengthy
process that required widespread participation from leadership and staff. We
are a much better organization because of our Magnet recognition, which raised
the bar for patient care and inspired every member of our team to achieve excellence
every day.

CHOC has taken a
leadership role in developing a pediatric system of mental health care in
Orange County, with an inpatient center as its centerpiece. Do you have any
updates to share?

Our Mental Health Inpatient Center opened last April, filling a gap in a fragmented system that left children younger than 12 with no inpatient services in Orange County. The innovative facility, which features a warm, healing environment, is the only one in the state to offer all private rooms and an option for parents to stay overnight with their child, as appropriate. We’ve admitted more than 600 children since we opened and achieved an 86 percent positive rating in our patient experience survey. In addition, our restraint and seclusion rates are far below the national average, as is nurse turnover. The Center’s team has worked hard to create the right combination of “people, place and practice” to promote the best outcomes for our patients and their families.

How has nursing
contributed to evidence-based practices?

Evidence-based practice (EBP) is a dynamic process of
integrating research, credible sources of knowledge, clinical expertise, and
patient and family preferences and values to achieve optimal patient outcomes,
enhance practice, and manage health care costs. We developed an EBP Scholars
program that is a formal six-month long program funded in part by the Walden
and Jean Young Shaw Foundation. Scholars receive education about the EBP
process and guidance in developing their own projects focused on improving
outcomes. Results have included an increased number of external poster and
podium presentations, and nurse-led projects submitted for research
consideration and peer-reviewed nursing publications. In addition, six
nurse-led projects were awarded grants for projects that resulted in meaningful
change, increased patient safety, and decreased cost of care.

How involved have
nurses been in research projects?

We encourage a culture of inquiry among our nurses. Our
Nursing Research and Innovation Council promotes the integration of research,
and innovation into practice, and facilitates nurse involvement in related
activities across the organization. Our Nursing Research Associate
Training Program provides a meaningful and relatable approach to empower nurses,
at all levels, to participate in multidisciplinary research. Participants
attend classes and receive hands-on training with a clinical research
coordinator.

One example of nurse-led research was focused on pupillary
assessment (examining pupils’ reaction to light). This is important in
neurological evaluations because changes in the size, equality and reactivity
of the pupils can provide vital diagnostic information. Evidence suggests that
the traditional pen-light pupil examination is subjective and has low precision
and reproducibility. Automated hand-held pupillometers have recently been used
to provide more objective measurements of pupillary size and reactivity. Studies
suggest early detection of subtle changes using pupillometers may improve patient
outcomes in adults, yet there is not much literature on its use in children.

Over the past few years, our nurses have established an
organizational database of automated pupillometry to provide evidence for the use
of pupillometers in children. Findings from a preliminary study were presented
at the American Association of Neuroscience Nurses national conference in
Denver, Colorado this past March and demonstrate a statistically significant
inverse relationship between pupillometer readings and increased intracranial (inside
the skull) pressure. We have since expanded the use of pupillometers in our
emergency department and started additional multidisciplinary studies.

How have your nurses
taken leadership roles in advancing patient safety throughout the hospital?

CHOC nurses have initiated and/or been asked to participate
in numerous quality improvement projects focused on enhancing patient safety. I
am especially proud of our team of safety coaches whose roles are to reinforce
― often through real-time feedback ― safe practices. This team now consists of
88 clinicians from more than 25 different areas across our entire healthcare
system.

Additionally, we recently created the role of discharge
nurse navigator whose focus is on successfully transitioning patients from the
hospital to their homes. This includes educating families on after-care
instructions and any other follow-up recommended by their physicians. The
ultimate goals are decreasing readmission rates and improving patient and
family satisfaction. We’ve seen our seven and 30-day readmission rates decrease
beyond our initial goals and patient/parent satisfaction regarding nurse
communications increase.

What makes CHOC
nurses so unique?

Obviously, I am biased and think our nurses are the best in the profession. Every day, I have the privilege of witnessing the countless ways they preserve the magic of childhood. They are compassionate advocates for our patients and families, and proactive in implementing positive change that improves the care and service we provide. They are also collaborative, partnering with our physicians, each other and staff from across the entire healthcare system. They are committed to nursing excellence in everything they do, and selflessly dedicated to advancing our mission and our vision. I am incredibly fortunate to lead such an amazing team.

Have you been inspired by a nurse at CHOC? Nominate them for the Daisy Award

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CHOC Children’s PICU Earns Gold Beacon Award Recognizing Exceptional Patient Care for Third Time

The American Association of Critical-Care Nurses (AACN) recently conferred a gold-level Beacon Award for Excellence in the pediatric intensive care unit (PICU) at CHOC Children’s Hospital. This is the third time CHOC has earned the gold-level distinction.

beacon-logo

The Beacon Award for Excellence recognizes unit caregivers who successfully improve patient outcomes and align practices with AACN’s six Healthy Work Environment Standards. Units that achieve this three-year, three-level award with gold, silver or bronze designations meet national criteria consistent with Magnet Recognition, the Malcolm Baldrige National Quality Award and the National Quality Healthcare Award.

“The Beacon Award for Excellence recognizes caregivers in stellar units whose consistent and systematic approach to evidence-based care optimizes patient outcomes,” explains AACN President, Clareen Wiencek, RN, PhD, ACNP, ACHPN. “Units that receive this national recognition serve as role models to others on their journey to excellent patient and family care.”

CHOC’s PICU earned a gold award, the highest designation, by meeting the following evidence-based Beacon Award for Excellence criteria:

  • leadership structures and systems;
  • appropriate staffing and staff engagement;
  • effective communication, knowledge management, learning and development;
  • evidence-based practice and processes; and
  • outcome measurement.

“This award is further validation of our entire pediatric intensive care team’s dedication to the highest standards of patient safety and care,” says Melanie Patterson, RN, MHA, DNP, vice president, patient care services and chief nursing officer, CHOC Children’s Hospital. “We are entrusted with caring for some of the sickest and most medically fragile patients, and our goal is to deliver the best possible outcomes for them and their families.”

Have you been inspired by a nurse at CHOC? Nominate them for the Daisy Award

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