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 and to receive tips and education from mental health experts.

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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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A day in the life of a child life specialist

The Cherese Mari
Laulhere Child Life Department
at CHOC Children’s strives to
normalize the hospital environment for patients and families. “Normalizing” the
hospital experience means making things like medical equipment and procedures
feel less strange or foreign. By doing this, patients and families can feel
more at ease while at the hospital and will be able to focus on what is most
important: feeling better.

But just because we’re a children’s hospital, doesn’t mean we only treat little kids. CHOC child life specialists work with teen and young adult patients, too. Follow along for a day in the life of Karlie, an oncology child life specialist.

6:00 a.m. – My alarm goes off and I quickly push snooze. I lay in bed for a bit longer as I am still trying to master the art of getting out of bed as soon as the alarm tells me to. After a few more moments of relaxing I get up, ready to take on the day. I get ready, make some breakfast, pack my lunch and my workout clothes, and head out the door by 7 a.m. to get to work on time.

8:00 a.m. – After making it through infamous Southern California traffic, I arrive at work. During my drive, I usually listen to some sort of motivational worship talk or devotional and once I park, I say a quick prayer to help me be ready for the day. I walk into my office and greet my fellow child life specialists. The office is full of smiling faces, and despite the early hour, it’s already bustling with colleagues talking about various patients and their needs. I work on the hematology/oncology unit, but we have child life specialists embedded in practically every unit and area of the hospital. Our team is filled with energetic, gracious and positive people trying to provide the best support possible to the patients and families that we serve. I feel so grateful and able to take on the day with them by my side.

8:15 a.m. – To start the day, I get a copy of the patient census—an overview of the current patients admitted to the hem/onc unit. I also check the surgery schedule to know what surgeries or procedures my patients have that day.

8:30 a.m. – I head to a meeting with the oncology multidisciplinary team which consists of the medical and psychosocial team. We discuss various patients and their plans of care. We also discuss what psychosocial needs have already been met and what support they still need. We make sure to communicate with each other so that as a team we can ensure we’re meeting our patient’s physical, emotional, spiritual and mental health needs.

10:00 am – I head up to the hem/onc unit and check in with the bedside nurses, so I know what the plan for the day is for each of the patients that are on the unit. We discuss how we can work together to best help each patient. I talk to one nurse about a 17-year-old patient that was just admitted last night with a new diagnosis of leukemia. She tells me that he is feeling nervous about a procedure he’s scheduled for later that day. We go over my plan to support him and I tell her I will keep checking in and keep her updated with how the patient is feeling. I then go into his room and introduce myself and tell his family more about what child life has to offer in terms of “normalizing” the hospital environment. We also talk about what he likes to do, his favorite sports teams and who makes up his family. After we have built some rapport and trust, we talk about his upcoming procedure and I explain it in a way he’ll understand, and it helps ease his anxieties. We talk about why the doctors want him to get some tests done and what these tests will tell the doctors. We talk about the roles of each staff member he will meet, and how they will help him. We set up a hospital tour for later that day. In the meantime, I call my volunteers to drop off a soccer Xbox video game for him to play in his room while he waits.

10:30 a.m. – I get a call to come and help one of my long-time patients with her port access. A port is a medical device surgically placed under the skin in the chest that can be accessed with a needle for infusions and lab draws. When she was first admitted, we worked on coping techniques including medical play, and now she doesn’t get as anxious for procedures. She’s been in treatment for six months, but she still prefers me to be there, and I enjoy seeing her and being there for her. We play her favorite iPad game together while the nurse does the procedure. During the procedure I remind her of each step of the process as it comes, to help her feel empowered and ready. During the needle poke, we do deep breathing exercises together to breathe away any pain or discomfort, and she squeezes my hand. As soon as the poke is done we go back to playing on the iPad and laughing at inside jokes we’ve developed over the last few months. I applaud her for how well she has been doing with her port needle accesses and tell her how proud I am of her.

11:00 a.m. – I take the time to check in on some more patients that I know, and make sure they have everything they need for the day, including some fun activities to look forward to. A few of my longtime patients are in the middle of long hospital stays, so I come up with a plan for something fun and different for them to do that day to help make the most of every day they are there.

11:30 a.m. – I check in on my new 17-year-old patient and find that he is ready for his tour. We start by walking around the hem/onc unit and I show him the gym and the teen room. He loves air hockey, so I show him the air hockey table in the playroom as well.  On our tour, we cross paths with a pet therapy dog, so we stop to spend some time with him, and we all laugh as the dog does one of his famous tricks that he has practiced for a doggy treat. We then head down to the second-floor lobby to check out the amenities it has to offer. We check out Seacrest Studios (our in-house radio station), the movie theater, another teen room, Turtle Talk, and two outdoor patios. Child life organizes a lot of special events for patients, and today we are hosting several baseball players from the Angels. We stop by that event while we’re on the second floor and check out the games going on, crafts, giveaways and my patient snags a few photos with his favorite players before I escort him and his family back up to their room.

12:00 p.m. – I take time for a quick lunch break with my fellow child life specialists. I work with some of the kindest, strongest, most giving and selfless people that I know. We enjoy some great conversation about work and about our lives outside of work. My coworkers are my greatest support on the job and I feel grateful to be able to work alongside them and the other wonderful staff at CHOC. I am thankful every day for the wonderful coworkers I have that are also some of my closest friends!

1:00 p.m. – I head back up to the 5th floor to take part in one of the best parts of my job. Today we’re celebrating the final chemotherapy treatment of a 22-year-old patient. I have a trophy and a sign that reads “Happy Last Chemo!” I gather the nurses, clinical assistants, nurse practitioners, and any other available staff to join in. We parade into the patient’s room cheering, and sing the “Happy Last Chemo” song to the tune of “Happy Birthday.” As I look around the room, I see that the patient, her family, and all the staff have tears of joy in their eyes. We are so happy for this patient reaching the end of her treatment. This is definitely something worth celebrating.

2:00 p.m. – I get a call from the front desk that some special visitors are waiting for me. I know it is the surprise we have in place for another patient. This patient, a 13-year-old girl, has been in the hospital for a while and I know she could definitely use an emotional boost. Today is her golden birthday, which is the perfect time for a big surprise.  I reached out to a local jewelry store and asked for their help. They agreed to bring some cute gold jewelry items for this patient to help celebrate her golden birthday. I feel so grateful for our community partners that are so generous and willing to help our patients. Seeing my patient’s face light up warms my heart. She knows that she was thought of individually and that people wanted to make her day brighter.  I am so grateful to be able to help provide these special and meaningful experiences to a patient like her that is so kind, strong, and such an example of perseverance.

2:30 p.m. – I return to the room of my 17-year-old patient and take him down to the pre-operative unit for his scheduled procedure. We talk about new questions and concerns that he has thought of since this morning, but we also talk about the things in his life that are important to him; his friends, family, sports, school, and fast food. When it’s go-time, I stay with him as his parents go wait in the lobby. Before he receives anesthesia, I stay with him as we listen to his favorite artist and talk about what songs he likes. I’m a terrible singer, but we sing together to take his mind off the procedure. We continue doing this while the wonderful team of nurses, technicians, physicians and anesthesiologists get everything ready. The patient and I continue to talk, and I interject every once in a while, to let him know what the procedure staff is doing as we go along. It is time for him to receive his anesthesia and I talk with him until he falls asleep. Afterwards I thank the procedure room staff and doctors for all that they do and I exit the room for the procedure to begin.

3:00 p.m. – Afterwards I head back up to the hem/onc unit for a planning meeting for our biggest event of the year. Each year, the CHOC Children’s Oncology Ball presented by The J. Willard and Alice S. Marriott Foundation is a chance for oncology patients and their friends to celebrate their life and all they’ve been through. This event is part of the Adolescent and Young Adult (AYA) treatment program. Our team spends months planning this event so that every patient, no matter their age, can feel like Prom King or Queen for the day.

4:00 p.m. – After that brainstorm meeting, I check in on the family of a newly diagnosed 2-year-old boy. As I enter the room I see that the patient is napping but that his big sisters have come to visit. I talk with the siblings and educate them about what they see in the room and help them understand their younger brother’s diagnosis through a medical play activity. I help them understanding what the nurses and doctors are doing to help him get better. We talk about how they are feeling and concerns and fears that they have. One sister thinks this diagnosis happened because she once got really mad at her brother for taking her toy. I assure her that her brother’s cancer is nobody’s fault, and that there is nothing anyone did wrong that made this happen. We talk about how they can help their brother while he is in the hospital. They can play with him, draw him pictures, give him hugs, wash their hands so he doesn’t get germs, and help mom and dad around the house. I want them to know that as siblings they are important too, and I am here to provide support to them as well. I remind them that every fun thing in the hospital is for them too! With their parents’ permission, I take them down to Seacrest Studios to hang out with the staff there. Seacrest Studios music and programming is broadcast to every patient’s room, and the girls get to help host the daily game of Bingo. To see them feel special and get the attention they need warms my heart. Illness really does affect the whole family and taking the time to acknowledge and be there for each family member is so important.

5:00 p.m. – After leaving the siblings in the excellent care of the staff in the Seacrest Studios I head back to my office to gather my things and head home for the day. On my drive, I call my mom who lives in Utah. I talk to my mom about my day as much as I can without breaking patient confidentiality. I enjoy talking to my parents and know they will always give me sound advice. My mom hands the phone over to my youngest brother, who is a senior in high school and we catch up on his day. I love hearing about my siblings’ lives. I am one of ten children!

5:30 p.m. – I arrive at the gym for my workout. Exercise is a great time to decompress from the day and relieve any stress I may be feeling from whatever sad or difficult situation that may have happened that day. I absolutely love my job, but it can be hard to watch these patients and families go through such difficult things― patients feeling sick, losing their hair, hearing that their cancer came back, having to get a poke for blood, and the reality of sometimes losing a patient to cancer, all takes a big toll on our staff. In addition to support from my colleagues, I also try to find things outside of work that help me cope, and working out is one of those things. Today was not one of those really difficult days, but running on the treadmill and doing some weight training definitely helps me decompress and transition out of work.

6:30 p.m. – I head home and make dinner while I talk to my roommates. We talk about our days and then we have friends come over for a fun game night.  It is a great night spent relaxing and connecting with friends.

10:00 p.m. – Time for bed so I can give tomorrow all the energy it needs! I count my blessings, especially being able to spend every workday with the most amazing kids, teens and young adults who are fighting their illnesses with grace, positivity, joy, strength, wisdom and the desire to make the most of every day. I look forward to tomorrow, and the opportunity to offer each patient and family member I come across my best care and support to make their day even a little bit brighter.





Learn more about CHOC's child life services




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CHOC Children’s leaders observe International Women’s Day

As the world celebrates International Women’s Day, we are highlighting several CHOC Children’s female physician and nursing leaders. They offer insight and words of encouragement to women seeking to pursue careers in medicine.

Melanie Patterson, vice president patient care services and chief nursing officer

melanie-patterson

“When beginning your career in medicine, don’t focus on one trophy. The fields of medicine and nursing have so many opportunities within them; be courageous and try new things. The most important aspect of leadership and of career success is to be kind. Remember to form your own opinion—go into every relationship with your eyes open and stop looking through others’ eyes; they don’t always have 20/20 vision.”

Dr. Mary Zupanc, pediatric neurologist and co-medical director of the CHOC Children’s Neuroscience Institute

dr-mary-zupanc

“When I went to medical school, women were not encouraged and it was hard. There were a lot of things that happened that made it very difficult, but medicine is truly one of the most gratifying professions you will ever have.

Every patient is different. I believe that if you really and truly listen, a patient and their family will give you the diagnosis you’re searching for. Everyone’s story is so fascinating, and that makes our work like being a detective. Sometimes I feel like Sherlock Holmes searching for answers. Then once you do find an answer, you need to work with the family to make sure the treatment works for their lifestyle, culture and religion. That makes the work challenging, fun and meaningful.

The best piece of advice that I’ve ever received is to never apologize for excellence. Anyone would want their doctor to strive for excellence – and that goes for any profession.”

Amy Waunch, nurse practitioner and trauma program manager

amy-waunch

“Never underestimate your capabilities; do not shy away from opportunities and always take on new challenges. Believe in yourself but don’t be afraid to ask for help. You may not have all of the answers all of the time, but you do have the ability to learn and grow.

Spot growth opportunities when they present themselves because they are the key learning opportunities. You will know because they make you uncomfortable and your initial impulse will be that you are not ready.”

Dr. Azam Eghbal, medical director, radiology

dr-azam-eghbal

“Since I was 7 years old, I wanted to be a doctor and becoming one has been the best decision of my life. As a female immigrant, I was told that I could never get to medical school, which of course motivated and challenged me even more to do so.

The best advice I’ve gotten is: don’t be discouraged about all your falls and obstacles, think about how you can succeed to get where you want to be.”

Dr. Amber Leis, plastic surgeon

dr-amber-leis

“My advice for women pursuing a career in medicine is to trust yourself! Early on in your career it’s easy to be overcome by feeling like you are not up to the task ahead of you. Your unique qualities will become your greatest strengths, so just keep chasing your passion.

I have great faith that if I stay true to my core principles, the right path will open in front of me. I try not to set specific goals for the future and instead I give my best to where I am. It keeps me focused on what I am doing now, and not distracted by trying to maneuver into some future place.

The best piece of career advice I’ve ever gotten has been ‘You get to choose what kind of person you will be.'”

Dr. Jasjit Singh, medical director, infection prevention and control

dr-jasjit-singh

“My advice for women pursuing a career in medicine is to follow your passion! There are few other careers that offer the personal satisfaction and the intellectual rigor that medicine does. Find a good mentor early in your career. Later, make sure your practice partners have abilities that you respect, and the talent to make your shared time together meaningful.

I learned early on that delegation and time management are important, particularly if you want to balance a medical career and family. You can’t always do it all, and prioritization is tantamount to success in all the different spheres of your life.

One of the best pieces of advice that I got was from a mentor during fellowship, who told me “It’s not enough to just be a good clinician.” He showed me the importance of asking good research questions and pursuing new knowledge. He also encouraged my love of teaching upcoming generations of pediatricians!”

Dr. Katherine Williamson, pediatrician

dr-katherine-williamson

“I love being a pediatrician. I help take care of kids every day and partner with their parents to help keep them healthy. To me, being successful is loving what you do because then working hard and being motivated to do well doesn’t feel like work; it’s fulfilling a passion.

When asked to give advice, I always say these three things: be yourself, don’t rush, and follow your heart every step of the way. Be yourself, always. No matter how busy or loud life gets, never lose sight of who you are and what you want to do.  Don’t be in a rush. Enjoy the journey because that is where you learn who you truly are. Lastly, follow your heart in every decision you make. When I look back on what got me to where I am in my career, I realize that it was not one or two big decisions that were the deciding factor, but instead it was a million little decisions along the way. And with each of those decisions I followed my heart and my passion.”





Explore career opportunities at CHOC.




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