Last week was National Nursing Week and Pomegranate held a reception to honor its nursing team. Nursing as an occupation varies widely in scope, specifics, practice type and requirements. Whether one takes blood pressures, teaches, directs a large staff, performs physicals and writes scripts, there are several levels, differing accreditation requirements, and settings- from the smallest town, to a school, to a suburban community practice to the large med-surgical hospital.
According to the American Psychiatric Nurse Association, “Psychiatric Mental Health Advanced Practice Registered Nurses (PMH-APRNs) offer primary care services to the psychiatric-mental health population. PMH-APRNs assess, diagnose, and treat individuals and families with psychiatric disorders or the potential for such disorders using their full scope of therapeutic skills, including the prescription of medication and administration of psychotherapy.” Further, “the PMH-APRN role is an advanced nursing role requiring extensive education in development, physical and mental health assessment, the diagnosis of mental health conditions, integration and implementation of care, psycho- pharmacology, psychotherapy, practice evaluation, consultation, and liaison.” See:
According to Rosetta Cowan, RN, BSN, Director of Nursing, “Psychiatric Nursing is different in that a medical model is combined with trauma-informed care and evidence based practices to promote the well-being and stabilization of both youths and parent/guardian. The goal for the patient is to be discharged to a less-restrictive environment with follow-up care appointments for medication management and counseling. Psychiatric Nursing combines several methods of healing including holistic, spiritual, and scientific interventions to enhance the care, safety, and well-being of each youth Pomegranate serves.” CNP Philip Wang explained what treatment team is like, sort of the ‘grand rounds’ at Pomegranate Health Systems with members of a multi-disciplinary team present.
Pomegranate’s registered nurses are responsible for conducting an initial assessment of the patient, to obtain a complete medical history and documenting identified concerns. This responsibility then extends to completing assessment notes, progress notes and required documentation within hospital and regulatory guidelines. In addition to the clinician’s therapeutic treatment, nurses also monitor and evaluate patients in the context of individual and group treatment for progress or development of additional symptoms of mental/behavioral disorders.
Each ‘at risk’ patient also receives risk/lethality evaluations, medication consents and med administration and monitoring. Lab reports, infection control, safety and physical monitoring are all part of the nursing role. Nurses not only communicate with clinicians and medical doctor/s, but with families, guardians, and case manager/s.
Nurses at Pomegranate Health Systems are also required to have first aid, CPR, Crisis Prevention Intervention training, client rights, abuse and neglect, minor aversive intervention and major aversive intervention training, behavior management plan, identification and assessment of contraindications, non-physical intervention/de-escalation techniques, assistance with self-administration of medication, fire and disaster procedures, obtaining medical and psychiatric assistance and other monthly and annual training. There are nurses on all three shifts, seven days a week, year-round caring for our teens.
The nursing team is supplemented by a wellness nurse who conducts nursing education groups on the residential units, unit clerks and medical records staff, administrative nurse and certified nurse practitioner. There are different needs between the acute hospital (treatment team meets daily) and residential treatment (the treatment team meets weekly). This is a different model than you’ll find at many residential treatment facilities with less acuity in the patient population. “A teen in crisis is in a vulnerable place,’ explained Nursing Director Cowan, ‘we work together to stabilize each adolescent and promote healing and resilience.’
Videos on psychiatric nursing: http://www.apna.org/i4a/pages/index.cfm?pageid=5495