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Psych Nursing In A Pandemic

When they say, “the hospitals are full,” or “the wait in the Emergency Department is long,” or “patients are being shipped hours away when a bed is finally found,” you think that is not an issue that will ever impact your life. And while these statements are all true for patients with physical medical needs, I want to paint a different picture for you.

You are the parent of a child who is struggling with their mental health. They may have been doing great before the pandemic or even just decent, but we are now two years in the trenches and things have reached a tipping point. You are now waiting in that Emergency Department, maybe in the hallway on a cot, only allowed to remain with your child because they are a pediatric patient. Both behavioral health zones are full, the child/adolescent inpatient unit that is across the skywalk is also full, and you are being told your child may need to be sent hours away when an appropriate bed is found. This is your child that has never even had a single therapy appointment. Your child that spoke up and said they were struggling a few months ago, and being the caring parent that you are, you signed up for numerous waitlists for virtual therapy, so your child could speak with a professional over video chat about their life that you didn’t know was falling apart. They never made it to the top of the waitlist, so here you are, on a cot, in a full Emergency Department, waiting and hoping for a nearby inpatient psychiatric bed.

The bed becomes available, and your child is transferred to the inpatient unit. You say your goodbyes in the Emergency Department and schedule your Zoom visits and phone call times to try and stay connected during their care. Sometimes you call the unit for an update and the phone rings and rings, and you think no one will answer it. When they finally do, you can hear in their voice the struggle to sound polite and provide good customer service, and you can also hear the tired. You can’t escape the tired of working for almost two years, with ever changing restrictions and new protocols to ensure safety, and most of the time without adequate staff to provide quality care. The phrase, “we’re all doing our best, and we can do better,” is no longer a dialectic that anyone wants to utter, and yet, it is where we find ourselves every day. Instead of building rapport with three patients sitting at a table playing cards, you are reminding them, “two to a table,” “sorry, you have to sit diagonally,” and “you know, I think the Uno cards are still in quarantine, is there something else you’d like to play?”

This unit that used to bustle during visiting hours and slow down around the holidays now has virtual visits and is overflowing during the holidays. One psychiatrist has retired, and a traveling psychiatrist signs a brief contract to help provide medical coverage. The newly constructed unit across the hall has had their opening date pushed back multiple times as the hiring process to find a provider has been unfruitful. The next generation of enthusiastic psychiatric providers are becoming burnt out before they have even reached their clinical rotation. They are now worried about whether they will be able to have a clinical rotation before their anticipated graduation date arrives. Teaching hospitals are no longer teaching to minimize the amount of people in the building to mitigate the risk of spreading illness.

Your child waited four days before their transfer to an inpatient psychiatric bed. They are approaching the end of their stay and you need to schedule a follow-up appointment. It will be a six month wait for an appointment with the psychiatric provider you received a referral to for medications. It will be a three month wait for the therapy provider you already waited three months on the waitlist to see prior to your child’s hospitalization. You now wonder if their virtual follow-up with their pediatrician and your support will be enough to keep them out of the hospital until they meet their new providers.

When they say that healthcare workers are exhausted, this is not an exaggeration. We want to help you, and we are truly walking the line of “we are doing our best, and we can do better.” This dialectic is something that should hold true for the world. When you start to find yourself frustrated with the person in scrubs, a mask, and goggles, telling you this cot in a busy Emergency Department hallway is where you must wait to see the psychiatric consult services member for an assessment for your child, and you want to raise your voice and demand privacy or a chair for yourself to not have to share the hospital cot, please know they are doing their best and we can all do better.

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