Caroline Cusick Vierheller, MSN, MHA-I, BA, RN, CEN, COHN-S is a certifi ed emergency nurse (CEN) and certifi ed occupational health nurse specialist (COHN-S). She is a member of the leadership team for Nash Health Care Systems (NHCS), a community hospital health care provider in eastern North Carolina. Caroline’s roles include Operations Improvement Program Coordinator, Stroke Coordinator, Nursing Quality Council Chairperson, Pneumonia Process Improvement Champion, and advocate for Patient & Family Centered Care. Caroline worked as an emergency department nurse for the fi rst 17 years of her nursing career at this organization and she transitioned into leadership and informatics roles since completing a Master of Science in Nursing, followed by a Masters in Healthcare Administration Informatics. Her other concurrent experience includes two years managing an occupational health clinic inside and two years as the quality data specialist for the NHCS emergency department. She has published two peer reviewed articles in nursing and international healthcare journals and shared evidence based and research projects through regional and national poster presentations.


Context: Emergency department nurses are challenged by the potential dangers associated with increasing volumes of psychiatric patients. These high-risk patients can threaten the safety of employees delivering care and contribute to escalating violence in the health care workplace. Recognizing a concern that one fourth of all Americans have underlying mental health conditions compounds the challenge to providing safe care. Mental health patients may seek care for acute physical illness, trauma, or chronic conditions that exacerbate their psychological instabilities (Bennett, 2001; Sorkin, Pham, & Ngo, 2009). When emergency care teams deliver medical care to mental health patients, superior training, planning, and skills can improve employee safety and patient outcomes. Method: Literature review, retrospective data analysis from local patient populations, and experiential knowledge from reviewing patient care scenarios led to development of a plan for improving patient and employee safety related to psychiatric care in one rural emergency department. Results: Th e case review shared a nurse’s experience caring for a medical patient with underlying psychiatric illness. By learning from this experience, leaders developed a strategy to improve employee safety, share education, mandate training, instill confidence, and promote competence in an interdisciplinary environment. Observing safe staffing ratios, recognizing escalation, reducing length of stay, and starting early therapeutic intervention for behavioral health problems improves patient outcomes and reduces the risk of patient outbursts. Conclusions: Mental health populations represent a vulnerable segment within the United States' health care system. Th e trend of increasing volumes in this sub-group can be expected to increase as state facilities close and patients are discharged back into communities for long-term management. Aging populations facing isolation, depression, or declining cognitive stability have increased the incidence of patients with combined mental challenges and physical illness. Increasing awareness, maintaining vigilance for safety, and minimizing danger are important to the success of delivering medical care to these mental health patients.

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