After working in the emergency department for a few years, I decided I wanted to take some time and work inpatient psychiatry without any experience and was assigned Sherrie as my preceptor. Sherrie had worked inpatient psychiatry and in the pediatric psychiatric setting for many years, and her passion was very evident as she taught me how to work with psych patients.
In nursing school, you learn about care plans and assessment, not truly understanding the importance, but the magnitude of a care plan is very evident in psychiatry. Patients in inpatient psychiatry are often deemed hopeless or frequent fliers or delinquents. These patients often have underlying conditions or have been in the system for very long periods of time. They often lack support or care and develop poor coping skills because of the circumstances they have grown up in.
Although I saw and learned so much about active listening, boundaries, and care plans from all of Sherrie’s interactions with patients, I saw all of it really come together with one patient in particular. This patient was a product of the system for several years, after removal from his dysfunctional family, with very little support. He never had visitors unless they were CPS and longed to make phone calls to family members who often would make promises they could not keep.
When he was mad, he would become aggressive and destructive and attempted to bully others when he did not get his way, although his way often did not seem logical. Several staff members thought we would just wait out the time until he moved into a long-term facility and that we would not be able to offer him much assistance due to his repeat history of being in facilities similar to ours. Sherrie saw otherwise.
Sherrie worked with this young man, treating him like she would one of her own sons. She assessed his negative interactions and helped him to develop a true safety plan and coping mechanisms to implement when he was escalating because something did not seem fair. Instead of just letting him escalate and then reprimanding him when he was calm, she practiced active listening and helped him to sort out the intrusive emotions that seemed to bubble up even on little things. When he paced the hallways, instead of ignoring him she partnered with him and showed compassion pacing the hallways with him, helping him to understand consequences to actions. He went from punching walls and flipping desks when things didn’t go his way, to being able to better articulate himself and problem solve.
Although she developed this care plan for him, she did not give him any passes. She held him accountable when he knew the right thing, but chose the wrong thing using our point system within psychiatry. Instead of it being a negative thing to lose a point, she used it as a teaching opportunity and showed him respect, helping him to come up with activities on level 1 that would help him learn from his mistakes, such as journaling his thoughts and feelings or writing letters. She helped him to understand that he was not a mistake and that he didn’t have to let his current circumstances dictate his future.
One thing that has always impressed me about Sherrie is that she doesn’t have to work, she doesn’t have to devote her time to these kiddos, but she does anyways because she is passionate about making a difference in their lives, even if it is for a short time. She pushes the care team to make decisions that will benefit the patient and helps novice psych nurses develop skill and understanding when making an individual plan for the patient, even in the short term.
Sherrie thinks outside the box, not just generic interventions when working with these complex patients. Someone once said, “Don’t judge each day by the harvest you reap, but by the seeds you plant.” We often didn’t know what the patients’ outcomes were after they left, but that didn’t stop Sherrie from continuing to provide excellence and strive for the best. Psych didn’t work out for me, but I learned so much about seeing past the here and now to knowing that one of my actions can benefit someone’s entire life.