Psychiatric emergency room holding cells

Did you know that patients with psychiatric emergencies have to wait the longest to receive care? At my local hospital the average daily census in the “psych ER” is 60 patients. That is, 60 patients a day are triaged and waiting for a bed to become available so they can get treatment. Not just a bed on the psychiatric unit at that particular hospital — I’m talking about a bed on a psychiatric inpatient unit anywhere in the western part of the state. Patients can wait for days, weeks, and even months to be transferred out of the ER and into a hospital for treatment by psychiatric medical professionals.

One particular ER at a large hospital in the southeast has psychiatric patients wait for days in small, dark rooms, 4-6 per “pod”, with nothing to do except look at old magazines or DVDs. There are no windows, and there are no clocks. The only way to mark the passing of time is during shift change and by what meal is being served. Some of the pods don’t have beds — just recliners. There is no counseling or therapy. Some patients are allowed to journal in composition books, the closest form of treatment until they are admitted. Medication is adjusted by staff covering the ER; it’s often cursory at best and is just a temporary measure. But the staff are kind and caring and patients try to support one another. Everyone is trying to make the best of an awful situation.

So the next time you find yourself in the ER, whether it’s for yourself or a friend, count your lucky stars if it’s not for mental health reasons. As you wait to be treated for your medical emergency, try not to complain that it’s been 3 hours and you’re getting uncomfortable on your hard gurney, and you’re cold and need another blanket from the warmer.

person holding hour glass

Photo by samer daboul on


Holistic options for psychiatric NPs in long-term care



As a psych NP new to working in LTC settings I’m finding scant research on what to prescribe that has the fewest side effects. How can I incorporate holistic care into my practice? I prescribed chamomile for the first time but didn’t get the chance to evaluate it because the patient was discharged from the short-term rehab she was on. Aromatherapy is not being used enough, at least not in the facilities where I practice; how can I bring it to my practice in an easily delivered manner? I read where one psych NPs provided boxes of Lorna Doones for nurses to keep on the med carts and actually wrote orders for them to be used PRN. As long as diabetes isn’t an issue that might work but I haven’t found the nerve to use them yet!

If you have suggestions I’d love to hear them. If you know of resources, websites, articles, anything — please share.


For All Time

Music has such power to heal. Thank you to outofagreatneed for this post from June 23rd that I’m reblogging here on NurseGrit.

Out of a Great Need

This song…

pulls me back to the darkest days, during our younger daughter’s adolescence, when long drives helped her racing mind in the midst of the overwhelming symptoms of her severe brain illness.

We took long drives every single day for several…yes…several years.

We listened to music.  This is a song from one of the CDs she would bring along.

But this song does not upset me.

It reminds me that all of the quiet patience made a difference.

It reminds me of a bond that cannot be broken by a severe brain illness.

This song reminds me of the power of love.

It reminds me to NEVER give up.

View original post

7 Step Diet and Lifestyle changes for Alzheimer’s Prevention


The topic of Alzheimer’s disease treatment has been a topic of conversation multiple times in the past few days so this is my blog topic today. While we wait for a cure for AD, there are steps we can take to hopefully better position ourselves from a prevention standpoint.

At the International Conference on Nutrition and the Brain, Washington, DC, July 19–20, 2013, multiple recommendations were brought forth with respect to diet and lifestyle changes for prevention of Alzheimer’s disease (Barnard et al., 2013). Below is their list of 7 steps to take.

  • 40 minutes of aerobic exercise three times a week
  • Eat a plant based diet
  • Minimize intake of trans and saturated fats. Trans fats are often found in snack foods (especially pastries and fried foods). Saturated fats mostly are in meats and dairy.
  • 15 mg of Vitamin E every day, coming from plants and not vitamin supplements. Vitamin E rich foods: Seeds, nuts, green leafy vegetables, whole grains.
  • B-12 supplement of minimum RDA (2.4 micrograms daily for adults). Age can lower B-12 so be sure you get levels checked. Your primary care provider can do this for you easily.
  • If you take vitamins/supplements choose those those without copper and iron.
  • Avoid aluminum products. Jury still out but it’s linked to Alzheimer’s (as well as cancer). Aluminum is in many products we often use: deoderant, cake mix, dyes, processed cheese, antacids, baking soda/powder, foil, cookware.


Barnard, N. D., Bush, A. I., Ceccarelli, A., Cooper, J., de Jager, C. A., Erickson, K. I., et al. (2014). Dietary and lifestyle guidelines for the prevention of Alzheimer’s disease. Neurobiology of Aging, Volume 35 , S74 – S78.

Image: Physicians Committee for Responsible Medicine


NC #1 in naloxone distribution

The Guardian  published an article today (Timothy Pratt, June 10, 2016) about naloxone rescue kit distribution efforts in NC. The state claims national leadership status in the number of lives saved with naloxone in the shortest period of time (not by police, ERs, or other medical first responders). Key to that effort has been getting the rescue kits into the hands of opiate users and their peersThe NC Harm Reduction Coalition (NCHRC) is the organization responsible for this monumental undertaking. Most states are making similar efforts but some advocates have expressed frustration about the lack of cohesive plans to reach those in need.

Peter Davidson, a professor at the UC San Diego School of Medicine who has studied opioid deaths said it’s “frustrating” to see that other states haven’t yet adopted North Carolina’s methods, which he believes should be a national model.

“We have a really good … public health response that works, and seeing it not being done more comprehensively is infuriating,” he said. “You’re watching the death reports come in, and you know they don’t need to be that high.”

Let’s all learn from each other with the common goal of not just saving lives but treating addiction adequately in the first place.



How one NJ hospital’s ER is combating opiate addiction: no routine opioids for chronic pain

New Jersey ER bypasses opiates for chronic pain

Timely for APNA 14th CPI — NY Times 2016 article describes how this ER is using alternatives to opioids for managing many types of pain.

As psychiatric nurse practitioners our clients often have chronic pain. Knowing about alternatives to meds for treatment of pain can be helpful info to share with them and/or could reinforce what they might be told by their PCP or pain medicine clinic, in terms of alternates to opioids.