Nursing Workforce Development: Implications for Children’s Mental Health

1. Nursing Workforce Development: Implications for Children’s Mental Health Nalini Jairath, PhD, RN, Dean Ellen Mahoney, DNSc, CARN, RNCS, Clinical Assistant Professor Sylvia Stevens, MS,RN,CS, Clinical Assistant Professor School of Nursing, The Catholic University of America The Skills to Succeed -The Values that Guide

2. Purpose: Describe an educational initiative for nursing personnel caring for adolescents and children in a dedicated psychiatric facility • Assumption: The knowledge, skills and attitudes of care providers can be changed through targeted, on-site education The Skills to Succeed -The Values that Guide

3. Mental Illness in Childhood • Approximately 1 in 5 American children have diagnosable mental illness in any given year (US Surgeon General) • Mental illness significantly affects daily life for approximately 5 million American children and adolescents • The most severely affected children require some type of acute/longer term intervention in a dedicated psychiatric setting The Skills to Succeed -The Values that Guide

4. Mental Illness in Children • Anxiety Disorders • Disruptive behavior disorders • Developmental disorders • Eating & Elimination disorders • Learning & communication disorders • Affective/mood disorders • Schizophrenia • “Tic” disorders • Dual Diagnoses The Skills to Succeed -The Values that Guide

5. Treatment • Medication • Psychotherapy (directed counseling) • Expressive therapies (music, play, art) • Team approach; all care providers are involved in therapy The Skills to Succeed -The Values that Guide

6. Nursing Role • Therapy involves changes in life patterns and responses • Therapy is not confined to encounters with psychiatrist, but also occurs in groups and individually • Nursing personnel are present 24 hours The Skills to Succeed -The Values that Guide

7. The Concern • Massive shortage of nurses • Even greater shortage of psychiatric nurses because of need for special skills, stigma of mental illness • Balance between RN, LPN and psychiatric technicians • The role of culture and education upon knowledge, skills and attitudes of nursing personnel The Skills to Succeed -The Values that Guide

8. Nursing personnel must be present in sufficient numbers and must have the knowledge, attitudes and skills to be therapeutic as opposed to simply being present The Skills to Succeed -The Values that Guide

9. Grant Goals • Develop career advancement program for culturally diverse nursing personnel • Augment skills in current child and adolescent psychiatric-mental health care roles across clinical settings • Promote entry into nursing and advancement through nursing degree The Skills to Succeed -The Values that Guide

10. Partners • School of Nursing: The Catholic University of America • Adventist Behavioral Health Network • (Potomac Ridge) • (Crownsville Hospital) • (Adventist Healthcare Group Homes) • (Runaway Program) • Montgomery County Community Mental Health Center/Linkages The Skills to Succeed -The Values that Guide

11. Potomac Ridge Adventist Behavioral Health • Acute children’s unit • Acute adolescent unit • Two long term units for girls who have been sexually abused • Sexual offender unit for boys The Skills to Succeed -The Values that Guide

12. Nursing Personnel • Roughly 30% registered nurses, 20% licensed practical nurses & 50% psychiatric technicians • Many of the nurses have been educated outside of the United States, most notably in the Caribbean & African nations • Multicultural staff The Skills to Succeed -The Values that Guide

13. Orientation Unit-based training of nursing staff REMEDIATION Pre-nursing transition Intro to Psych. Nursing Certificate Offerings Nursing Degree Programs Proposed Developmental Pathways Through Career Advancement The Skills to Succeed -The Values that Guide

14. Strategy • Non-degree certificate program • Articulation into nursing degree program • Pre-nursing transition program • Computer Labs & Web-Enhanced Learning The Skills to Succeed -The Values that Guide

15. Certificate Programs • Caring & The Healing Arts of Psychiatric-Mental Health Nursing • Human Growth & Development in the Early Years • Social Justice & Mental Health Care Ethics for Children & Adolescents • Clinical Observations & Assessment of Children & Adolescents The Skills to Succeed -The Values that Guide

16. Certificate Programs (cont) • Clinical Interventions for Children & Adolescents 1 • Clinical Interventions for Children & Adolescents 2 • Evidence-Based Clinical Practicum • Each module is about 20 hours The Skills to Succeed -The Values that Guide

17. Outcomes • Computer labs/learning centers established at two sites • Long distance teleconferencing/telelearning packages in place • Courseware for online learning functional • Certificate modules available via face to face and online The Skills to Succeed -The Values that Guide

18. Outcomes • 27 nursing staff employees of the Adventist Behavioral System have taken classes in certificate program (19 nurses and 8 technicians) • Approximately 1 on 5 nursing staff employees have taken certificate programs • 27% decrease in turnover rates for the combined group The Skills to Succeed -The Values that Guide

19. Outcomes (cont) • Pilot of streamlined admission process to MSN program at CUA through elimination of GRE requirement • Research project entitled “Hospitalized Psychiatric Patients’ Perceptions of Nurse Caring Behaviors” is under development • Poster presentation at American Psychiatric Nurses Association 2005 conference The Skills to Succeed -The Values that Guide

20. Issues • Computer competence of nursing personnel;in-service education required • Poor staffing and inclement weather affect ability to attend face to face classes • Different learning needs of ABH nursing personnel and Linkages to Learning personnel • Challenges involving nursing staff in research & evidence-based practice opportunities The Skills to Succeed -The Values that Guide

21. Conclusion • Personnel costs of grant offset by retention benefits • Nursing workplace program is cost-effective and should ultimately improve patient care The Skills to Succeed -The Values that Guide

22. Acknowledgement • The project described in this presentation was supported by a grant (D65HP03108) from the Bureau of Health Professions. Their support and assistance is gratefully acknowledged. The Skills to Succeed -The Values that Guide