NYSNA nurses at Erie County Medical Center (ECMC) are hoping a redesign of the hospital’s Comprehensive Psychiatric Emergency Program (CPEP) will reduce violent incidents and keep both patients and caregivers safe. ECMC’s CPEP serves a wide geographic area and its patients include inmates from county and state correctional facilities.
Katrina Reynolds, an RN and CPEP Charge Nurse, would like to see ECMC adopt a better CPEP triage system. “As it is now, all patients — those suffering from simple anxiety to the severely psychotic — are housed together in one big room. Sometimes a nurse may have 15 patients.”
Short staffing exacerbates the unit’s tense atmosphere. Ms. Reynolds says long wait times are a leading cause of workplace violence, and “in the CPEP, if one person goes off, it often sets off a domino effect that can quickly turn violent.”
By law, a CPEP accepts all patients in need and has no census cap. Moreover, many patients stay well beyond the 72-hour mark, at which point they are supposed to be either admitted or released. Ms. Reynolds reports this is especially the case with patients with developmental disabilities who have been abandoned by their families. “If we cannot find a safe discharge option, these patients end up essentially living in this big, open room with no privacy and fraught with potential for violence. It is not a good therapeutic environment.”
ECMC’s nurses are working to improve conditions for psychiatric patients. “A few years ago, we filed an arbitration that resulted in the creation of a behavioral health and safety committee that meets twice monthly,” said Ms. Reynolds.
CPEP is also a topic at the monthly labor-management meeting. And ECMC created a new title of employees, PSAs, (Public Safety Associates), who are specifically trained to work in the psychiatric unit to intervene and deescalate tension.
Ms. Reynolds and her NYSNA colleagues continue to generate ideas for creating a safer CPEP: “We’re eager to share our ideas with ECMC as it moves forward with the redesign.”