2022 California Council of Community Behavioral Health Agencies (CBHA) Conference

Upgrading Skills in a Changing Mental Health Care Environment

As healthcare has changed over time, so too has the knowledge and expertise required of the practitioners. Computer literacy for electronic medical records, knowledge and application of research and evidence-based best practices, and patient satisfaction are but a few of the most recent requirements. And, as information is more accessible, consumers are demanding more information about their providers and treatments; they are choosing providers based not only on their credentials, but on their advanced degrees, certifications, and their ability to empathize.

At NewYork-Presbyterian Hospital/Westchester Division (NYP/WD), the ways and means in which mental health professionals upgrade their skills in a constantly changing mental health care environment have historic roots. With roots dating back to 1808 and the original New York Hospital Asylum, we have provided continuous inpatient services to those with mental illness. We value our responsibility to continue the legacy passed on to us. As part of a teaching hospital, over the years we have trained medical students, nursing students, social work, psychology, and psychosocial rehabilitation specialists, and do so to this day.

Our primary focus is putting patient care first above all else. We respect patients and families by keeping them at the center of their treatment and recovery. Interdisciplinary teamwork is hard-wired as we provide empathetic care, ensure excellent quality and service, and find innovative, cutting edge solutions to treatment planning and work-flow. To ensure that staff provides the highest quality care, NYP/WD has developed a number of initiatives to increase knowledge and competencies, including formal education, certifications, ongoing training and real-world practice. According to Linda Espinosa, MS, RN, Vice President of Patient Care Services and Nursing, “We’ve seen the quality of care, patient satisfaction and employee engagement increase as our staff has become more educated and leaders in their respective fields.” By emphasizing the importance of education and reinforcing it, our clinicians are able to provide care according to current best practices. When available, staff can participate in established programs; if not, we create our own to address the need.

NYP has partnered with a number of schools to create an RN to BSN Program, Executive Master of Science Public Administration: Concentration for Nurse Leaders (EMPA), a Master’s in Nursing Education, and a Doctorate in Nursing Practice for nurse leaders. An education stipend is available, so an advanced degree is attainable rather than a burden. For areas where no formal program is available, we create our own to fill the need. Due to shorter lengths of stay for patients, our Department of Social Work responded by enhancing skills in the area of brief treatment. They created a curriculum for social workers to learn about creating narratives with patients, treatment contracting, assessing risk, stabilization of acute symptoms, developing safety plans, as well as empowerment and recovery.

When staff members receive their degrees, they are encouraged to continue their education and pursue certifications in their respective fields. More than a third of our nurses are nationally certified in their specialty. Many of our Psychosocial Rehabilitation therapists completed Cognitive Behavior Training and went on to become licensed. Staff Chaplains are increasingly required to become certified as Board Certified Chaplains and/or Clinical Pastoral Educators. These certifications show a commitment to becoming experts in every field in order to provide the best quality care to patients.

After receiving a degree and/or license, the hospital encourages maintaining and updating skills on a regular basis. Through ongoing in-service training, grand rounds, seminars, management training and mandatory yearly education requirements, staff remain current on behavioral health treatment methods and learn about best practices from the literature and other institutions. Additionally, staff is encouraged to publish their work, to participate in poster presentations, and attend and present at conferences.

One of the most important parts of education is putting it into practice. The Department of Nursing has an established Shared Governance Model, which encourages nurses in direct patient care with a mechanism to change practice based on research evidence. The clinical Career Pathway program fosters professionalism, leadership, consultation, and teaching by the direct care nurses. Our Primary Nurse model for direct care nurses enhances the development of the therapeutic relationship of the nurse and nursing support staff team with their primary patients. Nurses endorse the recovery model by allowing patients to direct their care with the guidance and advocacy of their Primary Nurse. By modeling certain techniques and behaviors, our patients see firsthand how to utilize skills they are being taught.

Yet education goes beyond the classroom and peer training. In some ways, updating very basic skills is what is needed. According to Beth Harris, RN, MA, PMHCNS-BC, Coordinator of Health Education, “We’ve moved from self-learning (hard copy) manuals to online manuals and in some cases to interactive online learning. We allow employees to complete required educational materials electronically from home when they prefer. All staff members have 24/7 access to the Medical Libraries from all hospital computers which translates to staff members being able to search the literature for research and evidence 24/7.” By embracing technology, we are better able to adhere to current requirements. Our staff reduces errors by inputting all patient information into electronic medical records to better track the patient’s progress, medication, and status. While basic, these skills are necessary to ensure a better and safer patient experience.

With rapid changes occurring in healthcare on a regular basis, all healthcare providers in acute care settings, including mental health, must upgrade the professional skills in their treatment-toolbox. On-going professional growth, education, and teamwork, in addition to partnering with clients and families in their recovery, provide the best outcomes with the most efficient, cost-effective means possible. Healthcare professionals cannot be inflexible and reluctant to learn new evidence-based ways and means of caring for patients. The ability to be engaged, flexible and innovative, to seek evidence in the research for best practices, to be a life-long learner, to take the next generation under their wing – these are essential skills. Preceptors, mentors, supervisors, managers, and leaders should encourage their protégés and supervisees to develop and apply these skills. Herein resides the best hope for acute care hospitals and their constituents to not only survive the future, but to thrive.

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