Video: Child and Adolescent Psychiatric Nursing

Slide 1 - Introduction

• My name is Jessica McCurry. I am a Nurse Practitioner at CHOP. I’ve been with CHOP for just about 10 years now in different functions, but I’ve been a Nurse Practitioner for about four.

Slide 2 - Jessica McCurry, MSN, CRNP

• So I went to high school in Massachusetts. It was a small public high school, so I am not as familiar with this area in terms of high schools. But I have been here for college ever since I went to Penn for both my undergrad degree, which was in nursing, which is a BSN and/or a Bachelor’s in the Science of Nursing; and then I also got my Master’s at Penn in Psychiatry Mental Health. So I am a Psych Nurse Practitioner, and I work at CHOP in our Behavioral Health Department doing a couple of different things that I’ll get into, but one of the really exciting things that kind of drove me to Penn and towards CHOP as well was Autism. So I specialize in Autism Care, and there is a Certification Program that exists at Penn and nowhere else that does the Nursing Care of the Autism Spectrum Disorders. So that really, kind of sets me a part and makes me different and was a really great opportunity for me to kind of continue my career.
• This is a lovely picture that I dug up of me in Nursing School. I don’t wear scrubs anymore to work. I really miss them desperately, but I figured that was the best picture.

Slide 3 - Department of Child and Adolescent Psychiatry & Behavioral Sciences

• Alright, so right now where I work is technically called DCAPS. We’re in the middle of the process to rename the department, because that is the lamest acronym ever, but it is okay. So within the Department of Child and Adolescent Psychiatry, there are three different divisions, and I work within two of them. So the first one is Outpatient. We have an Outpatient Clinic at 34th and Market Street in Philadelphia, and that is where I spend about ¾ of my time doing traditional outpatient psychiatry. So that looks like seeing kids anywhere from 4 to 18 for things like anxiety, depression, ADHD as well as Autism, because that is what I specialize in. The other ¼ of my time that may be a little more interesting to people who are interested in traditional nursing is I spend one week a month in the Main Hospital on one of our units, the MBU. So it is a newer unit, and it is a Medical Behavioral Unit, and it is a 10 bed unit where we admit kids who have a medical problem whose behavior gets in the way of treatment. That is the intent of the unit, but we also sometimes hold kids who are waiting for an inpatient bed for psychiatry that is not yet available.

Slide 4 - Medical Behavioral Unit

• This is a picture of the MBU, so you can kind of see what that unit looks like. It’s just about 3 years old now, but it still looks pretty much like these pictures.
• So the picture on the left is a view of where our nurses’ desk is. One of our administrative assistants sits there and you get a view of almost all of the patient rooms. The unit was designed really carefully to make sure there is access to natural daylight for all patients and staff throughout the day. And it was themed with a nature theme very specifically on purpose, because there were studies done to prove that that is calming and helps with the experience. So you’ll notice that there are other pictures- there’s trees. And even our conference rooms, they have like opaque glass so you can kind of see through them so that way even in conference rooms that are more private, there’s access to natural light.
• The picture on the right is our playroom. So kids on the unit interact with each other and there are Child Life Specialists to help facilitate that play, because we can have anywhere from 2 year olds to 20 year olds, and they don’t really play the same. But there are people on board who help with that.

Slide 5 - Medical Behavioral Unit

• The picture on the left is another view just down the hallway of all the natural light we get inside. The one thing this unit does not have that some of our other units do have is access to the outdoors. Our unit is locked for safety, but in general, we do have some patients who are able to go to like our roof deck play place when they’ve earned it.
• On the right side is a picture of one of the hospital rooms. So it looks like one of our traditional patient rooms, but it has only, they serve only one patient at a time, so it is only one person per room whereas some of our rooms are two though but most are now one person. So you can kind of get a sense of what a room might look like inside our hospital.

Slide 6 - Research

• So the one other thing that kind of comprises part of my job, so in general, most of my job is clinical care. I take care of patients and that’s the most of what I do. But I do have a research background, and I am doing some clinical hands-on research right now. So when I was in college, I worked at the Center for Autism Research as just a basic research assistant, which was really nice because I got my hands in everything and I met all different people. In general, that also connected me with a lot of the Autism specialists that I now know and use as mentors and use for connections. I love the Center for Autism Research. It’s beautiful, they’re made up of great people. And if you’ve heard of the Eagles Autism Challenge, it greatly benefits them.
• The way that I am more directly involved in research right now is clinical research. I am one of our study clinicians for a study called MOBILITY. I included what that actually stands for but I could not have told you that, because the acronym doesn’t line up like at all. They stretched really hard for that one. But it is a study where we are looking at adding the medication Metformin, other treatments that kids are already getting, to see how that changes their outcomes for things like weight, blood pressure, and blood sugar. So it’s nice, because it is a study that is integrated into my day to day clinical care that by taking data from the care that I am already giving, we can inform changes for other kids down the line. So that we’re giving the best care and best practice to everyone. So that is a nice way to stay involved in research while it’s not my primary focus.

Slide 7 – Day to Day

• A look through at my day-to-day schedule and it was kind of depressing to write this out. But I don’t do these both on the same day. One is one type of week. One is another type of week.
• In outpatient, I work a little bit more by myself because I am seeing patients just throughout the day. In general, I get there about a half hour before I start the day to review. I check emails. I check messages. I check refills. I do all that to get ready. I do a block of clinical care. So those are usually 30 to 45 minute appointments, 1 on 1 with a child and their family to follow up on how medication and/or therapy is going for one of their diagnoses. From 12 to 1, pretty much every day I have a team meeting for something – whether it be a nurse leadership group I am in or our outpatient division needing to talk about cases and brainstorm best practice. And then I have another block of clinical care. And then most days, so not every day, some days I leave I’m like okay I’ll deal with that tomorrow; most days, I again check emails, check refills, check phone messages, kind of wrap of everything that needs to happen for the day as well as finishing up my charting.
• When I am on the MBU, my day looks very different, because we work very much so work as a team. So it is co-run by Psychiatry and Pediatrics. And so I do a lot more team work there. I come in again a half hour before everything really starts, to really get caught up and make sure I really read about what happened overnight, check-in with people, see what the concerns are, but then we round as a team altogether so the entire staff gets together for a full hour to talk about each of the 10 patients on the unit and really make sure we are moving in the right direction for them. Then I go on to do my clinical care, writing notes. Throughout that times, there’s usually meetings- so meeting with families, meeting with schools, meeting with like city agencies so like people who may have custody, people who have home behavioral services. So meeting with all those different people to make sure we’re all on the same page. And then I usually wrap my day up by just going around to see everyone again, making sure nothing changed, checking in with nurses saying "how can I help you, how’s the day gong, what can I do to support you, how can I help?”. And then I close it up, and then I head out of there.
• I think that is the end of my stuff.