Isabel Buckingham, Nu’22

I was accepted to the Univeristy of Pittsburgh Medical Center’s Western Psychiatric Hospital, one of the hospital’s 13 interns, and assigned to the inpatient Center for Autism and Developmental Disabilities (CADD).

The patients on CADD encompassed a spectrum of acutely aggressive and/or self-injurious individuals as young as 5 and as old as 56 during my 10 weeks. Their diagnoses spanned autism spectrum disorder, intellectual disabilities, and conduct and personality disorders.

The aim of their admission was to stabilize their behaviors through medication management and appropriate post-discharge placement.

After training in comprehensive crisis management, I became a part of the interdisciplinary team caring for these vulnerable patients.

Alongside my nurse preceptor, I was tasked with the various responsibilities of a psychiatric nurse. The most critical responsibility, of ensuring patient safety, involved responding to patient crises, in which the patient posed an imminent threat to themselves or others. This included participating in locked seclusion and safe restraints, communication with caregivers and physicians, and completion of associated documentation.

Most hours of the day, however, were spent sorting and handling the patient’s assortments of psychotropic and medical-focused medications, implementing and documenting various patient care and assessments such as the mental status exam, and assisting patients with basic ADLs and therapeutic tasks.

Due to the acuity of the patients’ presentations, collaboration and trust between staff members was integral to the safety of patients, visitors, and team members. I was genuinely inspired by the compassion and resilience of the nurses, milieu therapists, and support staff.

Through the tragic, frustrating, and even ridiculous events of the day, they responded with humor and skill. When a safety officer engaged in an incorrect patient restraint, I witnessed a nurse calling for him to be replaced, advocating for the patient even during a crisis. When a patient had a seizure during a parent visit, the milieu therapist immediately alerted the nurse; with the quick administration of midazolam, the patient was revived without medical complications. And, when it was a patient’s birthday, all the staff signed a card for them.

I was humbled by the immense trust being placed in CADD’s staff for these patients, many of whom literally unable to speak for themselves.

The responsibility of the nurse also clearly ranged from mental and medical health, as many patients had comorbid epilepsy, diabetes, constipation, GERD, and other conditions that required consistent support and intervention.

And, while discharge was often fraught with challenges in finding group homes, petitioning for institutionalization, or setting up in-home supports, the joy of our patients when they got to put on their shoes and head home was beautiful.

As my internship concludes, I am confident in my decision to pursue the field of psychiatric-mental health nursing.

I was honored to care for and protect the patients on the unit, and to meet the many staff and nurses who serve such a unique and complex population. And, I am grateful to my time at Penn Nursing, from the many appointments with Career Services to the encouragement and resources to apply for graduate school and summer opportunities.

I look forward to continuing my studies, and the day I can take on the incredible responsibility of being a psychiatric nurse myself.

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