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SEATTLE – Nurses bit, beaten and concussed – details of injuries suffered by staff within Seattle Children’s Psychiatry Behavioral Mental unit (PBMU) have captured attention, but the nurses say the crisis extends far beyond their own safety.
“Our unit is built to manage these behaviors,” said Lauren Swinney, a PBMU charge nurse. “The fact we’ve had to reach out to the police department, call out codes overhead and not been able to maintain within our unit is pointing to the fact we’re in a crisis.”
Swinney is one of six nurses who have spoken with FOX 13 about the concerns unfolding inside Seattle Children’s. Voicing their concerns in a public manner comes with risks, though – all say it’s a necessity after past attempts to fix what they call a “broken system” have failed.
Earlier this month, 44 nurses signed a letter that was sent to the hospital’s executive action team.
The collective call to action came after two instances where police were called to the PMBU due to violence within the unit.
However, when nurses sat down with FOX 13 they didn’t want to focus on the violence – they wanted to explain how they got to the point where they are.
As staff explained, the escalations can be traced to a lack of resources. Instead of offering therapeutic care, nurses are playing whack-a-mole with various crises unfolding throughout the day.
“How we run the inside of the unit has turned into us reacting to escalations instead of providing the trauma informed care,” said Swinney. “We just don’t have the resources to be able to do what we’re trained to do.”
One of the most commonly discussed concerns within the PMBU is the use of restraints, or holds, on children who are in a state of crisis. In the past, they were a last resort – lately, they’ve become normalized within the PMBU, according to nurses.
Nurses said that holds are traumatizing for both the patient and the staff who are implementing them.
“To know that this is the best option we have to offer them, right now, is not okay,” said Brayden Schander, a nurse on the PBMU.
“To know this is the best we have to offer patients right now, breaks my heart. The patient care we’re providing at PBMU is not something Seattle Children’s should pride themselves about, it should be something they’re deeply concerned about.”
In a written response to FOX 13 News, Seattle Children’s called the situation a youth mental health crisis. They said they’re seeking travel nurses to supplement staff, and explained how they opened an emergency operations center in October to respond to the situation.
“Seattle Children’s cannot solve this crisis alone,” they wrote. “This work is ongoing, and we are actively collaborating with external partners at the local, state, and federal level to identify and eliminate barriers and find rapid solutions to address the extremely high number of patients seeking care for mental and behavioral health crises across the state.”
Nurses didn’t deny that the issues extend beyond Seattle Children’s. In fact, a core issue is that the PBMU at Seattle Children’s is designed to work with children between the ages of 4 and 17-years-old on a short-term basis.
When operating normally, a patient would be expected to stay at PBMU for 3–7 days. Instead, since there is a lack of long-term beds at the mental health facility for the pediatric age-group, patients are staying weeks, months or up to a year.
“It’s bigger than us,” said Henry Jones, a charge nurse. “These kids need places to go where they can grow.”
“These events are all consequences for staying in the environment for far too long, it’s not what we’re supposed to be doing.”
According to the Washington State Health Care Authority, there are only 109 funded beds across Washington state that are designed for children and youth that are designed to assess, treat, and stabilize children with a severe psychiatric disorder.
Those facilities often have a lengthy waitlist, which has trapped many patients in settings that were never intended to house patients for the period of time they are currently being held.
Staff told FOX 13 that construction on the PBMU has reduced their physical space, which has forced them to spread patients to various places in the hospital – all while struggling to keep enough staff.
Amy Lamson, a nurse, said it was a scary scenario – noting that the only thing holding the team together is their passion for their work. Lamson and the others said that people were spreading themselves thin to make unworkable situations workable. Howeber, they fear that if they burn out, their patients will be left with no one.
“It’s hard to hold those two things,” said Lamson, talking about her passion for her job compared to her concern for safety. “To be really passionate about something and to really want to provide excellent care, but not being able to because the system is under-resourced and to have the ramification: seeing your co-workers get hurt.”
The staff identified a list of actions that could provide immediate relief in mid-November: a safety officer role, additional staffing, spaces dedicated to PBMU patients, and a nurse-to-patient ratio no bigger than 1:8.
A member of the executive leadership team responded saying that they’ve added resources, and will on-board traveling nurses. The changes fall far short of what nurses have called for.
“To see unanimous approval of violence and subpar patient care, that’s the emotional part that makes me not want to come back to work,” said Schander. “It’s almost like, ‘What’s the point? I can scream at the top of my lungs and try to advocate for these patients, but it’s not going to matter.’”
It’s unclear what happens next. The executive team has agreed to meet with the union in mid-December, a wait that is significantly longer than the team had hoped.
FOX 13 has reached out to the state agency in charge of children’s long-term inpatient program beds to see what, if any, actions are taking place to expand the space for children in desperate need of mental health services.