Westchester Behavioral Health Center

Westchester Behavioral Health Center

Magnet® Excellence

NYP Westchester Behavioral Health Center & Weill Cornell Medical Center Psychiatry Program (NYP-WBHC & WCMCPP) is a Joint Commission accredited, full service, 283 licensed bed psychiatric/mental health facility. It was the first behavioral health hospital in the nation hospital to receive recognition as a Planetree Designed Patient-Centered Hospital and achieved Planetree Designation with Distinction®. NYP/WBHC & WCMCPP is affiliated with Weill Cornell Medicine and serves as an academic, treatment, and research facility, providing a wide range of services for patients and their families and clinical education for future healthcare providers, including registered nurses, physicians, social workers, and psychosocial rehabilitation specialists.

For over 226 years, NYP/WBHC has served patients with mental illness. The first two patients were admitted in 1791 to New York Hospital in lower Manhattan. In 1808, a separate asylum was built adjacent to the main Manhattan hospital to care for the “insane.” The asylum was New York State’s first and the nation’s second medical facility for the mentally ill.

The Bloomingdale Asylum was a private hospital founded by New York Hospital in Morningside Heights and was opened in 1821. The mental health reformer, Dorothea Dix, visited the hospital in 1851 and wrote a blunt review that led to improvements in living conditions for patients. In 1894, Harper’s weekly described the hospital: “From first to last [the Bloomingdale Asylum] has been regarded here and abroad, as typical of all that is best and most advanced in asylum practices.” That same year, the Bloomingdale Asylum for psychiatric services relocated to a new facility in White Plains to an even more serene setting atop a hill surrounded by farmlands. The asylum was later designated as the Westchester Division of the hospital.

In 1932, the Payne Whitney Clinic opened in an eight-story, freestanding building on the New York Hospital campus in Manhattan and became affiliated with Cornell University Medical College. In 1936, the hospital in White Plains was renamed the New York Hospital Westchester Division. In 1990, the Payne Whitney Clinic moved into the main hospital when its original building was demolished to accommodate expansion of the New York Hospital.

Today, psychiatric services are offered in the emergency department and as inpatient care, with outpatient and continuing day treatment programs provided in an off campus building. The relationship between the two facilities – Payne Whitney and Westchester – has been maintained and strengthened over the years. In 1998, The New York Hospital merged with The Presbyterian Hospital to create NewYork-Presbyterian Hospital. The hospital in White Plains became known as NewYork-Presbyterian Westchester Division. In October 2019, NewYork-Presbyterian unveiled a new name for its leading academic psychiatric center: NewYork-Presbyterian Westchester Behavioral Health Center.

2021 Measures of Distinction

53%

National Board Certification Rate

96%

Percent of RNs with BSN and Higher Degrees

20

Newly Obtained National Board Certification

10

Formal Degrees Conferred

1

Nursing Research Studies in Completed

2

Nursing Research Studies in Progress

1

Professional Publication(s)

0

Podium Presentation(s)

1

Poster Presentation(s)

Contributions of Nurses

NewYork-Presbyterian Westchester Behavioral Health Center was charged with adapting quickly to the infection control and social distancing guidelines amidst the COVID-19 pandemic crisis of 2020. The Chief Nursing Officer’s leadership led to restructuring, revising, and adapting programming that would safely support the unit’s psychiatric milieu. This restructuring was conducted through grouping no more than six patients through a cohort model.

To achieve this strategic transition, all disciplines required adapting their usual routines and daily practices to meet the needs of these cohorts. For example, while Cohort 1 would be eating a breakfast meal, Cohort 2 would be in the dayroom area for the morning group. Depending on the daily census, some units were required to have up to four cohorts.

The goal of the cohort model was to ensure that up to six patients would stay together throughout the course of their hospitalization. Limiting interactions between other cohorts and having one assigned registered nurse/team member managing the assigned cohorts decreased the risk of potential infection. Each unit was required to create a cohort list and to schedule and collaborate with multiple disciplines to ensure the cohorts remained intact and the needs of all the patients were being met.

Under the Chief Nursing Officer’s leadership, the units responded to the cohort model with continued interprofessional collaboration. Mealtime, activities, activities of daily living, and television time were coordinated by the cohort schedule.

All disciplines were committed to using innovative technology, maintaining a uniform process, and consistently adapting the unit programming as required to maintain the functionality of the cohort model.

The potential for spreading COVID-19 infection was high in the traditional milieu model. This cohort model supported the need for ongoing social interactions to avoid feelings of isolation while advancing an approach that would limit the number of interactions with registered nurses, other members of the team, and other patients.

NewYork-Presbyterian Westchester Behavioral Health Center & Weill Cornell Medical Center Psychiatry Program fosters a culture of learning, including promoting continuing education and the achievement of higher levels of education of registered nurses. In early 2020, a target was set to have 50 percent or greater of all eligible registered nurses nationally board certified. Strategies to achieve this goal included:

Certified Nurses Day

On March 19 each year, the Department of Nursing celebrates National Certified Nurses Day by honoring registered nurses individually with personal recognition and a poster display with names of all nationally board certified registered nurses. The poster is placed in a prominent place in the hospital for all to see as they pass by. Registered nurses express a great deal of pride seeing their names listed.

Success Pays® Program

NewYork-Presbyterian Westchester Behavioral Health Center & Weill Cornell Medical Center Psychiatry Program registered nurses are eligible for the American Nurses Credentialing Center’s Success Pays Program, which reimburses registered nurses who successfully pass their certification exam. The registered nurse has two attempts to successfully pass.

Review Course

Registered Nurses interested in seeking national board certification are sponsored by the Department of Nursing, which pays their registration fee to attend the Psychiatric Nursing Certification Review Course held each year. During National Nurses Week, copies of the Psychiatric Nursing Certification Review manual were raffled for registered nurses.

By the end of 2020, NewYork-Presbyterian Westchester Behavioral Health Center & Weill Cornell Medical Center Psychiatry Program achieved its goal: 50 percent of the eligible registered nurses were nationally board certified with 21 registered nurses receiving their initial national board certification.

Research shows that workplace safety for nurses in an inpatient psychiatric environment almost solely relies on early detection and management of patients at high risk for aggression (Slemon et al., 2017). Registered nurses and other healthcare personnel working on an inpatient psychiatric unit believed that this approach to treatment enhanced their confidence and proficiency in managing challenging patients (Tolisano et al., 2017).

Would implementing behavioral plans and a handoff tool for managing patients at high risk for violence decrease the number of assaults? The nursing admission assessment includes questions to identify those patients at high risk for violence. Questions are based on historical forms of aggression and recent aggression resulting in hospitalization. Patients on the Inpatient Psychotic Disorders Unit who were identified to be at high risk for aggression received an individualized behavioral plan that was designed based on the assessment of the aggression reported on admission and aggression observed on the unit. The behavioral plans were documented in the electronic medical record (EMR).

A handoff tool was designed to use with patients on safety watch 1:1 and on security watch.

The handoff tool, which was made available to all team members at the start of the shift, specified essential information to assist frontline personnel in using antecedent-based strategies and coping skills to provide a therapeutic environment and prevent episodes of aggression. This Quality Improvement Project began in April 2020. Results showed a significant decrease in assaults following implementation of the behavioral plan and handoff tool with no assaults in the month of August 2020. There is sufficient evidence to show that incorporating behavioral plans and improved communication in the management of patients at high risk for aggression is an effective way to decrease assaults on the Inpatient Psychotic Disorders Unit.

References

Slemon A., Jenkins E., Bungay V. (2017) Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice. Nursing Inquiry. 2017Oct; 24(4):e12199. Epub 2017 Apr 18.

Tolisano P., Sondik T. M. , Dike C. C. (2017) A positive behavioral approach for aggression in forensic psychiatric settings. Journal of the American Academy of Psychiatry and the Law. 2017 Mar; 45(1):31-39.

Administering intramuscular medications during adult psychiatric emergencies is an integral practice of behavioral health nurses. When identifying the need for intramuscular injection (IMI), safe and efficacious administration of medication is critical. The process begins with site selection.

The literature offers a variety of recommendations regarding site selection. The three muscle groups identified for IMI are the deltoid muscle of the upper arm, gluteal muscles of the buttocks, and quadriceps muscles in the thigh, with the ventro-gluteal identified as the site in which the medication will most likely reach the muscle tissue for which it is intended (Ogston-Tuck, 2014).

Much of the research focuses on the debate between the use of the ventro-gluteal and dorso-gluteal muscle. Wynaden (2006) surveyed mental health nurses’ site preference and found that due to the reluctance of nurses to use ventro-gluteal, the dorsogluteal was identified as the preferred site. Wynaden (2012) repeated the same survey, noting that 86 percent of nurses continued to prefer the dorso-gluteal (Wynaden et al., 2015).

This study, led by Joanne Giblin, BSN, RN, PMH-BC, clinical nurse, Geriatric Unit, utilizes a cross-sectional survey design to examine the knowledge, attitudes, and practices regarding site selection for IMI during psychiatric emergencies of nurses at NewYork-Presbyterian Westchester Behavioral Health Center & Weill Cornell Medical Center Psychiatry Program. All registered nurses, clinical managers, advanced practice nurses, and nurse administrators were included in the study.

Completed in October 2020, the study showed a gap between knowledge and practice regarding site selection of intramuscular injections (IMI). Many of the nurses did not learn how to map all available IM sites in nursing school. They cite ventrogluteal as the easiest site to identify yet used it the least. The deltoid muscle is used the most. Nurses tended to make a decision regarding site selection based on their comfort level with the site. The survey also indicated that most nurses administer IMI infrequently and that more education and training related to this topic would be beneficial.

Ms. Giblin shared the results of the study. Plans to create an educational program for clinical nurses regarding IMI site selection are under discussion. The study has been submitted for publication.

References

Ogston-Tuck, S. (2014). Intramuscular injection technique: An evidence-based approach. Nursing Standard, 29(4), 52-59.

Wynaden, D., Tohotoa, J., Omari, O. A., Happell, B., Heslop, K., Barr, L., Sourinathan, V. (2015). Administering intramuscular injections: How does research translate into practice over time in the mental health setting? Nurse Education Today, 35(4), 620-624.

Publications

Curran, M. J., Rivera, R. R., Knaplund, C., Espinosa, L., Cato, K.D. (2020). Engagement among psychiatric nurses: Is it different? How and why? Nursing Management, 51(8), 20.

Ward-Miller, S., Farley, E. M., Espinosa, L., Brous, M. E., Giorgi-Cipriano, J., Ferguson, J. (2020). Psychiatric mental health nursing in the international year of the nurse and COVID-19: One hospital’s perspective on resilience and innovation – past, present and future. Archives of Psychiatric Nursing. 2020 November 20. (online)

2020 Awards and Recognition

Excellence in Nursing Award Nomination
Hudson Valley Magazine,
Aviva Fisher, MS, RN-BC, CADC

American Psychiatric Nurses Association
Chair, Nominating Committee
Member, Staffing Task Force
Item Writer,
PMHRN Certification Examination
Janette O’Connor, MS, BS, BSN, RN-BC