Increased Volume and New Services Spur Change in McLean’s Psychiatric Neurotherapeutics Program

On any given day at McLean’s Psychiatric Neurotherapeutics Program, some 50 patients come through the door for ECT (electroconvulsive therapy), 20 or more for TMS (transcranial magnetic stimulation), and about four for the program’s new ketamine infusion service. “That’s a lot of people,” said Teresa Henderson, BSN, RN, “and our program had to make some changes to make sure we could handle that volume in the most efficient way possible.”

According to Program Director Paula Bolton, MS, APRN-BC, growth in volume and the recent addition of the ketamine service made it necessary to increase staff and add new roles. “The medical complexities involved in post-anesthesia care and in infusion therapy, as well as the skill needed to assess and treat patients with serious mental illness, necessitates a staffing pattern with a larger number of RNs. We have recently hired new staff to our services to meet the demand,” she reported.

To help manage and support the staff, the program promoted Henderson to the role of nurse manager. In this newly created position, Henderson will serve as a full-time resource available to nurses caring for patients. Bolton explained that Henderson “will oversee nursing practice and be able to assist in problem-solving patient care issues as well as workflow issues that arise during the day.”

Henderson, who has 14 years of nursing experience, including seven in McLean’s ECT Service, said her new job will combine patient care with day-to-day administration. “In this new role, I get to be involved in bigger clinical issues and still be involved in patient care,” she said. In addition, Henderson hopes her years of experience will be of value to nurses in the program and across the institution. “I feel I’ve been here long enough that I can jump in and answer questions, and I hope to be a good resource for nurses around the hospital who want to know what’s going in our program,” she said.

In addition to providing day-to-day clinical and administrative support, Henderson plans to assist with professional development. “I have a lot of interest in professional development, and I want to bring educational opportunities to the program,” she said. Moreover, Henderson said that she plans to “stay up to date on clinical practices and see that nurses have good job satisfaction, are valued for the work that they do, and have the opportunity to grow.”

Henderson will work closely with Bolton to ensure that the Psychiatric Neurotherapeutics Program runs efficiently and effectively—a challenging task given increases in patient volume and the addition of the popular new Ketamine Service to the already busy ECT and TMS Services. ECT, which treats patients struggling with treatment-resistant conditions like depression, acute psychotic illnesses, and some severe forms of dementia, is the program’s busiest service, Bolton said. In general, she explained, patients start—as either inpatients or outpatients—in an acute course of ECT, three days per week for two to four weeks and then taper down, but maintenance can go on for many months. Moreover, Bolton reported, “Our nurses run support groups for our outpatients and their families once per month and for our inpatients on our busiest programs on a weekly basis.”

Adding to the workload is the TMS Service. “Our TMS Service has grown tremendously since its inception in 2009, and we now run three treatment rooms daily,” Bolton said. For this service, patients come to the program five days per week for four to six weeks and then taper treatments depending on their response, she said.

The Ketamine Service, introduced this year, has also presented workload challenges for the program. Bolton said, “Patients receive treatment twice per week and are initially scheduled for three treatments. If they respond favorably to the first three treatments, they will usually complete nine treatments, coming twice per week with a subsequent taper.” The ketamine infusion service, she explained, is “staffed by a psychiatrist and nurse who meet with the patient prior to the treatment and monitor the patient during and after the treatment.”

Despite the challenges, Bolton and Henderson are confident that their administration and staff can handle the increased volume and new responsibilities in a way that will put patients first. “We have amazing staff, and we all work together very well,” Henderson said. “I think we’re in a great position to take on all the changes that have taken place in the program.”