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When Katherine (Kate) Cederbaum, MA, MSN, PMHNP-BC, applied to become the first ever Nellie Blumenthal Advanced Practice Psychiatric Nursing Fellow at McLean, she felt highly motivated to win the fellowship, but she could not anticipate how emotionally charged the process would become. After earning a degree from Boston College as a nurse practitioner in May 2012, she wanted support and experience as she transitioned from school into professional practice. “I couldn’t fathom going straight into a clinical setting without better preparation,” she said during a recent interview. Her goal matched many of the purposes of the Blumenthal, which is awarded to an Advanced Practice RN to help the recipient enhance skills in assessment, differential diagnosis, psychopharmacology, and patient teaching.
The problem for Kate was how to support herself while waiting for the fellowship winner to be announced in September 2012. She took a risk and stopped applying for other positions, while she worked as a bartender, did an internship at Solomon Carter Fuller Mental Health Center in Boston to keep up her skills, and lived at home with her parents. Her father, an oncologist, and her mother, a rheumatologist, both strongly supported her choice. Her father urged her to hold out until she knew about the fellowship. When she won the honor of becoming the first Blumenthal Fellow on September 4, 2012, she and her family rejoiced. On October 1, she began the fellowship.
She recognized almost at once that the working environment at McLean presented a different picture from the flawed treatment settings that she and her parents had often discussed when considering the American health care system. “Collegiality and a shared intellectual interest in what we are doing existed here, even as everyone coped with the many demands of daily clinical practice,” she observed. “There are no dollars in the health care system to support clinicians talking to each other about their patients, and yet that is such an important part of what we do.”
Kate was quick to praise the four clinicians who have supervised her during the fellowship year: Dost Öngür, MD, PhD, director of the Center of Excellence in Psychotic Disorders; Rakesh Karmacharya, MD, PhD, known as Dr. K, medical director of the First Episode Clinic and of the Schizophrenia and Bipolar Disorder Research Clinic; Linda Flaherty, MSN, RN, CS, Senior Vice President, Patient Care Services; and Beth Murphy, MD, Medical Director, The Clinical Evaluation Center. Meeting with each of these supervisors for an hour every other week has provided an invaluable opportunity to interact with senior clinicians, who answer questions and discuss cases with her.
Another ally has been Kirsten Bolton, LICSW, program director for McLean OnTrackTM (First Episode Clinic for Psychotic Disorders). She and Kirsten have run a therapy group together. “We have been a great team,” Kate said. “Kirsten, who has four more years of experience than I do, provides therapy, and I handle meds, so we share our impressions of patient needs and adjust our approach accordingly.” Working on the CEC unit “has been so great, a completely informal but essential form of education on the job.” Kate appreciates the value of working with experienced nurses and residents, who delve into cases with her. Observing grand rounds and listening in on the residents’ didactics has also enlarged her understanding of her practice, while attending morning rounds on the inpatient unit specializing in psychotic disorders has been another invaluable experience. “Numerous educational opportunities are intrinsic to simply being at McLean,” she added.
Another important aspect of her experience this year has been patient and family work in the McLean OnTrackTM Program. “I didn’t train for family work, but I soon realized how key it is to helping patients recover.” She knew, theoretically, that family would be involved when a patient, typically an 18-25 year old, is treated at the clinic. Reality is different from theory, however, and Kate gratefully acknowledges how valuable staff supervision and support have been as she enhanced her skills in working with patients and families.
For a variety of reasons, a patient may be discharged from the hospital before he or she is entirely well. The patient may even remain psychotic and dependent on family. Kate has seen individuals return for follow-up visits, who look disorganized even though the discharge notes indicate that they have been stabilized. Kate sees her role as a mediator between patients and their families as an important component of their transition from the hospital to life outside. She checks in with families once a day, and may make medication changes based on the feedback she hears.
After discharge, Kate sees patients once or twice a week. She must determine whether a patient needs to be admitted again or if another day or a good night’s sleep will smooth the transition. She doesn’t set boundaries with patients for how they should behave at home; that is the role of their families. However, she can help patients and families communicate better about the issues that may cause friction between them.
Kate’s fellowship year is drawing to a close, but she looks forward to continuing at McLean in a position that involves many of the same duties. She will be a prescriber in the First Episode Clinic, the only on-staff nurse practitioner in that role. Her research and development interests focus on developing a group therapy program; preventing and treating metabolic syndrome; and standardizing the course of care for First Episode patients. Next month, she will also begin working on development of a dual diagnosis program in the McLean Substance Abuse Program.
Kate Cederbaum’s intelligence, compassion, and dedication to becoming the best possible clinician motivated her to take full advantage of the opportunities that the Nellie Blumenthal Fellowship opened for her. She has set a fine example for the other Advanced Practice nurses who will follow in her footsteps.