Imagine you wake up tomorrow and your job is to be the leader of an inpatient psychiatric unit. You are in your late thirties, trained in psychiatric nursing, and have eight years of experience working in mental health.
You have no management training, yet you manage 100 co-workers in the care of 30 adult psychiatric clients 24 hours per day, seven days a week. You have no business or financial training, yet you are responsible for a budget of $3,000,000.
On the drive to work, you wonder if today will be a day when the unit has too few clients (and you must worry about controlling costs) or if there will be five new patients all in need of care and you must scramble for resources.
About one-fourth of clients are homeless and carry everything they own in a plastic bag. Most of the individuals you care for have complex medical conditions, some may have trach tubes, open wounds, or undiagnosed but emerging medical conditions.
Some clients have little education and cannot provide medical histories. Three-fourths of those you care for use alcohol, marijuana, meth, fentanyl, heroin or some other drug. Many clients use multiple drugs and demonstrate symptoms of withdrawal over the course of treatment.
What really makes your program unique and especially challenging is that every client you care for suffers from severe and persistent mental illness, such as schizophrenia, bipolar disorder or major depression with psychosis, and each has reported dangerous thoughts or actions harmful toward themselves or others within the last few days.
Today, will be a busy day. In addition to your usual management duties, you will meet with a new staff member who is often late and has not completed required job training on time. In addition to your usual duties, this morning you present your plan to improve client care with the senior leadership team of the organization. You know they will ask tough questions, especially about any additional costs. It was hard to sleep last night because you kept finding yourself rehearsing your presentation as you struggled to sleep. You hope things go well and you know the staff is depending on you.
You day ends speaking with the head of social work services. The newspaper recently reported possible cuts to Medicaid programming and you wonder if staffing reduction will be necessary. You talk about morale on the unit. While most of the time staff are highly compassionate and provide excellent care, you know some suffer from compassion fatigue and burn out.
You both worry that the tired staff will negatively impact other staff or the patients and consider ways to support colleagues suffering from work-related stress. Before going home, you walk the unit to make sure it is safe. You want to be sure that the maintenance worker, who fixed the heater an agitated patient smashed the day before, did not accidently leave any tools on the floor which a patient might use to harm himself or herself or another patient.
As you pass through the parking lot and approach your car, the new medical director stops for a chat. She attended your presentation on improving patient care, and she tells you what a great job you did. She shares some additional suggestions and expresses interest in partnering with you to improve client care on the unit. As you say goodnight, she mentions the great work done by one of the discharge planners, a woman who was once treated at your center for substance use and depression, in arranging services for a client who responded well to treatment.
As you drive home, you think about the client leaving the facility to a new home and new opportunities. You think about the support from senior leadership on your proposal to improve care on the unit and how good their support feels. You think about the new medical director who wants to partner with you. You think about how wonderful it is to have a job where you can help so many people and be a leader.
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