My Specialty

Psychiatric Emergency Nursing, Sandy Kesler-Newman, Arrowhead Regional Medical Center

Caring for vulnerable behavioral health patients

Sandy Kesler-Newman, RN, BSN, PHN
Unit Manager, Psychiatric Emergency Department
Arrowhead Regional Medical Center Colton

Tell us about the trajectory of your life and career.

I have been a nurse 33 years, 22 of which were in the ED. The way I got my job at Arrowhead Regional Medical Center is a funny story: I was in a car accident and went to the ARMC emergency department to be treated. I started talking with a nurse manager who inquired about my work experience. Soon after, I was hired to work here in the ED!

After a couple of years as a charge nurse and then assistant nurse manager in the ED, I was asked to coordinate the new Medical Indigent Program, which was established using funds the Obama administration had made available for low-income healthcare. I love building new programs, so this was a great challenge.

From there, I became a nurse educator for heart failure patients. Then, in 2019, I received a phone call saying the Behavioral Health Department needed help building its medical aspect. I had no behavioral health experience, but I thought I could be a good liaison between the medical and psychiatric sides of the ED.

Here I am two years later, and I love it. I’m still considered the liaison, but I’m also the unit manager for the psychiatric ED.

What are your main responsibilities?

I make sure my department runs efficiently and safely on all levels. I have several assistant managers who report to me, along with two charge nurses; I call them my executive team. One of my responsibilities is building our staff’s capacity so that patients’ behavioral and medical issues are equally addressed.

Behavioral health issues can be triggered by underlying medical issues — blood sugar or thyroid problems, for example — so providing highly therapeutic care for these vulnerable patients means assessing and treating them holistically.

What populations do you serve?

We serve San Bernardino County and beyond. The homeless population in our county is very high, but there’s a great deal of chronic mental illness among people from all walks of life, as well as untreated underlying comorbidities and significant psychiatric disabilities.

We build trust on a daily basis with a patient population aged 18–64. Many of our patients are “frequent flyers” we know by name. When they return for another visit, we start building trust all over again. I say to them, “Remember me? I’m Sandy. We’re here for you.”

Nursing Education

I have such a passion for caring for these individuals: I will bathe them, feed them and help bring them back to life. Anyone can be in such a compromised state — we see mothers, fathers, brothers, professionals — and they all need to be treated with compassion and kindness.

We’re currently working on building an adolescent unit and an addiction unit to further increase our capacity and reach.

How has the pandemic affected your work?

In the behavioral health setting, many of our patients are not in a cognitively or emotionally stable enough state to answer COVID-19 screening questions, so we need to protect patients and ourselves by donning PPE and doing a swab as soon as they arrive. If they have any acute medical conditions needing immediate attention, we send them to the medical side first.

The fact that we generally cannot get an accurate history from patients regarding their potential COVID-19 exposure is stressful for our staff. We’ve protected our staff with masks and other gear, so we’ve had no coronavirus outbreaks in the behavioral health unit, but I’m sensitive to their fears.

We do debriefings and huddles to talk about what’s going on, and I give them an open forum to express their concerns and fears.

What percentage of patients who come to the psychiatric ED need to be hospitalized?

About 60 percent need to be hospitalized. Diagnoses include suicidal ideation, schizophrenia and other psychiatric disabilities.

When we determine that someone has a coexisting acute medical diagnosis that needs emergent treatment, we liaise with the medical ED. We have access to a 24-hour physician assistant who can evaluate patients and either clear them medically or send them over to the medical ED.

If a patient needs to go to the medical side, our psychiatrist will consult so the patient’s psychiatric issues are addressed alongside their medical diagnoses. If the patient is admitted for medical issues, the behavioral health team will continue to consult on them throughout their stay.

What makes you get up in the morning and want to go to work every day?

I get up every morning ready to come to work and serve. There are moments when I wonder if I’m doing enough and accomplishing all I want to do, so I try to build and do more.

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I love people from every walk of life, and I never know what I’m going to encounter from day to day. Each patient is someone’s relative, friend or loved one, and I always treat everyone with empathy, love, care and compassion. That could be me or my family member seeking help.

I try to keep things orderly and safe for patients and employees. I make my staff a part of my world. People are facing such loss — jobs, family members to COVID-19, their sense of safety and wellbeing — and we have to be there for them. I always ask God to help me serve this community as best I can.

What have you needed to bring to the table to do what you do?

Prayers, first of all. I have a spiritual support group that I turn to for guidance.

Before I address any particularly challenging situation, I ask myself, “How am I going to make sure the individual I am communicating with has a positive outcome?” Everyone comes to the table with something different, so listening is crucial, as is being able to talk to others in a supportive, compassionate way.

With such emotionally demanding work, how do you help your staff in terms of self-care?

Most of my staff readily takes time out when they need to. If they come to me and say they need a day, I don’t even wait for an explanation before I say yes. I’ll never let someone feel guilty about needing time off. They give 150 percent most of the time in behavioral health.

I’m pretty direct. If I notice that someone needs help, I call them into my office and ask what I can do for them, even if it means they need to go home right then and there.

I would prefer being short-staffed to having a staff member continue to work when they’re in dire need of a break. As a leader, you have to consider the larger picture and ask yourself what the outcome will be if that staff member stays. Is there the potential of a major error occurring if a worker is distracted or upset?

Also, I try to lead by example, so I’m not going to watch someone struggle with a problem that I could take care of myself. If I don’t know a staff member’s responsibilities and duties, I’ll try to learn them so I can jump in and help.

What goals do you have for yourself and your workplace?

I’m seeking to become certified in behavioral health nursing. My training in that area has been on-the-job, and now I want to earn the formal credential.

In the future, I want to see my staff become more comfortable medically assessing patients; we need to develop those skills and capacities. I also want to open our adolescent unit so that we can serve the younger population that needs our support. In the end, being of service is most important to me.

If I can serve others, lead by example and uplift both staff and patients each day, I’ve fulfilled my life’s purpose.


KEITH CARLSON, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996. He offers expert professional coaching at www.nursekeith.com.


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