With patients and families whose needs are 24/7, it seems a nurse’s work in never done. We had the chance to sit down with our nurses here at Seattle Children’s Autism Center to find out what a “day in the life” is like for them. First, let’s introduce you to them.
Andrea Valdez has been a nurse since 2004 where she worked on the Inpatient Psychiatric Unit at Seattle Children’s before moving to the Autism Center a year and a half ago. She is also pursuing her doctorate in nursing from the University of Washington.
Jason Russo has worked at Seattle Children’s for 16 years and has been a nurse for 11. He has worked on the Inpatient Psychiatric Unit (IPU) as well as in the Neurodevelopmental program before moving to the Autism Center a year and a half ago.
Jan Bersin has worked at Seattle Children’s Autism Center since it opened in 2009 and has experience working in primary care offices, ADHD clinics, and at the Autism Spectrum Treatment and Research Center (ASTAR).
theautismblog: What kinds of calls do you get from parents?
Jan: Parents call us to follow-up on information from their appointment with their provider.
Andrea: We get calls about behavior problems, crisis calls, questions about prior authorizations with insurance for medications.
Jason: Parents call for help in figuring out if a medication is working or not. Often we hear the question: “What should I do?” about many different situations, behavioral challenges in particular. We also do a lot of directing of calls to others who can answer them.
theautismblog: What kind of requests do you get from providers?
Jason: Providers frequently ask us to follow-up with families regarding medications. Sometimes we follow-up with the child’s other providers and relay information to our clinicians here.
Andrea: A lot of our providers forward phone call messages that they receive that we can then handle.
Jan: Providers often will ask us for help with documents and letters for families.
theautismblog: What is the #1 question or request that you hear from parents that call?
Jan: Refills and clarification about medications.
Jason: Parents wondering if it’s okay to increase a medication dose and wondering if a medication is working or not.
theautismblog: Do you have any tips for parents regarding medication refills?
Andrea: Call as soon as possible if you have concerns about medications. Call at least 5 days ahead of time for refills. Also, keep in mind that for stimulants (medications often prescribed for ADHD symptoms), it is required that you must have a paper copy of the prescription. This means we can’t call it in to the pharmacy and you will need to pick it up here or have it mailed to your home.
Jan: If you use only one pharmacy it allows for better coordination with your child’s medications.
theautismblog: What should parents be concerned about when it comes to medication side effects?
Andrea: The medication provider will always, from the start, describe what possible side effects might be. You should always call if you’re not sure. Some things, such as gastrointestinal upset (nausea), will usually go away. And there are some things that can be adjusted to help decrease side effects, such as the time the drug is administered or taking the medication with food.
Jan: There is also a useful book called, Straight Talk about Psychiatric Medication for Kids that is a great source for general knowledge about psychiatric medications.
theautismblog: If a patient followed by an Autism Center provider is hospitalized, are you notified?
Jason: If a child is admitted to Children’s Hospital, we will get a phone call, but if the child is admitted to a different hospital we will not have any way of knowing.
Andrea: And that’s an important point: always let us know about any major changes in health for your child.
theautismblog: What kinds of calls do you receive that you feel most able to help with?
Jason: The ones that I have an answer for. There’s a lot about autism we don’t have answers for so when we do, we feel most helpful.
Andrea: Also, I think sometimes being the “live” person to talk with helps decrease the caller’s anxiety.
Jan: I enjoy helping families with sorting through their options.
theautismblog: What kind of calls do you receive or what kind of situations do you find the most difficult to help with?
Jan: Helping kids from different counties (outside King County) is hard when services feel unequal or inadequate. We have restrictions (per Regional Support Network rules) on services we can provide for those who reside outside of King County and have Medicaid insurance.
Andrea: Explaining the waitlist for services to families.
Jason: I echo what Jan said: trying to find services that may not exist in other counties – or at least not yet.
theautismblog: What happens after a parent calls in with a question for their provider and the call is routed to you?
Jason: We try to answer calls live, as they come in, or at least return calls that day. Always remember, for more timely issues to call the Primary Care Physician (PCP) office or in case of an emergency, call 911.
Andrea: Our regular hours are Monday-Friday 8-4:30. After 4:30 a caller will reach voicemail.
theautismblog: You mentioned emergencies; what are some examples of things that shouldn’t wait?
Jason: The most common example we hear is when there are behavioral issues that are truly unsafe to the child or to others around them. Families can call their County Crisis Line to work through behavior issues over the phone as well. In the event of any life-threatening situation, immediately call 911.
theautismblog: If there is a delay in returning a call to a family member, why would that be?
Jason: Most of the providers at Seattle Children’s Autism Center are here part-time and when they are here, they’re seeing patients. We work very hard to connect with them so that we can promptly get back to you.
theautismblog: Why does a patient have to have a return visit before some medications will be refilled?
Jason: Prescribers need to be able to assess the child in person. Please know that our providers are very mindful of a family’s time and won’t ask you come to any appointment that is unnecessary.
Jan: Also, some medications require that the care and follow-up is documented, especially at certain intervals.
Andrea: It’s also important to know that the provider can sometimes observe things that a parent might not know to look for and seeing a child in person is a better assessment than hearing about him over the phone.
theautismblog: What else do you do as part of your job at Seattle Children’s Autism Center?
Andrea: If there are any onsite behavioral concerns at the center, the nurses often respond and assist the family with behavior management. (This is the role that Andrea and Jason had while working on our IPU. )
Jan: We also help the center to be aware of resources and help our providers expedite their care.
theautismblog: Before going, is there anything that you would like parents to know about our center or about working with the nurses in regards to their child’s care?
Jason: Knowing how challenging it can be for our patients and families, we think a lot about how we can better facilitate health care for kids with autism. We want to reduce the stress for all. For example, we are able to provide flu shots here in a safe, quiet, familiar place with staff who knows autism. We’re also currently working with Children’s Hospital staff to create a more safe and successful environment for blood draws for our patients. We all chose this profession because we truly care. It isn’t a field you go into if you don’t. We enjoy the relationship that we build with families over the phone and in person.
Jan: I want parents to know how dedicated our entire staff is. We deeply care about our patients and families and we try to expedite care. We also appreciate your patience.
Andrea: I want parents to know that we are your direct liaison to the providers here. We believe that you deserve quality health care and we want to do everything we can to help facilitate that.
Jan, Andrea, Jason – we appreciate all you do to help patients and families and to make life a little easier for all! You are a critical part of our team here at the center.