NUR 453 Module 8 Paper 4: Individual HCA Innovation Paper Example

Turning the Wait Into Care: A Behavioral Health Nurse Navigator for Youth Boarding in a Pediatric Emergency Department

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

NUR 453: Integration Concepts in the Health Care

Instructor Name

Month Day, Year

Turning the Wait Into Care: A Behavioral Health Nurse Navigator for Youth Boarding in a Pediatric Emergency Department

Introduction

On my clinical day, a 15-year-old girl spent her thirty-first hour in Room 12 of a pediatric emergency department. She had been safe, but she had not been treated. She had seen a psychiatrist once, by video, eighteen hours after arriving, and her mother had called four times to ask what was happening. Youth mental health boarding, keeping children and teens in an emergency bay until a psychiatric bed opens, is one of the clearest failures of the American mental health system. This paper proposes a nursing innovation to shorten that wait and make it therapeutic: a behavioral health nurse navigator.

The Issue

Mental health visits to U.S. emergency departments by young people grew by about 2.7 million a year over the decade to 2020, reaching 7.5 million, while the suicide-related share of pediatric visits more than quadrupled (Bommersbach et al., 2023). Many of these youth cannot be discharged safely and wait for a bed. In one children's hospital, more than a fifth of mental health visits lasted at least a day, and the longest stays belonged to young people with psychosis, aggression, autism or prior admissions (Hoffmann et al., 2019). Boarding delays treatment, crowds emergency departments and exposes youth to restraint and to an environment designed for medical crises (Nordstrom et al., 2019). Parents and clinicians describe unclear roles, poor communication and clinicians who feel unprepared and distressed (McCarty et al., 2022).

The Innovation

The navigator is a registered nurse with behavioral health experience, on duty in the children's emergency department for the twelve busiest hours of the day, a shift two nurses share as one full-time job. The role has four parts. First, for every youth held for a mental health emergency, the navigator starts a telepsychiatry consult within four hours. Second, the navigator writes a daily boarding care plan in the record, covering safety observation, activity, schoolwork, coping skills and family contact. Third, the navigator calls the family twice a day with the plan and any changes. Fourth, the navigator coordinates the bed search and keeps a transfer checklist so that the consult note and safety plan travel with the youth.

Evidence for Each Component

The telepsychiatry component rests on a statewide program in which emergency patients who received telepsychiatry had outpatient follow-up within a month nearly three times as often as matched patients without it, and half as many were admitted (Narasimhan et al., 2015). The study combined adults and youth and was not randomized, so the effect in a pediatric department may be smaller, but the direction supports earlier evaluation. The communication and coordination components respond directly to what parents and clinicians identified as quality problems during boarding (McCarty et al., 2022). The care plan template applies a basic informatics principle: scattered data become useful information only when organized for the person who must act on it (Matney et al., 2011). No study has tested this combination for boarding youth, which is why the paper proposes a one-year pilot.

Implementation

Stakeholders include the emergency department manager, the psychiatry consult service, the telepsychiatry vendor, informatics, social work and families. In months one and two, the department hires the navigators and builds the care plan template with nursing input. In month three, emergency staff receive a one-hour training on the role and the template. Months four through twelve are the pilot. Three barriers are expected. Telepsychiatry response times on evenings and weekends may be slow; the contract will include a four-hour response standard. Some emergency nurses may see the navigator as taking over their patients; the role will be framed as support, with the bedside nurse remaining responsible for care. Some families will be hard to reach; the navigator will text when calls fail, with consent.

One-Year Budget

Savings are possible but uncertain. If earlier evaluation allows even a small share of youth to go home with follow-up instead of being admitted, as the telepsychiatry study suggests, the hospital would recover some cost, and fewer restraint events would reduce injury and staff time. The pilot will measure these rather than assume them.

Evaluation

The pilot uses the SMART goals from the logic model: 80% of youth with telepsychiatry started within four hours by month three; 90% of those boarding over 12 hours with a daily care plan by month six; and a 25% reduction in restraint events by month twelve. Secondary measures are median boarding hours, discharges home with follow-up, return visits within 30 days, a short family experience survey and a staff survey on moral distress. Results will be reported to department leaders every quarter.

Ethics and Legal Conduct

The role carries ethical duties. The 2025 ANA Code asks nurses to honor each patient's inherent worth and to speak up for those least able to protect themselves (American Nurses Association, 2025); a teen held in a bare room for days is owed both. Legally, the navigator must work within the hospital's policies on safety observation, consent for telepsychiatry and restraint, documenting the reasons for any restriction and the efforts made to avoid it. The role may also reduce staff moral distress by giving nurses a clear plan to follow.

Conclusion

Youth boarding will not end until the mental health system has enough beds and community services. In the meantime, a nurse navigator can make the wait shorter and more humane, and a one-year pilot can show whether it works.

References

American Nurses Association. (2025). Code of ethics for nurses. https://codeofethics.ana.org/

Bommersbach, T. J., McKean, A. J., Olfson, M., & Rhee, T. G. (2023). National trends in mental health-related emergency department visits among youth, 2011-2020. JAMA, 329(17), 1469-1477. https://doi.org/10.1001/jama.2023.4809

Hoffmann, J. A., Stack, A. M., Monuteaux, M. C., Levin, R., & Lee, L. K. (2019). Factors associated with boarding and length of stay for pediatric mental health emergency visits. The American Journal of Emergency Medicine, 37(10), 1829-1835. https://doi.org/10.1016/j.ajem.2018.12.041

Matney, S., Brewster, P. J., Sward, K. A., Cloyes, K. G., & Staggers, N. (2011). Philosophical approaches to the nursing informatics data-information-knowledge-wisdom framework. Advances in Nursing Science, 34(1), 6-18. https://doi.org/10.1097/ANS.0b013e3182071813

McCarty, E. J., Nagarajan, M. K., Halloran, S. R., Brady, R. E., House, S. A., & Leyenaar, J. K. (2022). Healthcare quality during pediatric mental health boarding: A qualitative analysis. Journal of Hospital Medicine, 17(10), 783-792. https://doi.org/10.1002/jhm.12906

Narasimhan, M., Druss, B. G., Hockenberry, J. M., Royer, J., Weiss, P., Glick, G., Marcus, S. C., & Magill, J. (2015). Impact of a telepsychiatry program at emergency departments statewide on the quality, utilization, and costs of mental health services. Psychiatric Services, 66(11), 1167-1172. https://doi.org/10.1176/appi.ps.201400122

Nordstrom, K., Berlin, J. S., Nash, S. S., Shah, S. B., Schmelzer, N. A., & Worley, L. L. M. (2019). Boarding of mentally ill patients in emergency departments: American Psychiatric Association resource document. Western Journal of Emergency Medicine, 20(5), 690-695. https://doi.org/10.5811/westjem.2019.6.42422