Visionaries
David Leonard,
Nurse Practitioner
What was your path to mental healthcare?
I feel my career as a nurse has been defined by continual change and growth. As a new graduate 10 years ago I started my nursing career on an acute care medical-observation floor. I quickly realized healthcare was a vastly more complicated and difficult profession than even my prior healthcare experiences and nursing education could have entirely prepared me for. However, those challenges taught me to push myself and realize that growth can occur when I feel uncomfortable and challenged. This mindset eventually led me to the emergency department where I have learned and been shaped more as a human and healthcare provider than I ever could have imagined. Specifically, my interactions with behavioral health patients have left the greatest impression on me.
Most people's perceptions, like mine initially were, of the emergency department are not close to reality. Although we certainly do see traumatic injuries, heart attacks, and other medical emergencies, the majority of the work is not of this type. I was initially surprised to learn what a large percentage of our patients were psychiatric and not strictly medical. Even outside of patients with specific mental health complaints, a large portion of emergency department patients have unaddressed behavioral health needs that contribute to the medical condition we see them for. In these instances, I sadly have to say that collectively as providers we often fail to either recognize patient's behavioral health needs, choose not to attempt to address needs, or even when there is the best intention we do not have the ability to treat or offer adequate resources.
So what are the consequences of this? What is the end result of our society not only failing to provide adequate behavioral health care and resources in the emergency department but also in other settings? My experience in the emergency department provides an unfortunate glimpse at the answer. We see people that are in crisis. We see people with behavior that progresses until law enforcement is involved for criminal behavior. We see people who turn to illicit drugs to manage their symptoms and have to struggle with the numerous social and health consequences. We see people with a collapsing family and social life. We see self-harm. We see death.
Often times patients in the emergency department present in the late stages of a disease process having not received preventative care or proper management of their illness. This is especially prevalent with patients experiencing psychiatric emergencies or with other mental and behavioral health needs.
This is a problem, and the solution is challenging and complicated. Much like my initial realization of healthcare as a whole when I first started nursing, behavioral health has proven to be a larger more difficult area of healthcare than I would have anticipated prior to working in the emergency department. This is where I want to challenge myself, and this is where I feel being a psychiatric nurse practitioner will allow me to be a part of the change I want to see.
How will this scholarship help you?
I view the role of a medical provider as a role that must embrace continual learning. I consider this especially important in the early stages of my career where although I have an excellent base of knowledge and experience from my education, I also realize the vast amount of knowledge others have to share and that is continually being discovered by new research. I want to ensure that I am providing evidence based care, challenging what I know, and ensure that I am always deliberate in my care. I want to avoid settling into familiar and comfortable patterns of practice that don't evolve with our constantly expanding field of psychiatry. As a new provider, I know I would benefit greatly from the knowledge of experts in the field, as well as value the opportunity to create new relationships with those that will be my future colleagues. Choosing to pursue this career has been both an investment of time and money. With the limited stipend that is provided for my position as a fellow, I would greatly appreciate the opportunity this scholarship would provide me to continue investing in my career without additional financial burden.
What are your academic and/or career goals?
My current fellowship position is at the University of Colorado Counseling and Psychiatric Services. I sought out this fellowship because I have a strong interest in working with the college student population. I enjoy the opportunity to work with students as they navigate this transitional time of their lives, and to work collaboratively to help with their success as students. Upon completion of my fellowship program, I desire to continue working in a campus healthcare setting. I especially enjoy being in a training clinic that has an emphasis on interdisciplinary collaboration and education. I would love to have the opportunity to continue working in a setting where I not only have the opportunity to provide care, but also be in a role to serve as a mentor and educator to others entering the profession.
What does “exceptional patient care” mean to you?
One of the most valuable aspects of being a healthcare provider is the privilege to work with a diverse population and challenge my own biases and perspectives. It is exciting to learn about the vast differences in others personal experiences, culture, and identity, and to incorporate these differences into individualized care. It is essential because providing exceptional care extends far beyond only a biological understanding of humans. It extends beyond accurate diagnosis and competent prescribing. I am committed as a provider to seeing every person as a unique individual and creating an understanding and welcoming relationship that is respectful and acknowledges all the individual qualities that make up a person. On an individual level, I believe in providing this approach to care with every patient that I see. However, I believe as medical providers we are obligated to look beyond the level of the individual care that we provide. Social and political factors influence the physical and mental health of all individuals, and it is dismaying to see the current and historical efforts to marginalize and discriminate against certain people. As medical providers, we are committed to the health of others, and understand that health is a complex and multifaceted idea that is influenced by many factors including social influences. It is much more than only the presence or absence of an identified disease or illness.