title: The experience of gatekeeping: a psychiatric nurse in an emergency department.
abstract: Emergency departments are increasingly identified as the entry point to mental health services. In the hope of facilitating the flow of psychiatric patients through a general hospital's emergency department, experienced psychiatric nurses were asked to participate in a pilot project in a general hospital in Canada. This paper is a reflection of one emergency psychiatric nurse's (EPN) experience of her role being transformed into that of a gatekeeper. The notion of "gatekeeper" as a metaphor highlights "keeping psychiatric patients out" of an already strained emergency system. As a means to balance fiscal demands with patient care, the EPN inadvertently served to obscure entry for patients with mental illness who were seeking emergency services.
authors.affiliation: School of Nursing, Laurentian University, Sudbury, Ontario, Canada.
authors.forename: Margaret
authors.initials: M
authors.lastname: McArthur
authors.forename: Phyllis
authors.initials: P
authors.lastname: Montgomery
mesh_terms: D001291:Attitude of Health Personnel; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D004637:Emergency Services, Psychiatric / Q000458:organization & administration* / Q000706:statistics & numerical data; D020793:Gatekeeping; D006297:Health Services Accessibility; D006769:Hospitals, General; D006801:Humans; D001523:Mental Disorders / Q000451:nursing*; D009864:Ontario; D010865:Pilot Projects; D011568:Psychiatric Nursing / Q000379:methods*