Marcia Melby, RN, BC-PMHN
2011 APNA Award for Excellence in Practice ~ RN-PMH

When Marcia Melby’s colleagues describe her, one phrase is mentioned over and over: patient advocate. So it’s no surprise to learn that her favorite aspect of her job as a psychiatric mental health RN is the patients. “I truly appreciate psych patients,” she says. “I have found throughout the years that the further away I get from patient care the less I like my job, (and at my age job satisfaction is one of the most important aspects of working).” She has been in nursing for over thirty years. “I became an RN in 1975, worked med surg until 1982, and then became a psych RN. I have never regretted that decision.”

She currently works on an inpatient psychiatric unit in northern California. “I work in a unit where RNs have a patient assignment, but also review admission packets and evaluate potential patients who come in for assessments, referrals and admissions,” Melby explains. “It’s hectic but that works well for me since I like to stay busy.”  Some of the ways she stays busy: She is active on several committees that are devoted to improving patient care and hospital practice. She participates in weekly patients’ rights hearings.  She mentors fellow nurses on practicing within the recovery model. At the moment she is also busy, as is the rest of the hospital, with learning new technology. “We are moving from a paper chart to an electronic one,” she says. “So every member of the staff throughout our whole hospital system is learning a completely new way of documentation.” Even though she describes it as a “challenge,” her dedication and ability to integrate new demands into her daily work will undoubtedly make the transition a smooth one.

One component of Melby's excellence in nursing practice is her ability to identify issues affecting patient care and offer logical and realistic solutions to these issues. Melby recognized a gap in her facility’s methods of ensuring that its patients were appropriately tested for tuberculosis. (The facility’s population is especially at risk.) To remedy this, she formed a Performance Improvement Team and developed a teaching plan that trains staff to identify the patients that need testing, methods for testing, how to conduct follow-up assessments, and to create continuity of care through documentation. Through her tireless work and dedication, all licensed staff received this training. She even made sure that patients would receive comprehensive care after discharge by involving interdisciplinary team members.

A facility preceptor, she is frequently chosen to orient new RNs, based upon her ability to pass on her clinical expertise in a way that is easily grasped. “My most common advice to them,” she says, “is to treat our patients with the same respect that they would want someone to give a cherished relative of theirs. Our patients may have challenging behaviors, but their diagnoses have been far more challenging to them than their behaviors will be toward us.”