Nurse uses special skills to help mental health patients
Looking back at his struggle with anxiety, a 38-year-old Gibsonia professional recalled recently how he had been dealing with a stressful job and a young family when he became overly concerned about his health.
He made an appointment with clinical nurse specialist Wendy Zubenko at her clinic in Pine. She’s a type of advanced practice nurse who has the education and training to provide comprehensive mental health care, including assessment, diagnosisand treatment.
Ms. Zubenko first assessed her patient and then with each subsequent session, updated the assessment. He said he went once a week at first, to get cognitive behavioral therapy with Ms. Zubenko as treatment for obsessive-compulsive disorder. No medication was prescribed.
“She said it was OCD,” the patient said. “I had health-related anxiety, so yes, that was accurate.”
His condition is resolved, he said, after 1½ years of treatment.
“It’s most helpful. It definitely was what I needed. … The cognitive therapy gives you the power to solve the problem.”
Ms. Zubenko’s medical training was key to his success, he said.
“If it was a rapid heartbeat, she’d say, ‘No, you’re not having a heart attack,’ and she would share the knowledge she had about it.”
At Western Psych
Ms. Zubenko discovered psychiatric nursing working with children and adolescents at Western Psychiatric Institute and Clinic (now UPMC Western Psychiatric Hospital) in 1981. After a stint teaching at Carlow University and earning an advanced degree, she returned to Western Psych, finally leaving in 2010.
“Working at Western Psych was the opportunity of a lifetime,” she said. “I learned with the very best, had experiences you don’t get anywhere else. It solidified that psychiatric mental health nurse is my passion.” She earned a master’s in psychiatry, followed by a doctorate in education.
Another patient at Ms. Zubenko’s clinic, Anna, 36, of Ingram, said therapy with the clinical nurse specialist helped her deal with anxiety and OCD as she went through a recent pregnancy without any medications.
She said she sees her primary care doctor if she needs medication, but said she wishes Ms. Zubenko could prescribe. Although trained in medications used in treatment, advanced practice nurses cannot independently write prescriptions for patients, according to Pennsylvania law.
“It’s frustrating,” Anna said. “Sometimes there’s a disconnect, if she doesn’t know the physicians I’m seeing,” she said, adding that it’s difficult to get an appointment with a psychiatrist. Even after waiting for a month to see a psychiatrist last year during a crisis, she was treated by a physician’ s assistant.
While pregnant with her third child, she said she relied on cognitive behavioral therapy with Ms. Zubenko alone.
“This time I was much happier than the other times,” she said. “Going off medications is scary, but it’s better if you can avoid them. ... Because Dr. Wendy had so much more medical knowledge, it’s reassuring. She understands some of what I’m going through.”
Asking the right questions
“Family physicians are doing the best they possibly can,” Ms. Zubenko said. “Mental health is not their specialty. The way that medicine is today, you get 15 minutes with your primary care physician. To get a complete psychiatric assessment, it takes a minimum of an hour evaluation. … You have to ask the right questions.”
She recalled one patient, whose previous doctor had treated him for 13 years for insomnia and depression without success. After learning he couldn’t sleep because he wasn’t tired, she realized that was a sign of manic episodes.
“I treated him for bipolar disorder. He’s well and in remission for six years.”
This kind of insight can improve patient care, she said.
“We can bring our expertise to the table. To help primary care physicians in their practices. … Having psychiatric nurses to be able to fully and independently practice ... it will help so much the people out there.”
Setting up a practice
Ms. Zubenko was working at Western Psych when she started her own practice in Canonsburg in response to a plea in 1999 for mental health care for children and teens thatcame from primary care doctors in Washington County. Her husband, psychiatrist Dr. George F. Zubenko — a tenured faculty member at the University of Pittsburgh — openeda part-time practice there.
She eventually closed that office and opened one in Pine, which was closer to her home in Franklin Park.
There’s also a great need in the northern suburbs of Allegheny County, she said. “There’s a lack of psychiatric services. Patients are calling me and asking if there is a psychiatrist taking new patients.”
“I think an advanced practice nurse makes the best psychotherapist,” Ms. Zubenko said. “We’re trained in all aspects — social, physical, medical, spiritual — and we can help monitor the effects of the medicine. We also know other illnesses are related to depression, anxiety and psychosis.”
For example, panic attacks, she said, can’t be diagnosed without ruling out a physical cause. A clinical therapist without medical training can’t do that, she said.
“It’s all interconnected,” she said. “I think the best therapists are those that have the education and the training to approach treatment through that holistic lens. Psych nurses do that.”