Although it’s not easy, Sharon Wilson helps people who don’t necessarily want help.

She’s one of 25 emergency room safety attendants at Novant Health Presbyterian Medical Center who works specifically with behavioral health patients, as well as confused elderly patients who need kindness and companionship.

“Some patients don’t want to be here,” she said. “They can be very volatile. With a patient who has mental health challenges, it’s not going to always be easy. They don’t always want the help you’re offering.”

As the American mental health crisis grinds on, there are dozens of safety attendants staffing emergency rooms across the Novant Health system. Hospital emergency rooms across North Carolina have been seeing record numbers of behavioral health patients. At Presbyterian Medical Center alone, there are more than 9,000 such ER visits year, an average of 25 a day.

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The attendants play an invaluable role in helping keep patients safe and preserving calm in what can be a hectic setting. The job can also be a good foot in the door for someone who’s interested in the health care field.

“They ensure patients are not at risk of hurting themselves or anyone else,” said Katie Shryne, Wilson’s supervisor and nurse manager for pediatric and behavioral health emergency departments. “They have more face-to-face time with our patients than anyone else in the department. We rely on them to notice any changes, drastic or subtle, and bring them to someone’s attention.”

Wilson joined the unit in May 2022 after her mother, Sylvia Cathcart, told her she had the right temperament for a role – a job Wilson said requires compassion, open-mindedness and patience. And Cathcart would know; she’s been a safety attendant since 2021.

Within months of being hired, Wilson was promoted to monitor tech. “My responsibility is to monitor from the nurses’ station what I see in the waiting room, exam rooms and two seclusion rooms,” she said. “There can be up to 12 patients I’m responsible for watching and noticing if their behavior changes. If I see somebody getting wound up, I inform the nurses.”

It does happen. She’s seen patients get so angry that they knocked over tables. Amanda ReulBach, assistant nurse manager in the department, said, “We see all types of people. They could be passively suicidal or depressed, psychotic, manic.”

Given that reality, safety attendants have to be ready for anything. They’re trained to approach patients gently, but they also have to know when to call Public Safety or hit the panic button.

It’s a weighty responsibility. “There are a lot of unknowns when a patient comes into the ER – whether they come on their own or are brought here by the police or EMS,” Shryne said. “The patient could be in an acute crisis. They could be combative or agitated. Safety attendants must approach each person in the most therapeutic way possible. They need to be able to communicate effectively with patients – even those in crisis.”

The ER charge nurse assigns a safety attendant to every incoming patient. Safety attendants work 12-hour shifts and are often with the same patient that entire time. Patients can get attached to “their” safety attendant, which ReulBach said “speaks to the human element of the care they provide. They’re a calm and calming presence.”

Like mother, like daughter

Wilson and Cathcart aren’t ever on the same shift. Wilson works days, and her mom works nights.

Shryne is proud to have both on her team. “They’re so kind; it may be a family trait,” she said. “They are extraordinarily empathetic to all our patients. And our patients can test people’s limits and push buttons. But Sylvia and Sharon care for and about them all. They approach patients with warmth and kindness but also establish good boundaries from the beginning.”

Cathcart strives to maintain a calm demeanor, no matter what mood her patient is in. “I stay positive,” she said. “If a patient is upset about where they are, I’ll tell them, ‘You may be here today, but you don’t have to stay here.’ Some patients ask me to pray for them. We’re not able to touch them or hug on them, so we show them compassion through our words.”

That’s not the only time Cathcart prays while at work. “I pray every night before I walk in,” she said. “I ask God to cover me and let me have a good night.”

Cathcart doesn’t have a health care background; it’s not a requirement. She had previously been an HR manager and thinks she’s a good fit for the job because she can get along with nearly anybody. “This work takes a special person,” she said. “You can’t judge. You have to accept them where they are. You need to be loving – but also have boundaries.”

When Cathcart encounters a combative patient – like the one who threw ice water at her – she doesn’t take it personally. “They told me I could go home after that,” she said. “But I washed, changed and got back out there. I can’t run home every time a patient offends me. I’d be going home every day.”

Still, Cathcart said: “I love my job. I’m not just a safety attendant. I’m an attendant. I help nurses, doctors, other staff. I’m not above doing anything.” She’ll ask her patients what they want to do. If they’re antsy and want to walk the halls, she’ll go with them. Sometimes they want Cathcart to read to them or simply watch TV with them.

What does it take to do this job?

A safety attendant’s most important job is keeping patients physically safe.

“To keep them safe, we have to take a lot away – including their phone – and that can be isolating,” ReulBach said. “Our safety attendants chat with them, spend time with them, make sure they have everything they need, from a hot shower to an extra pillow. They stay in close communication with the nursing team, which helps us tremendously.”

ER safety attendants aren’t licensed, but the role they play is crucial, Shryne said. Although not required, many people in these roles have a health care background – they’ve worked in mental health facilities, in hospitals or group homes. Wilson, for instance, worked with behavioral health patients for six years as a counselor at a treatment center for addiction and mental health issues.

Wilson – now a monitor tech who watches several patients at once – can still “go out on the floor to do rounds, be with patients, build that rapport.” She loves making personal connections with patients.

And when patients are angry, Cathcart added, she knows they’re not mad at her. “They’re mad at their situation,” she said. “So, you just treat them like you’d want to be treated. They react off your energy.”

Some team members make a career of being an attendant. “But a lot of people use the role as a steppingstone to an area of health care they ultimately want to work in,” Shryne said. “It is a great place to get your start.”

While Shryne hates to lose a good team member, she’s always proud to see a safety attendant land the job of their dreams. Two safety attendants recently moved on – one earned her degree in occupational therapy, and another is now a social worker. “We’re delighted about their success and happy to see them grow,” Shryne said. “Sharon wants to be a nurse, and I want that for her.”

“This is such an important role in the ER,” Shryne said. “We rely tremendously on our safety attendants to be the eyes and ears of the ER. I have the greatest respect for what they do.”

‘Her calm and caring demeanor did not waver.’

The following story comes from the daughter of a Novant Health patient who shared her experience with an ER safety attendant. Here are lightly edited excerpts from her conversation.

I recently had a scary situation in which my father, who is 90, was brought to a Novant Health hospital for complications with COPD.

I understand that delays happen and was trying to be patient, but by the time he was admitted, he was very confused and agitated to the point where he required a sitter (safety attendant). I had my reservations at first, but the sitter ended up being one of the most compassionate people I have ever met. Even with my father’s confusion, her calm and caring demeanor did not waver.

My father was constantly fidgeting and growing more agitated. Without a moment of hesitation, the sitter brought us a “busy blanket” to redirect his agitation into something stimulating and soothing. I had no idea that was something we could even ask for! This sitter was genuinely interested in the well-being of my father. While her job was to be taking such wonderful care of my father, all of her actions had me feeling as if she was also taking care of me.

Throughout the stay, our sitter was constantly checking in on my father and his needs, turning him and repositioning him frequently. She kept warm blankets on him – I never had to ask for one! It felt as if she was caring for her own father. One day, I happened to be drinking a soda and before I could put the empty can down on the table, she brought me another one.  

To be honest, the hospital is not my favorite place and I did not love being there. However, having someone care for my father in the manner that the sitter did, and the level of kindness and compassion she showed, truly made me forget where we were. The best part of this was the sitter was newer to Novant Health. She began her role just a few months ago. I was shocked as she knew exactly how to treat people and make my father and I feel safe. This sitter understood everything my father and I needed before we even asked for it. You all must have the most amazing training!