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Jennifer Emanuel "makes us all better at what we do!"

UVA Health University Medical Center Care Management Director Monica Goldsmith, BSN, RN, ACM and BEE Award Committee Chair Hannah Kolpack, surprised Jennifer Emanuel, MSW, LCSW, Emergency Department, with a BEE (Being Excellence Everyday) Award.

William Woods, MD, MS, Emergency Department, and Associate Professor of Emergency Medicine and Pediatrics, UVA School of Medicine, nominated Emanuel:

"Jennifer Emanuel is a vitally important member of our Emergency Department (ED). She makes us all better at what we do. I am not an ED social worker, but I think it must be very challenging to represent the thinking of the ED medical team to agencies outside UVA Health — whether psychiatric hospitals, child protective service agencies, or entities with smaller scope such as those that provide Medicaid cabs. She does this with great insight and a nuanced understanding of these complex interactions. She helps provide a 'guiding hand' to all team members in order to help craft the message necessary to communicate effectively and accurately with outside agencies. 

"We often have patients with very long ED stays awaiting placement at psychiatric facilities. I know that whenever I go speak with Ms. Emanuel she will understand the issue around the delays in placement and offer concrete thoughts on how to improve the chances and appropriateness of placement. We had several young teenagers awaiting psychiatric bed placement. One boy was there for more than seven days while other children were getting placed ahead of him.  Ms. Emanuel pointed out that the original note by a consulting service frequently mentioned aggressive behavior in this teenaged, autistic child. 

"'The psychiatric facilities read that and don't think he will be able to participate in therapy so are unwilling to accept him, even though the aggressive behavior was all at home, and he has been well-behaved during his days in the ED and able to participate in therapy in prior psychiatric hospitalizations. We have been able to get Region 10 to take over the bed search so that we can communicate directly with the facilities to help them understand that he will be able to participate in therapies.'

"The boy was quickly placed in a facility where he had been previously, a facility that had been refusing him for days because of the medical records.

"We can't make Ms. Emanuel work 24/7/365. When she is working, she takes ownership of tough cases and shepherds us — the medical team — to get care for these patients. Consultants and ED team members will update and clarify notes. She will anticipate challenges around transitions — in this case, recognizing which family will help the child transition from ED to psychiatric facility, and pointing out who will have difficulty with the idea of the transition. She knows which types of challenges each of the receiving psychiatric facilities is more willing to accept — some of which include younger/older age, pre-existing medical conditions, and autistic behaviors. 

"One of the other challenging conditions where I find Ms. Emanuel's judgement invaluable is surrounding the care and reporting of children where we have suspicions of child abuse. Ms. Emanuel recognizes that reporting of a child to Child Protective Services (CPS) has an effect on the family, the child, and the trust the family is willing to place in the medical 'system.'  While we never want to miss an opportunity to protect an at-risk child, Ms. Emanuel also advocates that we don't want to report a child simply because we don't want to ask a clarifying question or because the medical team doesn't take advantage of medical resources available. 

'In another case, there was a toddler brought to the ED with an infection. During the stay, the team identified a skin lesion that they didn't recognize. The team's initial thought was to pursue a diagnostic evaluation for unrecognized injuries and to report the child to local CPS. Through Ms. Emanuel's gentle collaboration, the medical assessment of the skin lesion was escalated so a diagnosis of that lesion could be made — avoiding the emotional and financial aspects of the evaluation and subsequent reporting. I found this case typical of Ms. Emanuel's behavior. She pushes us to be our best, and, thus, provide our best care possible. This case was so special because the more common feedback from Ms. Emanuel when we discuss cases of potential child abuse is to help us make sure our notes and communications are clear enough. Commonly, she will come to me and say, "You need to be more explicit with this concern because this local agency won't pursue the investigation unless you comment upon this ...."  Again, her thorough and nuanced understanding of local resources is so valuable.

"I don't know how many times I have said to emergency medicine residents, pediatric residents, family medicine residents, and medical students that 'Decisions about whether to report a child to CPS requires compassion and wisdom. The easy paths, which I hope you won't pursue, are to report everyone or to report no one. The hard path is to be thoughtful and caring.'  I am so grateful when I have as a Ms. Emanuel partner on a challenging case. I feel that I walk away from these tough cases having done the best I can do for these children. 

"Our ED care is so much better because of Ms. Emanuel's firm but compassionate style and her depth of maturity and understanding. While we have a great team of ED social workers, Ms. Emanuel makes each member of the care team better at what we do."

Know a Deserving Team Member?

Every month, the Nursing Professional Governance Organization (NPGO) honors up to two UVA Health University Medical Center team members with this award.

The BEE Award recognizes UVA Health University Medical Center team members who work alongside our nurses to impact patients' experiences — just as bees and flowers depend on one another. Submit a nomination.