When Ernestine Cosby, MSN, APRN, BC, first came to Sheppard Pratt Hospital in 1969, she was seeking a job as a beautician. A young single mother, she knew very little about mental illness. In those days, she said, in-house services, such as hairdressing, were needed because patients had longer stays, but as luck would have it the hospital was more in need of paraprofessionals than beauticians and Cosby was hired as a mental health worker.

"I really did not know that much about mental health at the time," said Cosby, explaining she once had some of the same biases and prejudices many people still have today about mental illness. Now, as vice president and chief nursing officer for Sheppard Pratt Health System, which includes the hospital, Cosby can't imagine working in any other specialty. She manages a staff of more than 200 nurses, in addition to social workers, rehabilitation staff and direct care workers.

Growing a Profession

"I've had wonderful opportunities here to grow with my skills", she said. "I've learned a lot."

Cosby has experienced much professional growth at Sheppard Pratt. While working as a paraprofessional for the first 4 years, her duties included talking to patients and escorting them to and from meals, and on excursions outside the hospital.

She returned to school to become a nurse while holding down the job. She then left the Towson, MD facility to work in the psychiatric unit of the U.S. Public Health Service Hospital from 1975 to 1981, before returning to Sheppard Pratt. She has since held many roles including staff nurse, head nurse, unit manager, unit director and programs director.

Overcoming Obstacles

Personally, Cosby overcame many barriers to achieve her goals; for one the stigma of being an unwed single mother from the inner city of Baltimore. "By all history, I should be in a different place," she said, recalling words she remembers always. As she was about to give birth at age 17, she overheard the doctor say to the nurse, "She'll be back in a year."

Today, Cosby's only regret is that doctor cannot see how far she has come. Maybe his statement spurred her to prove him wrong, or perhaps Cosby has always been determined. "I always wanted to do more than be a high school graduate," says this CNO who is known at Sheppard Pratt for the "No Whining" sign hanging in her office, and for her simple and straightforward philosophy: "You are only limited by the limitations that you put on yourself."

Cosby is certain she is in the right profession and specialty, and hopes to soon pursue a doctorate degree. "No matter how long you're in it, there's always something new to learn...new places within the system to move to keep challenging me."

Over the Years

She has seen phenomenal changes within the mental health arena, the most notable a drastic reduction in length of stay for inpatient care. When she first entered the profession, the average LOS was a year to 18 months; now it is 6-7 days.

Despite being an administrator, Cosby still has opportunities to interact with patients and their families, and is pleased great strides have been made to decrease or stop both seclusion and the use of physical restraints over the years.

Her biggest challenge at Sheppard Pratt is "incorporating the financial aspect of keeping the hospital viable and providing quality patient care." In nursing and medical school, they don't teach this but "you have to be savvy," she said.

Cosby lives in Baltimore County, surrounded by close family including her mother, two sisters, her son and four grandsons.