Nurses Leading with Care to Promote Public Health
This month, we celebrate those who are highly dedicated to working to improve their community’s health – from immunizations to emergencies.
The Many Roles of a Community Health Center Nurse
Jennifer Burnett, BSN, RN, PHN
Public Health Nurse Manager
Sonoma County Indian Health Project
Santa Rosa, CA
Serving as a public health nurse and keeping local Indian Tribe community members healthy while providing sensitive and culturally appropriate care is no easy job – especially when the job includes visiting two remote reservations (2 to 2 ½ hours away). Just ask Jennifer Burnett, BSN, RN, PHN, Public Health Nurse Manager at the Sonoma County Indian Health Project (SCIHP).
Jennifer helped form the PHASE (Preventing Heart Attack and Stroke Everyday) team at SCIHP. This clinic is unique in that patients at high risk for cardiovascular events are seen one-on-one by their entire interdisciplinary care team. This team includes a physician, a registered nurse, a clinical pharmacist, a medical assistant, a registered dietitian, and a scribe. Patients seen in the clinic are able to tell their story once, instead of multiple times, and are seeing results. The PHASE project was first implemented as part of Redwood Community Health Coalition, and now has evolved to meet the needs of the SCIHP patients.
As part of the community health representative program, she sees patients at the clinic and in their homes, partnering with community health workers. Jennifer is also part of the infection control team and STI surveillance forming community partnerships.
Jennifer says the biggest misconception in her job is that public health is one subject. That couldn’t be further from the truth – the work in public health and community health is such a vast role. For example, during the COVID-19 pandemic, Jennifer has shifted her time to help lead the effort changing the daily workflow in the clinic focused on patient/staff safety and infection control. Processes have been modified and added to include screening of all people entering the building, universal masking, and curbside pharmacy pickup.
Compassion, Care, Connection – The Right Equation
Nicole DeGreg, RN, MSN, FNP-BC
Family Nurse Practitioner, Roberts Academy School Based Health Center
Cincinnati Health Department
Nicole DeGreg spends her days protecting the health and well-being of Cincinnati’s school-aged children. As a Family Nurse Practitioner for the Cincinnati Health Department, she leads the Roberts Academy School Based Health Center, a clinic inside a school for grades PK-8. Her school-based health center is one of 25 all over Cincinnati.
Not only does she care for the students but the health center is open to the community as well. The health center provides a safe, efficient, and cost-effective way to deliver health services to the students, their families, teachers, staff and the community. Afterall, one entrance to the clinic leads to the school cafeteria.
“We meet people where they are at. We have a unique Community Learning Center model, where we are a one stop shop for our families. Not only can they get primary health services but they have access to our community partners located in the school including mental health services, early childhood learning, after school enrichment programming, and a legal clinic with an immigration lawyer on site. Through the Roberts Welcome Center, families can also receive assistance with housing or rental concern, ESL classes, meals and employment. It’s all right here,” Nicole said.
Nicole’s health center provides primary care services — acute and well visits, mental health, care coordination, and health education. Nicole’s days are never the same. She gives vaccines, does check-ups, handles screenings, and manages chronic conditions such as asthma and obesity. She even helps patients get their prescriptions filled and provides referral coordination including linking patients with resources including those to assist with transportation barriers. Nicole does all this with just a small staff. There are four people in the clinic – most of whom are bilingual, which really helps with care delivery of their newly immigrated, mostly Central American patients.
When you talk to Nicole, it’s easy to see why her patients love her. When she speaks about her job, you can hear the enthusiasm in her voice about school based health centers. You can hear the happiness she feels when she talks about some of the families. She rattles off success stories of families she helped.
Her journey to school-based health centers started when she worked in AmeriCorps with homeless shelter immigrants as their case worker and interpreter when they went to their medical appointments. She decided she wanted to do more than interpreting and began her nursing studies. And the rest we say… is history.
COVID-19 and Year of the Nurse
The following is an excerpt from Near North Health Service Corporation’s recent newsletter.
Written by Near North Chief Operating Officer Tanya L. Ford, MBA, MJ
In February of this year, I had the pleasure of attending the 32nd National Black Nurses Day Celebration in which Near North Health Service Corporation’s Chief Executive Officer Ms. Berneice Mills-Thomas, RN, received an award honoring her as a Legendary Nurse. Nurses attended from all around, young and old, newly minted and well- seasoned, as well as student nurses, teaching nurses, and administrative nurses, dressed in business attire, white nurse uniforms, nursing school uniforms, and others dressed to impress in celebration of Black History Month.
In her acceptance speech Ms. Mills-Thomas passionately spoke of the nursing profession in relation to community health. Drawing from a movement that began well over 60 years ago and contemplating the current state of community health, her theme, “The More Things Change, the More They Stay the Same,” could not have been more befitting. She spoke of the impact that access to health care has on a person’s physical, social, and mental health, and their quality of life. She discussed the barriers that keep people from being able to access health care services (i.e. cost, inadequate or no health insurance, lack of available services, etc.) that unfortunately still exists despite the changes such as the Medicaid Managed Care, Medicaid expansion, care management and care coordination services, in addition to technology improvements (i.e. telehealth), and many, many others. When Ms. Mills-Thomas explained that even now being able to access health care services varies based one’s race, ethnicity, socioeconomic status, age, disability status, sexual orientation, gender identity, as well as residential locations, gasps could be heard coming from around the room. It is a proven fact that the lack of access to health care leads to poor health and health outcomes.
Ms. Mills-Thomas went on to discuss the social determinants of health (SDoH), such as issues with food insecurities, housing, transportation, literacy, income, employment, that are also linked to poor health and health outcomes. She asserted that SDoH were not a new concept among health care leaders, and added that community health centers have always worked to help individuals address social issues while working to eliminate health disparities and inequities within the African American, Hispanic, poor, and other vulnerable populations and communities.
With powerful affirmation, Ms. Mills-Thomas articulated that the fight for social justice reaches as far back as Harriet Tubman, and since then black nurses have combined their nursing duties with the fight to end social injustices. Their goal has always been to improve health equity in disenfranchised populations so that every person can attain their full health potential.
Not only did Ms. Mills-Thomas provide information on current challenges that exist in attaining better health outcomes, she also provided her audience with insightful knowledge for the future. She spoke of workforce development, technological advancement, expanding educational content, research and policy-making improvements, and community outreach and partnerships as pathways toward attaining health equity.
On March 11, 2020, less than two weeks after the celebration, news began to surface that the coronavirus, also known as COVID-19 had reached pandemic proportions. The numbers of cases and deaths had begun to rapidly increase. Nurses answered the call to action and took their place along with other direct care providers on the front line providing compassionate care at the risk of their own health and well-being.
According to the WHO’s first State of the World’s Nursing report, which launched amid the pandemic, “nurses from around the world are demonstrating their compassion, bravery, and courage as they respond to the COVID- 19 pandemic, and never before has their value been more clearly demonstrated.”
Worldwide celebrations will be had throughout the year. Please continue to acknowledge and recognize our nursing and midwifery heroes, and be reminded that National Nurses Week is May 6-May 12, 2020.
The WHO could not have identified more deserving reasons or a better year to celebrate the nursing profession. The year 2020 has truly turned out to be the YEAR OF THE NURSE!
Helping the Health of Our Kids…One Student at a Time
Penny Monty-Carbonari, APRN
Regional Director of School Based Health Services
Community Health Center, Inc.
School is always in session for Penny Monty-Carbonari, Nurse Practitioner and Regional Director of Community Health Center, Inc. (CHC’s) School Based Health Services.
CHC serves over 17,000 students throughout Connecticut and over 180 school-based locations across the state. Health education and awareness are critical parts of what Penny and her colleagues do for students.
“We are able to meet our patients where they are because they are already here as students. They can see us for anything they want at any point in the day. With my adolescents they can come down for birth control, STD testing, or just to ask me questions,” she said.
Penny has a passion for educating people about the dangers of vaping. She has acted as a medical advisor on vaping, participating as a panelist at a variety of events and was interviewed on the local news Station FOX 61. She works with high school health teachers to get involved with the CATCH program to help curb vaping through health class. Penny has also run programs for teens providing education on the effects of vaping and provided tools on how to say no under pressure.
In addition to her work around vaping, Penny is a staunch supporter of vaccines. She collaborated with schools to educate families on the need to get flu vaccines, tripling the number of shots administered in 2019, and is currently working with school nurses to advocate for schools and families to require vaccination of all students with no religious exemptions.
She has been a huge advocate of public health within Connecticut school systems. Other commendable actions by Penny have been her spread of awareness and resources to teens about teen dating violence in the month of February as well as her participation on a national level through a school-based health center online learning community called ECHO.
Some have told Penny Monty-Carbonari that community health nursing is easy work, but they don’t know Penny’s day to day. “Some mornings I meet with the leadership team as the regional manager. I’ll have a few appointments during the day, and I’ll perform the classic nursing skills of evaluation, diagnosis and treatment. I’ll make sure vaccinations are up to date, and I’ll have a weekly care coordination task between our behavioral and social workers with ongoing case managements,” she said.
That routine has recently changed during the pandemic. Since school closings in March, Penny has been triaging COVID-19/pediatric calls and doing telehealth visits from home. This allows her to continue providing quality care for her patients despite several physical barriers.
Penny especially enjoys her ability to give back to the neighborhoods where she grew up. “It shows these students that if you work hard you can have a great job. Many of these students have said to me, ‘My mom didn’t graduate, so how will we?’ I like to show them that hard work pays off and that education can take them anywhere. Seeing students with chronic anxiety and depression that were able to be helped here and see where they start from and watch their growth is amazing.”
An A+ for all involved.
A Day in the Life at STRIDE Community Health Center During COVID-19
Director of Nursing
STRIDE Community Health Center
Do I need to isolate? How long do I have to isolate? Am I a danger to my mom, my grandpa, my baby? How sick am I going to get?
These are the questions that are currently being asked when patients come see us at STRIDE.
As healthcare professionals, patients look to us for answers. This is something, as a nurse, I am used to. What we are not used to is having to answer so many questions with, “we don’t know” or “we are not sure yet.”
Colorado had its first reported case of COVID-19 on March 5, 2020, and by the end of the month, we had more than 2,900 cases.
My name is Stephanie and I am the Director of Nursing at STRIDE Community Health Center. We are one of the few sites throughout the state testing patients for COVID-19. Over the last few weeks, we have had patients from all walks of life come to our health centers for testing. Many are coming in because they are scared, they are sick, and they have nowhere else to go. Everyone is coming in because they want answers. Patients want to know if they can go back to work, if they can be around their loved ones or if this virus is going to make them sicker. Mostly, patients want reassurance that on the other side of this, it is all going to be okay.
My job as a nurse is to serve and protect my patients. My job as a leader is to protect my staff. In this current situation, neither feels entirely possible.
Each morning I wake up at 5 a.m. to prepare for the day. By 7, I am on an Incident Command Team call with an amazing group of leaders from throughout STRIDE. We work tirelessly each morning to ensure things are set for the day, staff are in place, all PPE and testing supplies are accounted for, and that we are able to ensure that all patients will be able to receive the services they need for the day.
After our meeting of the minds and making sure we are aligned for the day, it is “go-time” – true crisis management for each member of the team. When I say “team,” I mean all 450 STRIDE employees. Our staff is anxious – many are on the frontlines, and all of us are adapting to every change. Sometimes these changes happen within the very hour of a process being implemented. Our courageous staff screen patients at the doors for symptoms and continue to identify new processes to make sure we are all doing our best to keep each other and our patients safe.
Yet throughout the day, we have staff members supporting one another in every way we can. Sometimes this looks like driving PPE across town, or a clinician stepping in for another who just can’t swab one more patient. Sometimes it is answering phones or registering patients. Behind the scenes, we show up for each other. Not just because we are in a crisis, but because that is what we do as a COMMUNITY.
After our health centers close to patients, STRIDE’s Incident Command Team reconvenes to prepare for the next morning, reassess our PPE and supply use for the day, and discusses the urgent needs that have come up in the health centers. After this, there is still work to be done. Labs need monitoring for positive results, employees need to be notified of exposures, operations for drive-thru testing the next day must be finalized, telehealth infrastructure is continually iterating, and shift work is being implemented to prevent staff burnout.
These are just a few of the things that we couldn’t get to during the day. Many of us at STRIDE continue to work through the night to complete these projects so that we can ensure our patients are getting the best care possible and that our staff is getting the support and answers they deserve.
Since the pandemic begin, I would say my average workday ends between 12 a.m. and 1 a.m. every morning. Often, I go to sleep worrying about our patients and staff. But when my alarm goes off a few hours later, I wake up again ready to repeat the day. I wouldn’t change any of it. I am so proud to work for an organization that cares so much for the community, its patients and its staff. As a nurse, this is my calling. Maybe not the lack of sleep, but to care for people and to care for our community.