Nurses Leading with Care by Reaching Beyond their Walls

This month we honor our nurses who go outside their clinics for patient care. We also highlight the nurses presenting during CHI@Home Year of the Nurse 2020: Leading with Care Into the Future Education Session.

Working upstream to address the patient and the system

Courtney Pladsen, DNP, FNP, RN
Clinical Director
National Health Care for the Homeless Council
Portland, ME

Seventeen out of every 10,000 people in the United States were experiencing homelessness on a single night in January 2019 during HUD’s Annual Point-in-Time Count. These 567,715 people represent a cross-section of America- through every region of the country, family status, gender category, and racial/ethnic group. While Courtney Pladsen can’t help all these 567,715 people, she tirelessly takes care of Portland, Maine’s homeless population.

As a Nurse Practitioner, Courtney has spent the past eight years working at federally qualified health centers. For the past 2 years she has worked at Greater Portland Health’s Healthcare for the Homeless Clinic, a community health center providing primary, substance use, and mental health care.  Courtney recognizes coming into a health care facility can often be overwhelming for some patients. Greater Portland Health partners with the Milestone Recovery outreach team and they goes out in a van in the field to find unhoused patients. She visits encampments, woods, and drives around the streets. “I literally meet them where they are. I want to be sure the walls aren’t a barrier,” she said.  Once she locates her patients, she and other medical staff work to build relationships and provide much needed medical care. By decreasing the barriers to care, this develops a trusting relationship and makes it less overwhelming to access care at the health center.

Her work has been especially challenging these past few months. “COVID-19 has just exacerbated the inequities in our health system,” Courtney said. Almost half the Black people in Maine are immigrants, the highest share in the nation. She notes that in Maine, where Black individuals represent only 2 percent of the population, they represent 22 percent of those who have tested positive for COVID-19. The reasons, Courtney explained are compounded by systemic racism, densely populated shelters, front line jobs with no job security, and limited access to health care. COVID-19 has also increased the existing opioid crisis by fueling social isolation and anxiety. The number of overdose deaths in Maine have increased in the first quarter of 2020 compared to 2019. Providing medical, mental health, and substance use treatment with a health equity focus for Pladsen has been more important now than ever.

Courtney approaches advocacy as an essential piece of her work. In 2019 Courtney helped advocate for a bill by testifying before the state legislature to pair funding for substance use treatment with housing. This bill became law and Greater Portland Health, in partnership with the social service organization Preble Street, was awarded the grant. “The advocacy of our organizations that you ‘cannot have recovery without housing, because Housing is Healthcare” was a powerful message and ultimately we were heard. These partners will launch this program this fall that will provide much needed substance use treatment and housing for our patients, “ she said.

Courtney is ready for her next challenge. She accepted a position as the Clinical Director at the National Health Care for the Homeless Council. In this role she will be supporting the over 230 Health Care for the Homeless clinics across the country through research, policy/advocacy, technical assistance, and education. As she steps into this national role she will happily keep her roots in Portland, Maine and continue to see patients at Greater Portland Health one day a week. Her ultimate goal is to put herself out of a job. She explains, “I hope that one day that we will see the end of chronic homelessness, and that health care for the homeless will no longer be necessary”. She will continue her advocacy and working towards system change until this is realized.