Nurses Leading with Care by Supporting those in the Field with Data, Evidence, and Best Practices

Nurses don’t always need to see patients to help. This month we feature stories on nurses who use data, evidence, and best practices to support in the field.

Finding Knowledge, Experience, and Passion through Nursing

Andrew Hamilton, RN, BSN, MS 
Chief Informatics Officer
AllianceChicago
Chicago, IL

Originally, I entered my undergraduate education with a plan to eventually go to medical school. I knew at a young age that I wanted to work in the healthcare field– my mother, both of my grandmothers, and a few of my older cousins worked in the healthcare field. A month before I relocated for college, I applied for a job at the University Hospital to work as a patient care technician and was assigned to the Critical Care Medicine Unit. I could tell from my first day on the job that I would enjoy the challenge of working in the high paced, high stress environment. As time went on in that first year of employment, I realized the important role that nurses play in the delivery of care, particularly in the intensive care unit! I remember by the end of my first semester of studies going to the academic affairs office and asking about a transfer into the School of Nursing.

What I didn’t understand at the time is the enormous diversity of professional opportunities that would be unlocked by the successful completion of an undergraduate degree in nursing. I did, however, learn to appreciate quickly the academic, social, mental, and physical skills necessary to achieve a degree in nursing. After completing my undergraduate studies in Nursing and Political Science (I didn’t want my Liberal Arts degree to go to waste), I worked for a year as a registered nurse in the Pediatric ICU. Originally, I had no intention to work in Pediatrics as I had worked in the Adult Critical Care Medicine Unit for the duration of my undergraduate studies. However, after completing my degree and passing the Board of Nursing Examination, I was hired by the University Hospital during an incredible nursing shortage and was asked to “float” to the Pediatric ICU and agreed to that despite the more comfortable option of working in the same ICU that I had previously used as a training ground. Looking back, it is still one of the best professional decisions I have made because I gained an enormous amount of clinical experience and expanded by understanding of the importance of healthcare, public health, and community medicine.

Not long after my first few years of working in the Pediatric ICU, I trained as a flight nurse and also was certified as an ECMO nurse specialist. Both of these areas of nursing are highly technical and it was in those early days of those experiences that I grew to appreciate the intersection of healthcare delivery and technology. I also volunteered on an early experimental project that aimed to use patient clinical data to “predict” ICU morbidity and mortality (APACHE). Through these clinical and research experiences I was introduced to the hospital’s leading “nurse informaticist”. Like most others at the time, I had no idea what that meant nor did I understand it to be a formal area of academic study. After spending more time with my colleagues, I applied for the Master in Nursing Administration and Nursing Business with a focus on Nursing Informatics.

I consider those two decisions in my early career (to work in Pediatric Nursing & to Study Nursing Informatics) two of the best professional decisions I could have made.

I continued working as a Pediatric ICU nurse and my academic work for the next three years and upon completing my Master’s in Nursing, I relocated to Chicago. Not long after relocating to Chicago, I was introduced to several local clinical leaders that were working in Federally Qualified Health Centers. Before my move to Chicago, I had never heard of these organization and did not understand that I was about to make another life-changing decision. However unaware, I decided to make the leap into community health and not unlike my first job working as a tech in the ICU, I recognized immediately that I had found another passion.

I consider my work in community health to be the full expression of my personal mission which is to use the best available science and technology to build healthy, economically viable, and equitable communities. I can honestly say that my life journey would not and could not have been fulfilled without the knowledge, experience, and passion I have found through the profession of nursing.

I am so grateful for my parents, grandparents, and family members that strongly influenced my decision to pursue a career in the health professions. I am eternally grateful to the nurses I met early on in my undergraduate education as those women (and some, but few men) taught me very valuable clinical skills, but more importantly shaped my understanding of the enormous impact the profession of nursing has on healthcare delivery and community health and well-being. And of course, nurses were the early pioneers in the discipline of informatics and I’m honored to have learned from some of the most notable informaticians that paved the way for many of us working in the field today! I can only hope to leave a legacy as important and rich as they have!

With appreciation to Andrew Hamilton.

Not every idea will work but need a spark to get you going

Christina Nunnally, FNP-BC
Chief Quality Officer
North Mississippi Primary Health Care, Inc.
Ashland, MS 

Christina Nunnally, FNP-BC, started her career at a community health center assisting patients with pharmaceutical assistance applications. And nineteen years later, she is still in the health center world, noting that no year, no month, no week, no day is ever the same.

As the Chief Quality Officer at North Mississippi Primary Health Care, Inc., she collects and reports the data- but that doesn’t mean she doesn’t see patients. Every Tuesday, she provides women’s health services in the clinic.  “There is a need for these services in the area, and some patients are more comfortable talking to a woman,“ Christina said.

She administers the quality program at an eight site health center serving almost 15,000 patients. Christina has implemented and overseen several expanded care programs including telehealth psychiatry, behavioral health counseling, and Hepatitis C treatment.  According to her colleagues, her desire to see her health center as a leader, not only locally and state-wide, but also on the national stage has improved the variety of quality of services available for patients in the service area.

She’s a problem solver. When the state reduced funding for the mental health program in her small rural town, she leveraged a telehealth program in partnership with a university so patients who were worried about being stigmatized for seeing a mental health clinician could safely do live video with a psych NP in a regular exam room. It was so successful that they added an in-person licensed clinical social worker. She was also able to integrate social determinants of health screening into the triage process.  “Health and well-being is made up of more than physiological processes. Social and environmental factors influence health so powerfully, and connecting patients with resources to reduce related risks is essential in community health,” Christina said.

Christina works with human resources to make sure nurses are fulfilled and not overworked at the health center. Not only does Christina want to help her fellow colleagues, but she is interested in teaching future nurse leaders.  She serves as an adjunct professor at Freed-Hardeman University where she provides instruction to masters and doctoral candidates in quality and behavioral health informatics.

Leadership and QI Drive the Initiative

Jessica Britton, RN, MSN
Quality Improvement Consultant, Eastern AHEC
Roanoke Chowan Community Health Center
Ahoskie, NC

Jessica Britton started at Roanoke Chowan Community Health Center in the small town clinic of Murfreesboro Primary Care as a staff nurse, then nurse manager of Colerain Primary Care. She later went on to work in hospital quality, before returning to RCCHC in 2019 as a Quality Improvement Consultant with Eastern Area Health Education Center (AHEC). Her role is to lead and drive Quality Improvement initiatives while meeting regulatory compliance standards.

When asked what brought her to QI, Jessica responded, “Quality improvement is exactly everything I believe in; it’s the constant need to always improve, and the constant focus on how we can do things better for the organization and our patients. Even if we’re doing really well, we could be always be doing better.”

But how do you work on quality during a pandemic? Jessica admits it has been unique time for QI. Understandably, the focus is on COVID-19, and everyone is in some degree of “crisis mode” working to meet the needs of an influx of patients in new and ever changing ways. She coordinates with RCCHC leadership to keep a balance between not letting quality initiatives drop, while recognizing the unprecedented workload of the “boots on the ground” staff. “Leadership and QI drive the initiative,” she says, “but it’s the frontline staff really doing the work.”

With Jessica’s help, RCCHC achieved a clinical quality ranking of #4 in the OCHIN collaborative of 112 healthcare organizations in July 2020, as well as Patient Centered Medical Home (PCMH) initial recognition of two new clinics, and annual PCMH reporting for RCCHC’s two largest sites.

Jessica is grateful for the time she worked in a direct patient care role in the Community Health Center setting. It helped her get an understanding of common barriers for health center patients, especially in rural areas, like getting transportation to appointments or paying for medication. Those experiences are ones she always tries to remember in her work, although it’s less about patient interaction now.

“QI in a Community Health Center is big picture, the umbrella is little bit larger. You’re looking at how we can improve the health outcomes of the community, and the people of the community as a whole,” she says, “That’s very meaningful to me.”

Jessica has almost 10 years of nursing experience, including critical care nursing, community health, and Quality, Regulatory and Patient Safety. Prior to her current role with Eastern AHEC and Roanoke Chowan Community Health Center, she was a Quality Nurse Specialist III at Vidant Roanoke Chowan Hospital where she led the hospital in achieving Acute Stroke Ready Certification by the Joint Commission. Jessica holds a Bachelor of Science in Nursing and Master of Science in Nursing with a concentration in Education, both from East Carolina University.

With appreciation to Erin Storie.

There Are So Many Opportunities to Collaborate

Elizabeth Sledge, LPN, PCMH CCE, NCP
Quality Manager
OSIS

Elizabeth Sledge has been a nurse since 2001, working in various capacities, including the VA and a FQHC.  Currently at OSIS, a Health Center Controlled Network, Elizabeth represents a new type of nursing that many are not familiar with.  Elizabeth herself recognizes that nurses who work in quality, outside of a health center, are often misunderstood.  “Most people think that nurses are ‘hands on’.  I found that I make a difference remotely, working with many different health centers across the US”.

Elizabeth’s role at OSIS is vast. Her portfolio includes: UDS reporting, quality, PCMH, and EHR workflows (using NextGen).  She holds weekly/biweekly calls with health centers to assist practice support staff to implement quality programs that have a goal of improved patient outcomes and focusing on the Quadruple AIM. She is able to relate to the practices on a personal level, having been in the trenches herself.

Elizabeth has advice to give to nurses who want to lead with care in the area of quality: “…take every opportunity to learn.  Express interest and take opportunities to learn what you are passionate about and don’t be afraid to learn something new.  Branch out and use whatever resources are there. There are so many opportunities to collaborate”