Nurses Leading with Care, Dignity, and Respect
This month we celebrate nurses who take time to know their patients, their lifestyles, and their disease state with consideration for barriers caused by social determinants; then tailor evidence-based care plans to meet patients where they are. We also showcase nursing models for the 2020 Flu & COVID-19 Vaccines from three community health center nurses.
Click Here for Recording from October 14, 2020 Nurses on the Front Line…Models for 2020 Flu & COVID-19 Vaccines webinar. These nurses, and their associated innovative models for care are highlighted here: Callen-Lorde, CHC Inc. and Esperanza.
CPR – Compassion. Presence. Reassurance.
Sister Ruth Neely, CRNP
Certified Registered Nurse Practitioner
The Wright Center for Community Health’s Ryan White Clinic
Sister Ruth Neely, CRNP, would never describe her role at The Wright Center for Community Health’s Ryan White Clinic as a mere job.
“It’s a ministry,” she said.
Sounds like something a Catholic nun would say, although you probably wouldn’t expect her to be saying it in reference to an HIV clinic. However, one only needs to spend a short time in Sister Ruth’s company to understand that she’s right where she’s supposed to be.
A longtime nurse practitioner at the clinic, Sister Ruth delivers expert medical care mixed with profound compassion — precisely what the clinic’s vulnerable patients need in order to achieve long-term success in their treatment.
“They don’t see me as a nun. I think it’s my personality,” Sister Ruth said. “They trust me, though. They tell me things you wouldn’t believe.”
A member of the Sisters of Mercy order, Sister Ruth first went to work at the clinic in 1997, after spending the previous 25 years “taking care of old nuns” and getting her nurse practitioner certification from Misericordia University at the age of 50.
She was hired by Dr. Stephen Pancoast, an infectious disease specialist who many consider to be the region’s foremost authority on the treatment of HIV/AIDS patients. At the time, The Wright Center was still known as Scranton-Temple Residency, and the clinic was still several years away from attaining the federal Ryan White Part B and C funding that would take its operation to another level.
“When I started, I think there were like 129, 130 patients,” Sister Ruth said. “Now, there’s close to 500. Patients are aging with this disease now, because it’s become manageable. And people are finding us – we’re the first place that comes up on Google. … Things have evolved.”
Certainly, they have, thanks to monumental breakthroughs in the drug regimens now available to patients. That said, those “meds,” as Sister Ruth refers to them, need to be taken on a daily basis in order for them to work effectively.
“If the meds aren’t taken right, they build up a resistance. Then, you can’t take that medication anymore. So, I need them to come in here and pay attention,” she said. “And once they take all of their meds, they need to come back to me before they can get more. After all, they’re $3,000 a month. And I constantly follow up with phone calls. ‘Are you taking your meds?’ I’m on the phone a lot.”
Of course, when patients come to the clinic, they’re getting a lot more than just meds, Sister Ruth pointed out. They’re getting comprehensive care that also includes case management, mental health and nutrition services.
In addition, they get ample doses of what Sister Ruth refers to as CPR – Compassion. Presence. Reassurance.
Her CPR toolbox includes hugging, hand holding, breaking into song at a moment’s notice and passing out small plastic hearts that she implores patients to keep near and dear to them.
“When I have to tell someone they have HIV, you can see their head swirling. It’s overwhelming to them. So, they always get a big hug,” she said. “You need to be an upbeat person and encouraging and give them hope.”
That means refraining from preaching or judging, even when you’re a Catholic nun working with patients who have engaged in high-risk sexual behavior.
“I just see them as a person. When they come here, they’re broken. We need to find their inner strength,” Sister Ruth said. “You’ve got to have that gift to connect with them. You’ve got to understand their lifestyle, and then you can administer the medicine. You relate to them that the head and the heart match. When that head and heart comes together, that’s when the transformation happens.”
To illustrate, Sister Ruth mentioned a female patient who recently came to the clinic with advanced AIDS. Once committed to a daily regimen of meds, the woman saw her viral load reach a level where the disease is now nearly undetectable.
For those fortunate people, Sister Ruth gives them the news with a song, altering the lyrics to Nat King Cole’s “Unforgettable” to, “Undetectable, that’s what you are. Undetectable, I’m so proud of you.”
“The patients, they know they get darned good care here. They leave here smiling,” said Sister Ruth, who gets patient referrals from all over Northeast Pennsylvania, and even from out of state.
Of course, not every story has a happy ending. Many of Sister Ruth’s patients have passed away, and for each one, she makes it a point to attend their funeral. There, she can speak on their behalf, extolling “all the good things about them.”
“And we pray for them, and remember them,” said Sister Ruth, a two-time breast cancer survivor.
With appreciation to Patrice Wilding.
Evidence-based Care for All Patients
Melissa Lamb DNP, FNP-BC
Family Nurse Practitioner
Rural Medical Services
As a Family Nurse Practitioner in a rural FQHC with decades of experience in emergency medicine, Melissa has learned to focus on the patient, not their disease state or condition. She takes time to know each patient and tailor an evidence-based plan to meets their needs at their stage of life with consideration for social determinants that may cause a barrier. When she identifies a barrier, she’s quick with a referral and support.
Tracy Smith, a colleague of Melissa’s at Rural Medical Services, had this to say. “Melissa conducts the highest evidence-based care of any clinician who has ever practiced and does so with grace, dependability, and high ethics. Melissa does all of this and cares for her lovely family. – I can’t speak highly enough about the care Melissa provides to her patients or the value she brings to this organization and community. Melissa is dedicated beyond measure.”
Melissa notes that while the scope of her role as a Nurse Practitioner varies in practice depending on the state where a Nurse Practitioner works, research and evidence consistently supports the positive and direct impacts of NPs. They prove to achieve better access to care, better patient outcomes, reduced health disparities and, generally, a more efficient and cost-effective primary care system. Now, with her Doctorate of Nursing Practice, Melissa is living proof of these benefits for the Tennessee-based FQHC and rural communities in which she works.
The barriers and fears caused by the pandemic have led Melissa and her team to find creative ways to meet patients, identify alternatives to scarce resources, and increase patient visits for primary care (which has dropped by over 1/3 since the pandemic began). Often, her clients don’t have access to Wi-Fi or smartphones, so for Melissa to see approximately 25-30 patients each day, she will meet them outside the clinic, by their car in the parking lot, offer telephone or virtual visits, or meet them in the clinic which has been redesigned to safely manage and separate-out COVID patients. Melissa knows that even a quick, 10-minute follow-up call means the world to her patients.
Though her work is sometimes exhausting, Melissa is touched and rewarded by her team and her community. “Our organization has a diverse care group that works well together on so many levels to provide our patients and community with more than just medical care. We address our patient’s mental health needs, emotional needs, and have been able to support patients in ways that you would not expect a medical center to do. For example, we’ve partnered with other groups to offer a crib for a newborn, food boxes for those in need, financial assistance, community Trunk or Treat, Health Fairs, just so many things to improve the lives of our patients and community.”
What this pandemic has shown Melissa is that she appreciates her community more than ever. People go out of their way to help one another. Melissa deeply believes in the mantra: “be good to people and they’ll be good to you”, which makes her job easier and even joyful. To stay on top of her game, Melissa keeps up with numerous evidence-based journals and resources from nationally recognized organizations. “In this ever changing world of knowledge, you have to continue to learn in order to provide the best, safest, and most up to date care for your patients,” Melissa said.
Two Nurses’ Journeys to Leading with Care in Alaska
Judith Lewallen, MSN, MSN Ed, BSN, ASN, ANCC, BLS
Patty Linduska, RN, BS, PCMH CCE, PF
Two journeys. One passion. Judith Lewallen and Patty Linduska, both nurses with years of experience in community health currently work together at the Alaska Primary Care Association. They each found their way to serve in Alaska and provide support to communities and health centers.
Here are their journeys:
Judy: I knew I wanted to be a nurse from an early age. I think I was 6; my little sister suffered a severe head injury. I remember she had to stay in the ICU for weeks and every day my Mother would take me to the hospital, and I would sit outside the ICU while my parents stayed with my sister. This was 1955 and nurses wore white dresses, white hose, white cap, and white shoes. They would walk by me and say what a good girl I was and bring me ice cream. For years I thought this is what nurses did and that is what I wanted to do when I grew up. Later I learned that my mother’s sister and sister-in-law were both nurses during WWI. After the birth of my second child, I decided to go back to school, so I enrolled in a two-year Associate Degree Program in rural East Texas. It was the hardest two years of my life. I graduated in 1977 and getting my nursing degree was the best thing I ever did.
My first nursing job was in a large hospital in Ft. Smith, Arkansas. I worked nights with the rest of the new graduates. Next, I moved back to Texas and worked in a small emergency room. I continued to learn from new experiences and my confidence grew. I was no longer the novice. I continued to work in the emergency room, in the pediatric unit, and medical-surgical units in several different hospitals until 1980.
For the next 13 years I worked in a small rural Catholic hospital in Missouri. Working for the nuns was so different than anything I had ever done. It was like stepping back in time. It was hard work; each nurse averaged about 20 patients. I remember days when I never took a bathroom break or any break at all and always went home knowing that I had left so many little things undone. October 30, 1983 DRGs became a reality and everything changed. Suddenly, our census dropped. The nuns started looking for other sources of revenue. During this time, I went back to school part-time and got my Bachelor of Science in Nursing. The nuns asked me to help start up a home health agency for the hospital, so I did. I loved home health. I loved the one on one with the patients and listening to their stories and feeling like I had done a good job and a made a difference in one person’s life.
Judy: In 1993 the nuns sold the hospital to a larger hospital and I decided to enroll in the master’s program at the University of Texas and become a Family Nurse Practitioner. I left Texas and moved back to Missouri in 1999, went to work in a small rural clinic for the only Doctor in the county. Dr. Hill had 3 clinics with a full time NP in each clinic. I worked there for 8 years and loved it. My favorite experience was caring for the whole family. Having little kids run into the clinic crying I want to see Doctor Judy and I had provided prenatal care to their mothers and heard their first heartbeats. Also, the hardest and saddest when I could not hear that heartbeat on a mother that I had given prenatal care for 8 months and the baby was still born with the cord around its neck.
In 2003 I lost my husband, remarried in 2006 and we decided that we needed to make some changes. In 2008 we both took jobs in King Cove, Alaska and lived there for 2 years. When we came back to Missouri, I decided to teach nursing at a local Community College and was hired to coordinator a new satellite campus. While teaching I had summers off, and I would travel back to Alaska to work as a locum provider in numerous clinics around Alaska. I tried to retire but last fall, I accepted the Coordinator of Clinical Services position at the Alaska Primary Care Association in Anchorage. This has been a dream job for me. I am 70 years old but still feel I have a lot to contribute and am not ready to sit at home.
So here we are. I love that I get to use my teaching skills and my years of nursing knowledge and my clinical experiences as a village provider to help our Community Health Clinics in Alaska. The Alaska Primary Care Association is a great organization to work for, one of the best I have been associated with in my nursing career.
Patty: I had at least 4 nurses as role models in my early life and I knew I wanted to be a nurse by age 4. I used to tell neighbor kids I had a “medical chest” in my room that was white with a red cross (a total lie). Then at age six one of the nurses in my life gave me a nurse’s hat and I was sold.
My family did not have a lot of money, so I opted to go to a three-year nursing program and I received a Diploma in Nursing in 1973. We did a lot of hospital nursing related to didactic topics. It was kind of an apprenticeship model. I also worked as a Surgical Technician while I was in school. I got a job right away with Everett General Hospital in Washington State in the newborn nursery and delivery room. During my training I delivered over 35 babies. In my delivery rotation, there was a resident who was a local general practitioner who had to deliver patients from his practice. He let me do the deliveries. This worked out well for me in my future work in King Cove, Alaska where I had to deliver a few babies who decided to come early; one breach.
In 1978, I moved to King Cove, Alaska to run their tiny clinic for the city and cannery. I was the only medical person in town; no EMS. It was the first year of the Community Health Aid Manual which I used along with PHN standing procedures. I had the resources of the Alaska Native Services hospital at my disposal. I could call Doctors for distance help day and night, and often did. Telephones were new to the community and were not completely reliable, but better than the radio system they had been using for medical consults.
I lived in King Cove for 19 years moving in 1997. In that time I achieved by Bachelor’s Degree, Psych Nurse Certification, and substance abuse counselor certification. I provided primary care, emergency care, mental health and substance abuse counseling, school nursing, and taught health classes to junior high and high school students. Then I discovered I had a knack for grant writing, program development and leadership. From 1997 to 2013, I worked for a tribal organization as Director of Program Development, COO and CEO. I also worked for a non-tribal organization as their Executive Director. In between I had my own consulting business doing grant writing and strategic planning.
In 2013, I was hired by the Alaska PCA as the Director of Training and Technical Assistance and continue to do that same work seven years later. When I started at APCA, they had a new Executive Director and it was essentially a restart of the organization. We now have a robust Quality Improvement Team, Finance and Grants Management staff, Training & TTA staff. We have a Health Center Controlled Network with 16 participating health centers.
A typical day/week in my work life looks like a lot of meetings with outside entities as well as my team. My role is one of leadership. I have 6 staff on my team. I love that my job uses all of the experiences from all my previous work. Instead of working with one health center I can help many. My advice to others interested in this kind of nursing, or any nursing for that matter, is to be open to the possibilities. We measure the work we do through outcome measures. It’s not necessarily nursing, but it may be.