Nurses Leading with Care in Health Centers

This month we will follow a day or week in the lives of nurses providing direct patient care in community health centers.

Caring Is In Her DNA

Katrina Nguyen, MSN, RN, PHN
Registered Nurse, Community Medical Centers
Vacaville, CA

When you meet Katrina Nguyen, you can immediately tell that caring for others is in her DNA.

“I love being able to get to know people,” says Katrina, a registered nurse at Community Medical Centers’ Vacaville location. “I love being able to understand them. In the clinic setting, nurses are afforded more time than providers are to really be able to sit down and get to what is the concern.

“Patients open up and say, ‘Well, I didn’t have transportation,’ or, ‘I didn’t have anybody to translate for me,’ or, ‘Can you explain it more for me?’ ”

When Vacaville center manager Bill Byrnes was looking to fill a nursing vacancy five years ago, Katrina was the first – and only – candidate he interviewed.

“I’ve known from Day One she was perfect for CMC,” Byrnes says. “I instantly knew she was the right person.”

Katrina knew she wanted to be a doctor or work in the medical profession from the time she was a young child growing up in nearby Fairfield. But there were hurdles along the way.

After a rocky junior year of high school, Katrina thrived in an independent study program, got her diploma early, and enlisted in the United States Army. She was only 17.

“Going into the military provided structure, a source of independence and also a source of education,” she says.

Her Army stint took her to South Carolina, Texas, Washington state, and Virginia. By the time she was 19, she was a licensed vocational nurse.

Katrina was 22 and serving in the National Guard in South Carolina when she received the shattering news that her two younger brothers had been murdered by a gang member who mistook them for members of a rival gang.

Within months, Katrina moved back to California, where she was hired in 2007 to work at a day program for adults with developmental disabilities. Meanwhile, she continued her training, earning her license as a registered nurse in 2011.

Stymied by a tight job market, Katrina took a job as a patient care technician at Kaiser Permanente. She worked for Kaiser for 2½ years before her impressive Vacaville job interview landed her at Community Medical Centers, where she launched her career as a registered nurse.

“Looking back, I wouldn’t change a thing. Now I can see how my path has brought me to CMC,” she said. “I’ve seen how sometimes things don’t work out how you think they will or how you want them to initially, but then when you look back you can see how it all comes together. It worked out exactly like it should have.”

In the years since her hiring in Vacaville, Katrina “basically developed” CMC’s intensive outpatient case management program, according to Byrnes. She has led the program since 2017.

“In community health, primary care is in one building, specialists are somewhere else, and the lab is elsewhere,” Katrina says. “It can get very confusing for patients, especially when they have multiple chronic conditions, multiple specialists.

“Sometimes patients are homeless. Sometimes they need transportation, or we have to get them to do prep before a procedure. We walk people through the process.”

Even in her free time, Katrina thinks of others, providing medical aid on mission trips to Mexico, Panama, Uganda and Kenya. In Mexico, Katrina sat for hours beside a woman whose baby was stillborn, even though she speaks little Spanish and the woman spoke no English. “Mi angel,” the woman called Katrina afterward.

This is an especially significant year for Katrina. She will soon complete her training as a nurse practitioner, and she says she is eager to be able to do even more for her patients in her new role.

“I’ll be a stronger part of the treatment plan and I’m excited about being able to do that, being able to partner with the patient in a role that allows for a little more autonomy and shared decision-making,” she says.

“I think given all of my experiences, I will be able to better understand where my patients are coming from, and maybe help them a little bit more.”

Ginger Manss, CMC’s Chief Nursing Officer, says Katrina is ideally suited to work at Community Medical Centers.

“Katrina is one of those nurses who has the heart and the passion for community health care,” Manss says. “She will just go to the ends of the Earth for her patients. She has such a lovely heart. I just feel extremely honored to work with her.”

Submitted by Roger Phillips, Communications Manager, Community Medical Centers

Persistence Pays Off

Erin Raftery, RN, BSN, MPH, a Care Manager at Eastern Iowa Health Center (EIHC) in Cedar Rapids, Iowa, credits her current position to her organization’s involvement with NACHC.  When her organization participated in the ELEVATE program, convened by NACHC’s Quality Center, they identified a need for a clinical care manager.  Erin had been working in a variety of different settings before EIHC—a pediatric ICU, hospital quality department and then as a health coach with a wellness company.  When she learned of the care manager position at EIHC, which was newly created, and aligned with her personal and professional mission and values, she states “this is why I went into nursing.” She has held this role for 3 years and developed it throughout that time.

A typical day for Erin includes care managing a panel of patients. This involves troubleshooting medical related logistics—transport, appointments, and follow-up.  Erin also has a panel of patients that she health coaches on a variety of topics including weight management, tobacco cessation, and diabetes control.  She also works with her team on advanced care planning, which involves anticipating the needs of patients coming into the clinic in the near future and planning for that.

Besides patient care, Erin sits on several committees and attends meetings, including meetings related to quality, diabetes and the social determinants of health, a state-side innovation model group, and the Iowa PCA Care Management Working Group. She is also involved in a breast and cervical cancer screening navigation program.

One of the distinct contributions that Erin has made to patients in her community is the development of a diabetic log book.  Erin recalls that many of the patients she either care-managed or coached would be released from the hospital with a laborious diabetic log book that was not easy to use and asked for confusing information.  After developing her own tool and iterating on it several times, with patient input, Erin and her team created a streamlined log book that was part of an educational resource packet for patients at any stage in their diabetic journey. Bright green and simple to use, the notebook has now been adopted outside of the health center.  Local area hospitals and other health centers are using it with their patients as well.

Erin shares with her fellow nurses the following advice:

“Have a curious mind and be an innovator and leader (even if not in a “leadership” position).  Think outside the box.  As there are not always resources available, be resourceful with what you have.  Sometimes patients will make only small movements and be OK with that.  Take the wins with what they are.  Persistence pays off in this role”

We celebrate Erin and her colleagues at EIHC, as she is one of the many “Nurses Leading with Care.”

A Day in the Life of a Nurse Care Manager

Charlotte Ficklin, LPN
Nurse Care Manager, Southeast Community Health Systems
Hammond, LA

What does a typical day or week in your work life look like?

First thing in the morning, I sit down with clinical and front-office staff, and we do a daily huddle. We talk about anything going on that day, patients with special needs that may need accommodations, any patients that are visually or hearing impaired. And the majority of my day is doing planning for that next day. I take all the specialties at our clinics and make a list of patients and I look into their chart, see if they need any preventative care, any prostate screenings, mammograms, and make a list of that for the providers. For those patients that are visually or hearing impaired, I’ll arrange an interpreter. And I’ll also coordinate any quality assurance efforts, as well as oversee any maintenance issues. And if nurses call in sick, I’ll step in and provide direct care.

What is distinctly unique about your role?

Unique to my role as a care manager here at Southeast is that I get to do everything, not just the care management. I provide direct clinical care, I inspect the building, I handle incident report management.

What brings you the most joy about working in this role?

Definitely working with those challenging patients. We have many patients who are diligent about coming in twice a year and being compliant with their medications.  But we also have a handful of patients who are more challenging, and when you finally have that one patient get his A1c under control, or stay on top of his diabetes care plan, it is so rewarding.

What advice would you give to people who are interested in this kind of nursing?

Just know that you’re going to have challenges, and just to stick through it, because I’ve never had a more rewarding job. And for those that are currently practicing, I would say, never stop listening to your patients. We learn so much from our patients.

What is one memorable experience in which you led with care with patients/clients or community?

When I first started working here, I had a 62 year- old female patient, who couldn’t read very well, was very uneducated, and she had never had a mammogram and I knew she was 22 years overdue. She’d come in and say, “Oh Ms. Charlotte, I’m too busy,” and I’d go over every time why she should get one.  Finally one day she came in and said, “I’m going to get my mammogram for you, Ms. Charlotte. Only because of you.” And a few months went by and she came back to the clinic to see me and she hugged me, and she told me — and I will never forget this — She said “What you did for me, it saved my life, because I had breast cancer. If I had not listened to all those things you had told me, I would not be alive. Every time you would tell me something, and I thank you for that.” And I that was the first time I really, really felt like I was truly helping someone. It was very impactful and it truly sticks with me for each patient I care for.