Nurses Leading with Patient-Centered and Culturally Competent Care

This month we celebrate nurses who use their extensive skills to develop programs that empower and inspire patients in ways that reduce health disparities and significantly improve the lives of the people they serve.

Beyond the Needle



Daniel Serrano, LPN
Clinical Educator II- Vaccine Coordinator
Delaware Valley Community Health Inc.
Philadelphia, PA

When you ask Daniel what he does, he says: “I’m the Vaccine Coordinator but I do so much more than vaccines.” 

Daniel started at Delaware Valley Community Health as a medical assistant, progressed to a clinical education team member, and continued to earn his LPN and become the Vaccine Coordinator. He not only maintains vaccine inventory and is always survey-ready, but he looks for ways to deliver an improved patient experience.

Because Daniel truly sees what his community needs, and relates as the father of three boys, he understands what would help parents. This compelled him to start new walk-in vaccination clinics at three pediatric sites. His goal was to deliver a patient-centric model that enables patients to get vaccinated at more flexible times, so patients don’t have to miss work or school.

Daniel co-wrote standing orders with the CMO for the walk-in clinics and CPR training. He developed the model, tested it, and made adjustments so any nurse could comfortably serve those clinics. They opened in 2019 before COVID, and within a relatively short time, the clinics served over 500 patients. Even after COVID, when scheduling and pre-screening were required, there were over 81 patients who sought walk-in vaccination services at one clinic during a two-month period. He notes, “there is definitely a need.”

After spending several months focused on COVID testing and other direct services at Norristown Regional Health Center and at Girard Medical Center, Daniel focused on his flu clinics to make sure they operate at full capacity for both adults and children.

In a typical day, Daniel also heads the CPR classes offered to Delaware Valley Community Health’s 150+ staff members. He and his team of four trainers deployed a blended model to get providers certified with an online program plus a hands-on training portion. As the “go to” person, Daniel has trained over 300 people in CPR throughout this clinic system.

Overall, Daniel enjoys helping families and parents, especially when he can help them in ways that fit into their busy lifestyles. “If you like to help people, community health centers are the best place to be. As a nurse you’re really helping the community and you can easily use your skills to your full potential.”

Establishing deep roots in the communities, offering care and dignity no matter where their patients are

Three amazing nurses are featured with very different experiences at El Rio Community Health Center, which serves patients in 16 clinics throughout Arizona.


Joy E. Baynes, FNP
Nurse Practitioner, Women and Adolescent Health
Joy E. Baynes is a Family Nurse Practitioner who works with a true sense that the young people she works with are not “recipients” of services” but “partners”.

Joy had always known that her dream job would be to work with youth leaders on teen parenting and reproductive health. About 3 years ago she made that dream a reality by writing a grant to start programs in several large cities to reduce barriers to contraception and reproductive health by empowering young people to lead the way. Joy conducted focus groups for El Rio in Tucson and recruited teens who were dealing with issues of homelessness, teen-parenthood, foster homes, substance use, and STIs to help develop a program that would be most helpful.

Joy took the voices and needs of these youth to heart. As a result, the teen clinic is free and confidential with peer-led, walk-in resources for anyone age 14-20.  It is open after school and into the evening. The first person a teen sees when they walk into the clinic is another teen. Each teen leader gets 40 hours of training created by Advocates for Youth, which includes a 20 minute presentation by peer educators covering family planning, STIs and other topics.

Teens can text, call, or walk-in to get an appointment for a wide range of reproductive health services and will be seen within 24 hours withing their network of 11 providers in 16 clinics. Joy proudly describes the youth clinics as “immensely successful and super chaotic.”

Joy explains, “We piloted telehealth even before COVID since we knew it could access and reduce barriers. We use social media for outreach and education, and provide transportation vouchers. So many of the things we do came as a result of our partnership with young people.”

Though Joy’s first grant expired in 2019, she’s been able to sustain and even grow the program with new grant funds. The program covers everything from healthy relationships, to trans health (with a “boobs and binders” program), to HIV and STI screenings, to “Pizza protection parties” and more. Joy says: “Young people are already leading the way. We, as nurses, just need to step out of the way. When the people directly impacted by a program have a voice, the program can truly address their needs and be quite successful and transformative.“

 

Barbara Vermillion, RN, MSN, MBA 
Health Center Manager
El Rio Health
Arizona

Barbara Vermillion was hired as a Health Center Manager for El Rio just as COVID-19 hit the area. Instead of the job she thought she’d have, she found herself rolling-up her sleeves and heading to the local Travel Lodge motel to manage the quarantined homeless patients who tested positive for COVID-19.

Because decades of Barbara’s nursing experience had been in the hospital setting, she wasn’t sure what to expect. She very quickly learned two things: (1) that there is a huge and hidden homeless population in Tucson, and (2) that this would become one of the most humbling experiences of her life.

When she first arrived at the Travel Lodge, there were 5 COVID-19 homeless patients there. Within one month, her patient population shot up to 97. Most of these people didn’t even believe COVID-19 was a problem. Barbara was the only nurse offering services including tent screening, wound care, COVID-19 prevention, and managing things like hospital or telehealth appointments, and meals. She learned, “These are regular people. They too need help. Most are alone with no family contact. They often have many health and mental health issues and are just very underserved. — These patients touch you. They touch your heart. They deserve good care.”

By the time she left in mid-August to reopen her clinic, 20 patients were still there.

It was very difficult for her to leave these patients because they needed her consistent care. Barbara explains, “If I wasn’t knocking at their door, they went looking for me. – They felt abandoned when I had to leave for the clinic.” Barbara kindly told the story of one patient who looked forward to seeing her every day with a big “hello”. “They don’t like change. They have no stability. You never know what could set them off into anger.”

Quite a few of her patients let Barbara into their lives. Her nursing experience at the hotel was much more than textbook nursing. The experience touched her deeply. Fortunately, several patients still use services at El Rio so Barbara has seen some of them move from a debilitated position, to getting their lives together.

Barbara appreciates El Rio’s broad range of outreach programs for special populations, including their Street Medicine Program for homeless, programs for LGBTQ populations, and so many more. Now, she’d like to see her clinic become more involved with serving the homeless. She has behavioral health, family practice, and dental in her clinic– but believes she can serve special populations too.

Barbara shares: “Nursing offers a huge opportunity. Younger generations should realize how important nursing is. I love what I do. – I just love helping people and making sure they are treated appropriately.”

 


Jennifer Stivers, LPN
Population Health Manager, Southwest Pediatrics  

Jennifer Stivers loves working with the babies, and this surprises her!

El Rio was Jennifer’s first job. When she started nursing, she would say, “I’m comfortable with anything but Pediatrics”, but that’s where her job took her. “Low and behold, I love pediatrics now. I love the kids and their honesty”. At this point she truly can’t imagine working with adults.

Jennifer is the Population Health Manager at the Southwest pediatric clinic. At her clinic there are 7 pediatric providers. Each works with 1.5 MAs and 2 LPNs. She explains this is one of the smaller sites. While she mainly works as a clinic nurse on the floor: giving vaccines, medication treatments, caring for babies, she has another role. Jennifer also looks at the numbers. She studies population health measures based on recommendations from the American Academy of Pediatrics. “The statistics help us improve the quality of our care,” she observes.

Once per week Jennifer meets with her team to discuss population health measures and find ways to improve the way they work. She shares a story: “We saw that about 40% of our kids were getting vaccinations. We asked ourselves, “Why are we working so hard but the numbers aren’t good enough?”” As a result, they made some changes. The nurses started to track vaccinations better, put “smart screening summaries” in the EHR, reviewed their daily patient panels, and made telephone calls. “Because of these things, we’re now up to a 90% vaccination rate! The data pushes us to do better.”

Since Jennifer started in her role as Population Health Manager, her clinic has about 20 new protocols. This has led to improvements with autism screenings, lipid panels, TB tests, chlamydia testing, and more. She explains, “Ideas for improvement are coming from the entire nursing team… We work together to make the numbers work. Our medical director is on board, the providers are on board, and the weekly team meetings really get everyone inspired.” Jennifer’s team is like a family.  “We have a shared vision on how we want to care for our patients. It’s a great feeling to have.”

Even with these successes, Jennifer realizes that nurses feel a heavy burden with their jobs, especially during COVID-19. “It’s so hard as a pediatric nurse to deal with babies and see so much sickness. Our faces have to be covered which scares the kids.” Jennifer would like NACHC to help support nurses with tools for self-care. She points out, “We are last on the list of people we care about, but Self-care is really important.”

U.S. Navy Ombudsman and Community Health Care Nurse puts her skills to the test during COVID-19



Melissa Hodge, RN
Clinical Manager
Ammonoosuc Community Health Services, Inc.
Northern NH

Melissa Hodge, RN, is the Clinical Manager at Ammonoosuc Community Health Services, Inc., a Federally Qualified Community Health Center with five care delivery sites in rural NH serving over 11,000 patients. Nurse Hodge was promoted to this position just weeks prior to the COVID-19 outbreak. She stepped up to the challenge with diligence, organization, and incredible compassion. With her efforts, ACHS was, and continues to be, ready – keeping our staff and patients safe and cared for through this pandemic.

Nurse Hodge runs a tight, but kind, ship!

Prior to accepting the role of manager, she was our nurse Clinical Care Coordinator where she made tremendous strides and gained national success in affecting the outcomes of our patients with chronic care conditions. In her new role, she had a trial by fire when the COVID-19 pandemic took hold. As a Navy Ombudsman who serves as a liaison between Navy command and families, she brought forth her exceptional organizational, people and communication skills to truly save the day.

Keeping ACHS ahead of the COVID-19 curve

As a RN, she comes to clinical management with a set of skills that the ACHS team truly appreciates. She knows the ins and outs and understands the agency from a clinical perspective and from the patients. As part of our COVID-19 Incident Command Team, she was the link to what was really needed on the frontline at the agency. From managing our limited supplies of PPE and COVID-19 testing kits, knowing exactly what we needed and finding it in a dwindling supply chain, to quickly pivoting the clinical support team to tele-health in under 72 hours, to maximizing a limited workforce, she (with her trusty flow charts) was able to keep us ahead of the curve at every step.

With her help, ACHS was the first in the area to set up outside evaluation tents, and separate areas to see Non COVID-19 chronic care patients for their ongoing needs, ensuring that our most in-need patients had what was required to keep them cared for. When layoffs and staff illness meant provider support staff numbers were low, she donned her PPE and stepped in to assist. Always first to think of how the crisis would impact her team, she advocated to leadership on their behalf to ensure they had the tools to get the job done – safely.

The COVID-19 pandemic has affected us all. None of us will go through this unscathed, however, the ones that took the time to plan, organize and put the needs of the community above their own are the true heroes. Nurse Hodge has made a tremendous difference in this community health center and how we will weather this storm. With her efforts, Ammonoosuc Community Health services will survive and thrive.

With appreciation to Jill Kimball.

Leading the Way


Karla Pope, MSN, BSN, RNKarla Pope, MSN, BSN, RN
Director of Nursing
CompleteCare Health Network
Cumberland County, Gloucester County and Cape May County, New Jersey

Karla Pope is a true leader. In her role as Director of Nursing at CompleteCare Health Network she oversees the entire nursing staff, and all certified medical assistants. Karla works tirelessly as a mentor and educator. She makes everyone she works with better at what they do – even if they don’t work as a clinician. She has incredible patience and often spends her day consoling, advising, and comforting staff who call her for help and guidance.

Karla is always upbeat, positive and smiling. She often stops to check in on others, see how they are feeling, or share a positive story. Despite struggles in her own life, she comes to work happy and ready to take on the day.

Karla is also incredible with patients. When complaints or questions come from patients, she goes above and beyond to ensure that person feels safe, comfortable, and cared for. Even when she delivers test results or coordinates paperwork for a patient, she asks about their well-being and takes time to answer questions and address their concerns.

During the COVID-19 pandemic, Karla has stepped up to stand side by side with our Chief Medical Officer to lead CompleteCare’s coronavirus testing efforts. From the beginning, this duo created processes and procedures to get as many people in our community tested as possible. Karla went from testing site to testing site as back up for the doctors as they completed their tests. She prepared kits, bagged tests, directed traffic, rallied staff, and did whatever necessary to get patients seen quickly and efficiently. She helped establish multiple drive-thru testing sites and a walk-up site in an area where foot-traffic is common. She’s set-up more than one-dozen testing sites on migrant/seasonal agricultural worker camps in our area. Karla makes sure plans are clear and focused on the safety of staff. She was instrumental in getting PPE for all staff and helped design the protocol to provide vital patient care. In just the first few months of testing, thousands of people were able to get tested for COVID-19, while maintaining standard operations.

Throughout this period, Karla has continued to oversee staff at CompleteCare and keep them safe. She monitors all sites for OSHA compliance and ensures that CompleteCare meets high infection control standards. She provides clinical expertise to the Executive Team, Rapid Response Team, Business Performance Team and Performance Improvement Committee.

Karla has worked at CompleteCare since 2009 and has over 34 years of experience as a nurse. She received her LPN license from Vineland Vocational School in 1986. After, she spent over 20 years working as a nurse in medical/surgical, long term, laboratory management and pediatrics. She went on to graduate from Excelsior College with an Associate of Science in Nursing degree and from Wilmington University with a BSN degree. As a perpetual learner, in 2018 Karla earned a Master’s Degree in Nursing with a concentration in Leadership and Education, also from Wilmington University. Karla is certified in the practice of Culturally Competent Care by Cine-Med. She was also recently accepted into the Sigma Theta Tau Honor Society.

With appreciation to Kim Tweed.

See the news story featuring two semi-retired NPs from Shasta Community Health Center who volunteered for the COVID-19 vaccine trials.

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