Today I was at the Mercy Care
Chamblee Clinic which serves a large Hispanic population. We began the day with
a morning huddle and everyone dispersed to work on their own projects for the
day. I learned about the services provided that ranged from vaccines to patient
education. I saw how the scope of the RN is different in the public health
setting and that a lot of clinical work is delegated to the medical assistants.
We saw patients being triaged but ultimately sent the ER because the lack of
resources from the clinic. One of the nurses was calling patients to check in
on them in regards to their blood pressure readings for the American Heart
Association BP program. The level of bilingualism the clinic maintains is very
impressive and the medical staff is very competent with the limited resources
available. Mercy Care Chamblee is unique and has housing services for the
elderly and disabled right across the street which is pictured below. The staff
make it their priority to make sure all the patients are treated with respect
regardless of any socio economic or language barriers. This clinic is truly
admirable for their dedication to their patients and bond they have as a staff
PS: Mercy Care
cares for EVERYONE… literally pictured as our classmate Kayla was given two
stray kittens after her shift to take to the animal shelter and provide a safe
The Emory School of
Nursing’s neighbor across the street, the Centers for Disease Control, reports that
West Virginia has the highest rate of drug overdoses in the country. Opioid-related
deaths in 2017 was nearly
50 per 100,000 people, up 14% from the previous year. This epidemic has touched
nearly every patient I have seen at the New River Clinic either directly or
indirectly. I love podcasts, so to get the rundown on the history of the Opioid Epidemic before
it came to West Virginia, I listened to Throughline’s podcast from April 4th,
2019 called America’s
Opioid Epidemic and The Uncertain Hour’s third season: Inside
America’s Drug War. Historically, so much of West Virginia’s industry has
been comprised of very physically demanding, but poorly compensated work.
Staying home to heal was not a possibility for many, and painkillers,
particularly opioids, helped many people working people keep the lights on and
food on the table. They trusted their healthcare providers to do no harm, and
we failed them.
In true grassroots
fashion, the Fayetteville Health Department has created an innovative program
to help reduce the harm of this epidemic through a program comprised of
dedicated staff, both paid, and volunteer. On Wednesdays from 1-4, people are
able to turn in used needles and receive the same number of clean needles (30
needles max) in return. In addition, the program provides wrap-around health
and social services. Health services include Hepatitis and HIV screening,
vaccines and wound care. They also
provide birth control counseling and LARC placement. The social services they
provide include help with obtaining an ID, health insurance, housing, and food.
Patients trade in their dirty needles for clean with an addiction coach. Coaches
are others who are recovering addicts and can use their own experiences to help
steer others towards recovery. Coaches provide patients with clean needles, but
also dispense other supplies like alcohol pads, cotton balls (used for
filters), tourniquets and “cookers” to help avoid spreading infection. These supplies are
important because hepatitis can live on a surface for 14 days and is not killed
by the small flame used to “cook” IV drugs. Narcan is also given out to
patients, and patients are educated on West Virginia’s Good
Samaritan Law that allows drug users to give Narcan and call 911 without
fear of being arrested for drug possession.
Cliff Massy is the main addiction coach and the
coordinator for the Harm Reduction and Quick Response Teams. Massy is kinda a
big deal ‘round these parts. In 2017 1 on 1 Films, a
documentary production company based out of Ithaca, New York made a short film
called Out of Pills, which has won
a bunch of awards in the short film circuit. As Quick Response Team coordinator, he or someone
in his team follow up with everyone who overdoses within 48 hours, as people
are more open to recovery programs during this time. If recovery is not of
interest, they can at least be connected with the Health Department program for
harm reduction services. The health department is currently writing grants for
a new program called Engage. This would provide clean needles and harm
reduction services and education at local emergency rooms where many
underserved people receive their primary care.
The Public Health
Department the building seems innocuous, newly painted in fuchsia and lavender,
but it is surrounded by the Police Department, County Sheriff, Fayette County
Court, and Judge’s office. This location is obviously not ideal for illegal
drug users looking to access care.
Anita Stewart is a DO who
helps head up the harm reduction program. We talked about the importance of
community (particularly law enforcement) buy-in to ensure sustainability in the
program. Sometimes this buy-in comes with compromise. For example, While the
health department takes in more dirty needles than they give out (as measured
by weight) there is still minimal support for giving out more than 30 needles
because of fears that that will increase the number of discarded needles in
public areas. Similarly, the police have an agreement with the public health
department that they will not arrest people at the clinic, or after receiving care
there. Last month, however, the police recently broke this agreement, arresting
a patient who had a minor parole violation. The number of patients at the
clinic plummeted and are only just starting to rise again. The clinic is hoping
to have more sites to serve a wider population with sites away from the police.
However, while Anita Stewart says that it can be hard to “play nice in the
sandbox,” there has been greater acceptance among its critics as the program
becomes more established. She says that when people are skeptical about harm
reduction, she invites them to volunteer and see the wide range of people who
have become dependent on opioids. She says that type one diabetics, nurses, and
other people who have a greater comfort with needles seem more likely to become
IV drug users. Stewart also stresses the importance of healthcare providers
using their professional privilege for advocating harm reduction among
stigmatized populations. “After all,” she says, “many of these people got
hooked on opioids through legal medical prescriptions, we did this to
Needle exchange can be a controversial
issue, and until
2016 federal funding could not go to these kinds of programs. These
programs are still illegal in 15
states, but while stigma still remains, needle exchange programs are slowly
gaining popularity across the country because they work. Not only have decades
of studies shown that they reduce the spread of blood-borne diseases and the
number of needles in public spaces, they also can help connect people to
treatment when they are ready. Because of the increase in opiate-related
incarceration around the country, another controversial program is gaining
momentum in WV and across the country, called the Law Enforcement Assistance
program. It allows public safety officials to work with behavioral
health providers by diverting low-level drug offenders away from jail time and
towards treatment and support services.
Today, I went with the Mercy Care CHOP team to serve the homeless community by aiding to provide nursing services and housing resources. We went to Central Presbyterian Church to do this and sat in a room where patients could sign up and then visit us and utilize our services. Today, we saw 3 different patients. We took their blood pressure, and provided them with housing resources, food resources, and we gave them information about the Mercy Care clinic closest to them so that they could seek out healthcare.
One thing I learned from this experience was the different resources that Central Presbyterian Church for homeless individuals. I learned that they provide ID’s, birth certificates, resume assistance, and job resources. Additionally, they had an art studio for individuals to do art work, which I loved to see.
second day in West Virginia was just as great as the first! Jean graciously
prepared us a delicious home-cooked breakfast, so I was fueled up for a busy
day at clinic. This week, I’m rotating at Riverside School Based Health Center,
which is part of the Cabin Creek Health System. Cabin Creek Health System is a
federally qualified health center that provides high quality comprehensive
primary care to residents throughout Kanawha County, WV. My wonderful preceptor
is Dr. Jessica McColley, a family medicine DO who completed a fellowship in maternal
child health (her background is perfectly aligned with my dual FNP/midwifery focus).
As it turns out, Dr. McColley completed her fellowship at the same clinic in
Chicago where I completed an AmeriCorps program back in 2012 — we were in the
same place at the same time and had never met. What a small world!
the morning session we saw a wide variety of patients, from well child visits
to colposcopies to dental abscesses. In the afternoon, I had the opportunity to
participate in a health professional mentorship program for recent high school
graduates who are interested in pursuing careers in healthcare. One provider
presented on the liver and hepatitis, and Dr. McColley presented on sexual
health. The opening activity consisted of crafting the internal female
reproductive organs from pipe cleaners – what fun! We then played a jeopardy
game with categories including contraception, let’s talk about sex, and
consent. The participants had a great time and we all learned a lot! I really
enjoyed the opportunity to observe medical providers engage in community-based
activities outside of the clinical setting.
first two days have been an incredible learning experience. I feel like I’m
truly experiencing family medicine here. Many visits have included several
family members receiving care from the same provider. I’ve seen patients for the
management of chronic conditions, well care, sick visits and family planning.
This is my first rotation with a DO, and I have had the opportunity to observe
osteopathic manipulation for vertigo and musculoskeletal pain. The support
staff have been so kind, helpful, and a lot of fun. I’m looking forward to
continuing to learn from the wonderful preceptors and staff here and enjoying
the beautiful West Virginia mountains. I also can’t wait for our whitewater
rafting trip on Saturday!
From Cabin Creek Health Center in Dawes, West Virginia
the privilege of joining a meeting that was focused on implementing research
initiatives in primary care organized by a group of collaborating providers
from clinics in various counties. This
group was called WVACHS which stands for West Virginia Alliance for Creative
Health Solutions and the preceptor I worked with was the nurse practitioner
representative from her clinic. Her
proposed topic was on water quality and its impact on health of individuals in
the community. The group spent the
meeting brainstorming topics to implement and develop a white paper to submit
for publishing. The most popular and
decided on topic was barriers to accessing opioid addiction treatment and
implementation of MAT, which is Medication Assisted Treatment, for management
options. This topic proved to be most
popular and pertinent to the population in West Virginia given the epidemic of
opioid addiction and deaths from overdose.
It was quite inspiring to see the impact of research outside of the
academic setting and the impact it can have on quality improvement in clinics
and in the care provided to patients.
This group of interdisciplinary providers recognized a need for change
of practice and patients’ needs that weren’t being addressed and were not
sitting idly by. It was valuable to
experience the discussion about the topic of choice and witness the process
behind recognizing a health-related need and working towards a plan to address
plan to attend a MAT group therapy session later in the week to experience the
process patients endure when adhering to this treatment plan. This will hopefully shed some light on the
need for this treatment plan and how successful it can be in addressing the
patient need when properly executed.
process of integrating evidence-based practice into a clinical setting caused
me to reflect about some of the clinical guidelines or processes that are
implemented and if they truly are patient centered, proven to be effective and
produce successful outcomes.
Experiences like this are chances for professional growth and
development as I am coming into a provider role and will soon have to make
evidence-based decisions, nevertheless, have a chance to change protocol and
implement innovative guidelines.
Monday, our group spent the day in Emiliano Zapata Sur to continue refining our modules. We ate breakfast together before traveling and shared our thoughts and expectations about the day ahead. There was lots of anticipation and slight anxiety about what to expect. Once we arrived, we set up a home base at Victor’s feeding program site. After getting settled Victor, our community liaison took us on a walking tour through the community. We saw various living conditions. Many homes offered services that were otherwise unavailable, such as: laundry, cooked meals, novelties, etc. There are so many modern conveniences that we take for granted.
Walking through the neighborhood, Victor described some of
the challenges for his community: abuse, school access for the children, and
lack of resources. As we were on our walk we saw the brightly painted houses
with iguanas and many fruit trees. A Mayan healing plant, the Chaya was on
several properties. Our translators said you need to speak to the plant kindly
before taking any of its leaves, according to ancestral knowledge. These leaves look like green maple leaves,
and can sting the skin. They need to be boiled before consumed as a green
For many of us it was difficult to imagine this as the
reality for anyone in the 21st century. For others it was a gut wrenching reminder of
the unequal distribution of resources; common in our society. An unacceptable reality.
Each morning I start my day by listing things that I am
grateful for and end it with things that I have learned. This was a moment to reflect with gratitude.
1. I am surrounded by people I love much like the people of Emiliano Zapata
Sur. 2. I have access to clean water that is almost as pure as the hearts of
the children we spent time with at the feeding program. 3. I can change. I have the privilege of
being able to change my situation…. because I want to.
Today our immersion group had the opportunity to tour Grady Memorial Hospital
and it’s dialysis floor. We picked this immersion to learn how local immigrants
navigate through the healthcare system with the many restrictions that are
When we walked in there were already over 20 people in the waiting room
waiting to receive dialysis. Most of the population needed interpreters, but
there were only a few on hand so it was difficult for everyone in our group to
have a patient student interaction. Ebony and I got the opportunity to talk to
one of the patient’s caretaker who also was the patient’s child.
This caretaker has been going to Grady for over ten years now, since that
time the caretaker has only had time to graduate high school, help raise a
younger sibling, maintain a household, maintain a part time job, and help take
care of both ill parents. It was truly an amazing experience to be able to
listen to such a story. This individual is one of the most selfless human
beings I have ever met. When asked about the typical daily schedule, the
patient’s care taker replied with starting the day with giving parent 1 all the
food that is allotted for the day per dialysis diet, help the younger sibling
off to school, make sure parent 2 is taken care of, give both parents their
daily meds, etc. We asked if there was any help from family and or government,
but given their circumstances, this young caretaker is all alone for these
It was interesting to hear that typically dialysis patients start at 7 AM,
but in actuality patients arrive 4-6 AM to be able to get one of the first
spots. Twice a week the caretaker mentioned above, gets to the clinic at 6 AM
and typically is there till 10 PM. There almost seems like there is not enough
hours in the day for this individual to do it all. It was amazing to hear a
third party perspective to this process and it is amazing how selfless some
family members can be to help their loved ones.
Often as students we learn about diseases such as chronic kidney disease
from the textbook which can allow some emotional disconnect from what a patient
is experiencing. Having the opportunity to interview dialysis patients and
their caretakers allowed for us to connect to the patient on a closer level.
Today we had moments of sadness, disappointment and some angry when learning
about the federal and governmental infrastructures that limited the care that
the patients receive. However, what we took away from this how as future nurses
how we can advocate for our patients when they are not able to do so for
I started the day preparing to travel to Charleston, West Virginia. My flight was scheduled to leave Hartsfield-Jackson Airport at 2:56 pm. I took MARTA to the airport. When I arrived, it was packed with travelers. Because of the rain so of the travel apps were down, which caused travelers to have to check in at the Delta baggage drop sites. This process took over an hour. After getting the boarding pass, headed through security. Again, the lines were extra-long. Finally, arrived at the departure gates. Notices that a lot of people were delayed due to the weather. My flight was delay one hours. I didn’t get to leave Atlanta until 3:59 PM. Thankfully, the flight time was only 50 minutes. Carolyn Clevenger met me at the airport. We then travel to Fayetteville, West Virginia, where we were going to be staying. We met the six nursing students at a restaurant called Pies and Pints. An Emory alum, Sarah Hansen and the Education Director, Amber Crist, both live in West Virginia, joined us for dinner. Amber Crist talked about the facilities the student were going to working in for these two weeks. Sarah prepared the work schedule for each nurse. Dinner ended about 8:55 pm, we all headed to the housing location. It was late, everyone retired to their sleeping quarters.
Monday, June 10, 2019
Students rose early to prepare for their day away from the house. Each student prepared their lunch to take with them. Amber Crist, the Education Director had informed the nurses, that there was not a lot of places to get lunch in the area, so it was best to bring it with them. While the students were away working at the clinics, Carolyn and I went shopping to stock the house with food and items the students would need during their two week stay. Fayetteville is not a large town, but we did find a Wal-mart that had most of the food items the student’s requested. It’s still raining in Fayetteville; internet still not accessible. Each student were charged with choosing a night to cook dinner. When the students arrived back to the house from their assignments, they sat down to eat dinner together. During dinner the student’s expressed how much they appreciated being able to meet with patients at the clinics. This was primary care they were glad to be experiencing with real patients. When the students finished their dinner, Carolyn Clevenger conducted a debriefing with each student about their day at each clinic site. Every student reported. Some saw lots of patients that day, and some saw a few. The students appeared to feel very confident about how they handled themselves at the sites. As I listened, I was impressed with what the students knew about the conditions the patients had. The students also wanted to blog tonight, but the internet connection was not cooperating. More to come tomorrow!
The waiting room on the 9th floor dialysis unit of Grady Memorial Hospital was packed from the moment we stepped foot on the floor this morning. Men and women sat camped out for the day waiting patiently for their turn on the lifesaving dialysis machines. Surprisingly, despite their dire circumstances, the men in women there wore smiles while chatting and laughed while playing Bingo to pass the time. These people all share the unfortunate experience of dealing with the effects of end stage renal failure. Due to their lack of insurance, they must wait every week for “Emergency” dialysis treatment. While insured patients may receive dialysis 3 times per week, these patients are lucky to get one or two treatments a week.
We had the pleasure
of getting to know a couple of these patients today and hearing the stories
that brought them to be reliant on hemodialysis. We were helping with data
collection phase of a research study investigating environmental factors that
may contribute to the development of chronic kidney disease (CKD). CKD is a
widespread problem among the undocumented population. The two leading
hypotheses are that the CKD is a result of workplace exposure to toxins or
dehydration and heat illness. The study uses survey questions to investigate the
possible exposures and contributing factors these patients have
encountered. The research study’s
ultimate goal is to gather enough data to help protect future generations of
workers from developing CKD. The patients were so kind, eager to help, and
showed endless patience (especially while we stumbled through our knowledge of
the Spanish language).
The first woman we interviewed had been diagnosed with kidney disease about a decade ago when she went to her doctor with just a swollen foot. She was told she needed dialysis within the year, although she did not seek treatment until six years later. We did not ask why she did not seek care sooner, although we have learned that many undocumented patients do not seek care until it is emergent, due to limited options. As we began to interview our next patient, her blood pressure began to tank and a nurse quickly came running to restabilize her. That was an eye-opening experience that showed us the reality of how intense and uncomfortable these treatments are.
We moved on to our last patient, a young 37 year old man, who had been diagnosed with kidney disease very recently. He noticed something was wrong when he began fainting at work. He started working in agriculture at the age of 6 and had worked dozens of different types of jobs, although is no longer working because of his health condition. He believes his working conditions have a slightly negative effect on his health, especially the long hours out in the sun.
Just two interviews
gave us a little glimpse of the struggles these patients have faced, although
not once did they complain or even mention the difficultly. A small detail that
stood out in both interviews was that that each of them came to America alone,
without any family. These two individuals are resilient for dealing with the
daily struggles of a devastating disease, along with the countless obstacles
they have faced and continue to take on.
Speaking from experience, here are a couple tips to help you survive your first 12-hour clinical, whether it be on a GI, Cardiac, Oncology or other floor!
1. DRINK WATER This may seem like common-sense, but trust me, it’s harder than it sounds. It is so easy to get caught up in the busy work on the unit and forget to drink water. Bring a reusable water bottle and try to drink 2-3 bottles full of water throughout your shift. Trust me, your kidneys and bladder will thank you. 2. EAT BREAKFAST Many of you may be thinking, “I don’t need to eat breakfast, I never do and I’m fine.” Trust me, you’ll regret thinking that when you’ve been in a contact droplet room for the past hour and it feels like its 1,000 degrees inside and you’re about to pass out. It doesn’t need to be a gourmet meal, but putting something substantial in your stomach, like a breakfast or protein bar, will help you stay awake and alert during the first hours of your shift. 3. BRING MORE THAN ONE PEN You will lose one, period. No matter how hard you may try to keep your favorite pen, it will inevitably be borrowed by someone, or dropped or completely lost. 4. GET A GOOD NIGHT’S SLEEP This may seem like another common-sense tip; however, it is a serious one. Being on your feet and moving around for 12 hours is no easy feat. Try to give yourself at least 8 hours of sleep before a clinical, it will really make a difference. 5. PACK YOUR LUNCH There is no worse feeling than not packing lunch, running up to the cafeteria and then realizing they are serving some food you really don’t like. Not only will packing your lunch save you some time and money, it will save you some heartbreak. Try to pack it the night before so it saves you time in the morning. 6. BRING SNACKS Pack a few snacks in your clinical bag, you will get occasional breaks and a good snack can help replenish your energy and mood. 7. GET TO KNOW THE STAFF I don’t mean just the nurses, get to know the techs and the support staff. As you get to know them, you might find yourself learning even more about nursing and working in a hospital than you think. Many will give advice from when they were in nursing school, or the techs may share tips and tricks for moving a patient or taking their vitals. 8. SPEND TIME WITH YOUR PATIENTS This is easily one of the most important tips on this list. As a student, you will have a smaller patient load, giving you the opportunity to spend more time with patients than a staff nurse may be able to. Sit down with them and talk, many patients may not have any visitors coming that day or their nurse may have a heavy patient load and won’t have time to have a sit-down conversation. The patients will love having someone to talk to and you can learn a lot from having a good conversation with them, whether it be life advice or tips and tricks for caring for them and their specific ailment. 9. ENJOY YOURSELF AND LEARN Finally, take it all in. You only get a few semesters of clinical in nursing school, then you’re off in the real world. Take your time during clinical and ask questions, you may not have the opportunity later on. Enjoy yourself, clinical is an exciting time, it can help you realize what kind of area you want to work in and can help you visualize your future as a nurse!