Teaching clinical skills – and compassion

(L-R) Ursala Marinan, Jeana Holt and Elizabeth Daly were part of the team at the Nurse Practitioner Clinic. (Photos courtesy of the UWM College of Nursing)

“Annie,” a 64-year-old woman living in poverty, showed up at a local emergency room last year suffering from serious complications of untreated diabetes and other chronic health conditions. The emergency room staff gave her prescriptions for diabetes and high blood pressure medications, but she couldn’t afford to pay for them.

Then a hospital caseworker put her in touch with a Nurse Practitioner (NP) Clinic based at Cross Lutheran Church, where she could get free medical help. Within 48 hours, she had an appointment. The nurse practitioners ran lab tests, and helped Annie start working on diet and exercise programs to help improve her health. They also helped connect her to a drug company and other resources that could provide her with medications she needed for free.

Ursala Marinan, graduate student nurse from UWM, examines a patient while taking part in the clinic. (Marinan graduated in May).

Annie is not the woman’s real name, but her case is real. She was among more than 400 uninsured clients who received free primary health care through a unique partnership involving the University of Wisconsin-Milwaukee (UWM) Institute for Urban Health Partnerships (IUHP), the UWM and Marquette Colleges of Nursing and the Free and Community Clinic Consortium (FC3).

Clinical nurse practitioner graduate students from both nursing programs, working under the supervision of a Family Nurse Practitioner preceptor, provided the care through NP clinics at Cross Lutheran’s Bread of Healing Clinic and the Salvation Army. The Faye McBeath Foundation, the Greater Milwaukee Foundation and the FC3 program provided financial support for the NP Clinic Program.

The program, which started June 1, 2012, and runs through July 15 of this year, not only provides free primary health care for people who have no other options, but also serves as a clinical learning laboratory for the student nurse practitioners and other nursing students from Marquette and UWM, intentionally preparing NPs for care of uninsured and underinsured patients.

An eye-opening experience

Jeana Holt (left) works with UWM graduate student nurse Ursala Marinan as she checks a patient.

The experience was an eye-opening one for students, says Jeana Holt, who holds a doctorate in Nursing Practice and is the NP Clinic’s family nurse practitioner from IUHP. She supervised the students and maintained the client services at the clinics between semesters when the students weren’t available.

“Students are impacted by seeing how the social determinants of health can and do negatively impact the health of vulnerable populations, specifically the disheartening realities of the dearth of healthcare resources for the economically poor of Milwaukee,” says Holt.

Like Annie, many come to the clinic with multiple problems that haven’t been managed for months or years because the patients couldn’t access affordable health care. The nurse practitioners work with them to stabilize their conditions, then provide regular follow-up.

Students become adept at managing care with few resources, says Holt.

“I emphasize to the students that we need to practice judiciously because of our limited resources,” she says. “We are very creative with some of our plans of care, and we optimize the resources that we do have. I also emphasize the power of health promotion and health education to provide clients with the necessary tools to live a healthful life.”

The FC3 clinics also work together to share information on navigating the system and how best to share community resources, she adds.

Beyond clinical skills

In working in the clinics, the students learn not only clinical skills, but understanding of health disparities and empathy for those in difficult circumstances.

“Working in the clinic gave me the opportunity to become comfortable with treating chronic conditions such as diabetes, hypertension, asthma, high cholesterol and obesity,” says Ashley Saggio, a UWM student nurse practitioner. “I also enjoyed the teamwork among the three of us [Holt and Jennifer Falor, a Marquette student nurse practitioner were the other two]; it was always a great experience to collaborate and discuss our ideas regarding the care of the patient.”

“I learned a lot about patient care and the complexity of managing acute and chronic medical illnesses of patients without insurance,” says Falor, who is considering going into caring for low-income and underserved patients as a result of the experience.

“The students and I are amazed at the gratitude clients have for the care we do provide,” says Holt. “This extrinsic motivator, plus their own intrinsic motivators, help us to partner with each client to develop a plan of care that will empower them to achieve their best health outcomes. “

While the clinics’ funding ends July 15, “the lessons learned will move all the partners forward in our work together in the community and with our healthcare-professional students,” says Bev Zabler, director of IUHP and assistant dean for practice and partnerships in the College of Nursing.