Meet the Inaugural DEI Scholarship Winner

Kimberly DuBore, BSN, RN, began her nursing career in her late twenties, and is currently the PICC/imaging and procedural nurse at Harbor Regional Health, a rural community hospital. She has served as a clinical nurse educator of vascular access devices/procedures for a medical supply company for the past 13 years as well and is an on-call vascular access specialist for inner city hospitals in the Washington Puget Sound area. She is also the cofounder and nurse-injector for an aesthetics business. She started nursing a bit later in life because she was in the US Navy loading torpedoes and missiles on submarines, serving on the USS Canopus AS-34 in the Atlantic Fleet.

Her clinical background includes medical/surgical, operating room, and multispecialty. She identified and created the first and currently the only nursing position in her radiology department, moving the vascular access line—PICCs, midlines, and phlebotomy as well port accessing and catheter evaluations (dye studies)—from the operating room. In the event a chest X-ray is obtained, she has been credentialed by the chief of radiology to verify tip placement.

She is motivated by patients telling her “Wow! No one can ever get a vein on me, and you did it!” She wants to be patients’ superhero, and loves that patients ask for her by name, and if they don’t remember her name, ask for “the gal with the special machine.” She tells them that’s her superpower.

Please describe your hospital and the location of your hospital both in general and in relation to the Quinault Indian Nation.

Harbor Regional Health, formally known at Grays Harbor Community Hospital, serves residents in the southwestern region of Washington State, near the Pacific Ocean. The hospital is a publicly owned rural facility that helps support the county, including the Quinault Indian Nation. The reservation is located in Taholah, just shy of an hour from the hospital, in an even more rural area along the ocean coast.

Please describe your community population.

Our community is known as the “Gateway to the Olympic Peninsula.” The region has a rich history of being an old logging community. Logging, fishing, wildlife observation, and other outdoor activities are abundant. The Quinault Indian Nation is a sovereign nation that descends from other coastal tribes. The Quinault population is 10 percent of the population of the county, and their culture and contributions feel present: they are a major element of the community, working hard at maintaining their developed businesses, such as Quinault Pride (seafood distributing), Quinault Beach Resort and Casino, a health and social services department, a natural resources department, a maritime resort, and a mercantile. Only about a third of the Native Americans live on the reservation; the other two-thirds live throughout the county.

Describe what you do on a daily basis.

I currently work as the solo radiology nurse, a position I developed myself. Working in the operating room, I was one of only 2 PICC clinicians of the facility. At the time of X-ray verification, I found myself in radiology frequently, discussing tip confirmation. The chief of radiology would then request that I access ports and assess patients with contrast extravasations. As a result of my frequent presence, I built a case to show they needed a nurse. I could move my PICC service to radiology and place longer catheters in DIVA (difficult IV access) patients to assist with fewer extravasations and access their ports. The added bonus was that I was a procedural nurse that could pull procedures from the operating room and move them into an outpatient setting and decrease the cost to the patient by not needing an operating room suite. I then led a process improvement project to help identify DIVA patients so that they didn’t have to be “poked” multiple times, ultimately resulting in failed attempts. They would come in 15 minutes prior to their CT or MRI, and I would place a catheter under ultrasound guidance, usually on the first attempt. This increased patient satisfaction, vein preservation, and patient throughput.

What kind of facility is on the Quinault Indian Nation?

Roger Saux Clinic is a primary and urgent care facility located on the reservation. Resources and staff are limited in this rural area, and they tend to frequently refer to other facilities all over that state, as needed. The Quinaults have a diabetes and nutrition program, and also contract with an optometrist that comes weekly from outside the reservation area. Currently, they are seeking out other types of treatment, such as massage and acupuncture. Their team includes but is not limited to a dietician, a nutritionist, pharmacists, pharmacy techs, RNs, LPNs, an ARNP, an MD, and MAs, led by a health and wellness director who is a tribal member.

How do Quinault Indian Nation member care for one another, culturally? What is their cultural support system?

The Quinaults are family-oriented, and beyond the family comes the community of the tribe. When end-of-life situations arise, it involves the tribe, whether immediate family or not. The goal is to surround the family member at home, and meals, transportation, or any other support is provided by extended family or tribal members. Prior to COVID, the local hospital was able to accommodate many of the tribal members who desired to surround the family at their time of need. Like elsewhere, COVID created obstacles: out-sourced services and “big city” appointments became virtual, and younger, tech-savvy or formally educated members helped the population navigate this new reality. On the other end of the spectrum of life, when a child is born, the first sound the newborn hears is the mother or father of the child sing in their native tongue. Like with non-natives, there are many religious practices that vary. As COVID restrictions loosen, Harbor Regional Health is attempting to be more culturally sensitive to tribe members’ needs.

How does your facility supplement the tribe’s facility? What additional support do you offer?

Harbor Regional Health offers many specialties that the Roger Saux Clinic does not. We get referrals from Roger Saux Clinic to assist in keeping the patient and their family members as local as possible. I have come to know many of these tribal members and their families, and therefore I offer to speak with them on the phone or to answer questions or offer referral support. I make it clear that I may not have the answers, but I know where to seek out the support.

How is your staff culturally literate and sensitive? Do you have Quinault members on staff/or do you consult with them?

We currently do not have Quinault members on our staff; however, we have had a Queets tribal member, Samantha Capoemen, RN, work for one of our medical offices after graduating from her RN program, and she has been an integral resource for hospital staff who need to discuss cultural issues. During her clinical rotations, she worked with multiple family practice providers within our system, and is currently dedicating herself to finishing her nurse practitioner clinicals and sitting for her boards by this summer. Her goal is to open a practice in Queets, a federally recognized tribe of the Quinault Indian Nation, where currently a small rural clinic is open only one day a week. She will take up residency in the area and plans on opening her clinic for at least 3 days a week.

Describe the care transition team. How do they facilitate admission? Please give examples.

Our care transition team works closely with the social service team at Roger Saux Clinic. However, the Quinaults don’t have a home health division so they work with our local home health agency to involve the family as much as possible. The providers at the clinic are able to consult via phone regarding patient conditions, and to confer if admission is warranted. Generally, the process is fed through the emergency department.

How specifically do you all encourage patients to be proactive with their health care?

I discuss the plan of care with multiple members of the family, including the results or potential consequences. Each person might understand different elements of the conversation. I also provide patients with my business card which includes my email and phone number. I let them know I am available for any questions or concerns. I am clear that I will not know all the answers, but I will know where to go to find the answers for them. I also let patients know “who at the clinic” I know so that they are aware of our networking, hoping that this will lessen the barriers of communication.

What kind of education and support follow-up do you provide? What are some examples?

I provide visual tools. For example, when I discuss ports versus PICCs, I physically show them the devices, allowing them to touch and demonstrating how they work. My product reps will provide these devices. I also have a phantom chest so that they can see the anatomy as well. I discuss catheter occlusion issue: I was provided with a 3D model of a catheter displaying various types of occlusions. This helps my patients understand why their port is not aspirating which is useful in performing catheter evaluations, or “dye studies.” I also have pamphlets, but I find that face-to-face conversation is best because then I’m able to read the facial expressions and body language to help me know whether what I am saying is being understood. For follow-up, I encourage them to “contact Samantha at the clinic, and together we can troubleshoot.”

What aspect(s) of your current position do you find meaningful? Why?

Every day is different. I am involved in many aspects of patient care and do well with multitasking. I created my position, and therefore I have attempted to pull all aspects of my career together: operating room, legal issues (compliance and policy), sedation, vascular access, and PICC service. My radiologists are very supportive and have given me quite a bit of autonomy to assist with patient care and education. I don’t have to spend only 10 minutes with a patient; I spend as much time with them and their families as needed. I speak with each patient prior to invasive procedures to educate and answer questions before scheduling. When my scheduler contacts the patients, she often hears, “I want that nurse that I talked to.” That is rewarding: they may not remember my name, but they remember how I made them feel.

Do you have any other specific patient stories or examples you would like to share?

My active involvement started like this: one of the most respected elders of the Quinault tribe, Pearl Capoeman, who gave me permission to share this story, had been going through some changes in her health that required more than routine blood draws and contrast enhanced CTs, and she had been identified as a DIVA. Her access was extremely limited to support large volume phlebotomy and power injection diagnostic studies—so limited that even with oral hydration I was unable to gain suitable access.

After multiple failed attempts, I had discussed with her the option of a port placement. With her permission, I contacted her primary care provider. The provider was aware of my skill set, and when I told her that I was unable to provide the patient with her needs and recommended a port placement, the primary care provider gave a referral immediately and Pearl received an implanted port.

I assumed that the surgeon had given her instruction as to where to follow up for port care, but I was wrong. Samantha Capoemen, the RN from the Roger Saux clinic, called me indicating that Pearl was referred back to her clinic and that she had no experience with port care and maintenance. Because of the distance, Samantha did not want to send Pearl “to town” for each frequent blood draw, so I gathered some supplies, literature, visual aids, and my institutions’ policies and drove out to the clinic in Taholah.

There were 3 providers there, and two nurses to whom I demonstrated access, flush/lock, and de-access, along with return demonstrations. I lent them some supplies until they could get theirs ordered as well as connected them with contact information and order numbers for items they needed. By providing my policies, I allowed them to morph those into their own, while still following the INS Standards

Recently, the clinic purchased an ultrasound machine for multiple uses. Samantha mentioned that they are trying to teach themselves to use it for USPIV placements. I told her that if she can gather the providers and the other nurse (there are only 2 in the clinic), I will volunteer to come and teach them.

Congratulations Kimberly!

In the coming months, please keep an eye out for the application for the 2024 DEI Scholarship.

Are you interested in promoting the mission of INS by providing professional development opportunities and quality education? Read more about the INS National Council on Education (NCOE) to decide whether being a member of this council is your next career goal.

What Are the Responsibilities of NCOE?

The NCOE works with the INS Education Department to develop programs which address the latest methodology, current trends, most prevalent issues, and subjects of general interest to infusion nurses.

Council members:

• Attend quarterly virtual meetings, including an annual conference planning meeting

• Review submissions from the call for abstracts

• Plan and contribute to the development of educational topics, learning objectives, and content outline for presentations

• Collaborate with speakers to foster high quality and engaging educational content

• Implement and evaluate educational sessions

Who Are the NCOE Members?

NCOE members are active members of INS with a minimum of two years of clinical experience in infusion nursing and experience in the development of educational programs. Council selection is based on, but not limited to, practice environment, educational program expertise, and clinical and educational credentials. NCOE is comprised of content experts in the field of infusion nursing; council members are active practitioners in the specialty area and are well versed in the clinical aspect of the profession.

Members of NCOE, the INS Director of Clinical Education, the INS Clinical Education and Publications Manager, and the INS Conference Education Coordinator are all part of the INS Education Team. Because the INS Education Team believes that educational content must continually evolve to reflect changes in the science of professional nursing, the Team works diligently to ensure that the latest evidence-based education is available to INS members and to the infusion community.

Education Team Goals

1. To provide educational programs that will improve the delivery of health care and the practice of infusion nursing.

2. To disseminate knowledge by providing educational opportunities for infusion nurse specialists and members of allied health care specialties and professions to exchange information and clinical practice expertise and to explore collaborative practice.

3. To promote high quality professional practice through education.

If you are interested in being considered for a position as a NCOE member, please apply by May 12, 2023

Selected applicants will be appointed by June 9, 2023.

If you have questions about the position, please email Marlene M. Steinheiser, PhD, RN, CRNI®, Director of Clinical Education at marlene.steinheiser@ins1.org.

We are grateful to our NCOE members for their dedication to the infusion nursing profession.