2013 guide to nursing

2013 Guide to nursing

9 p.m.

midnight

Nicholas Flaucher, RN, BSN, is a staff nurse on the telemetry unit at Olathe Medical Center.

6 p.m.

Michelle Johnson-Lunn, BSN, RN, is on the orthopedic unit at North Kansas City Hospital.

A day in the life of a nurse

Find this week’s Nursing News inside

Sara McManus, RN, BSN, is a staff nurse in the Medical Intensive Care Unit at Truman Medical Center.

6 a.m.

Annie Beck, RN, is a staff nurse at the medical-surgical unit at St. Mary’s Medical Center.

9 a.m.

Menneka Scott, RN, BSN, is a staff nurse in the surgery unit at Providence Medical Center.

A special edition of The Kansas City Nursing News

Allison Marchese, RN, BSN, is a staff nurse on the telemetry unit at St. Joseph Medical Center.

3 p.m.

3 a.m.

Joe Keary, RN is director of the Emergency Department at Belton Regional Medical Center.

noon

Bret McClure, RN, is a staff nurse in the emergency department at Shawnee Mission Medical Center.

The Kansas City Nursing News celebrates a day in the life of a nurse The Kansas City Nursing News

T

his year’s theme for our 2013 Guide to Nursing, “A day in the life of a nurse” celebrates nurses doing what they do around the clock.

We don’t have to tell you about the range of motion in nursing.

It’s big. The profession spans from CEOs making healthcare decisions to informatics specialists to nurses helping patients in remote villages. They are the boots on the ground and decision makers in the corner office.

We thought it would be fun to feature local nurses who represent a small, but interesting smattering of what nurses do every day, all day and all night.

We found a nurse who developed a different model for private duty care. Another said yes to working with abused and neglected children in a residential center.

A nurse practitioner in women’s health inspires patients to higher education. Several nurses drive a big rig for patients in rural areas. Another is a corporate analyst.

The faces of this year’s Guide to Nursing belong to nurses who care for patients around the clock. We asked area hospitals to send photos of nurses practicing the art and science of nursing at the bedside at precise hours of their actual shift. Yeah, we got a few, “You want us to do what?”

It was nurses who stepped in to capture their co-workers in the wee hours of night. Nurses make sacrifices like that. It is one of the many reasons the Kansas City Nursing News honors the profession that never sleeps.

Linda Friedel can be reached at Linda.Friedel@npgco.com

September 2, 2013

By Linda Friedel

The Kansas City Nursing News

By Linda Friedel

4

RN applies nurse’s touch to residential center for children

Carly Bradley drew from a variety of skills when she settled into her new position this summer. Bradley, RN, BSN, became the newest nursing supervisor in a unique setting.

“She’s incredibly nurturing,” said Jannan Bradley, human resources manager at Gillis Center. “She’s also very organized and efficient – a very skilled nurse.”

Carly is what Gillis needs, Jannan said. It has been a challenge, Jannan said, for the nonprofit to find someone with the right combination of leadership skills and clinical skills to step in as nursing supervisor. New graduates do not have the management skills it takes to run a clinic, she said. It is tough to compete with the higher salaries experienced nurses can expect from hospitals, she said.

Carly is earning trust, however, Jannan said. She has built trust among the staff members who work together to help heal children, Jannan said.

“I already see that she is earning their trust,” she said. “They are looking at her more as part of their team.

It takes collaboration to work with children at Gillis Center, Jannan said. Staff members care for children who have been removed from their homes by the state. The reasons vary. Many have been abused. Their parents are incarcerated. Some witnessed violent crimes. Carly has done an excellent job in educating the staff on her role as a team member, Jannan said. She has helped staff members to care for basic health care needs of their residents.

“Empowering them to take a more active role in their basic care,” Carly said. “We are these kids’ parents here.”

Carly felt prepared for her new role, she said. She had considered the role for more than a year and waited for the opportunity.

“I love children,” she said. “I was hesitant at first. Psyche was never a forte of mine.”

Carly draws on 14 years of nurs-

the kansas city nursingnews

ing skills ranging from geriatrics, gynecology, surgery, primary care, med-surg, ICU and PACU to relief charge nurse. Gillis is a big shift from the physician clinics and hospitals where she formerly worked, she said. The focus is different.

“The emphasis isn’t on the medical aspect, as it is on the therapeutic aspect,” she said. “The medical part is very important. The emphasis is on their therapy.”

Bradley likes the autonomy she has as supervisor. Working in a leadership role has empowered her professionally, she said. She has always seen herself as a leader.

“It’s very autonomous,” Bradley said. “It’s very different from any job I’ve had. I do enjoy it. It gives me more self worth as a nurse. It puts me more in a leadership role. I like to teach.”

Bradley tackled an aging clinic on

limited resources when she first arrived. She cleaned, pitched, sorted, installed unclaimed furniture and painted. Then she put the wheels in motion for a complete re-design of the clinic. Bradley coordinated with the art teacher to create a mural on the wall that would not only add a vibe but teach. A multi-colored mural of the human body and balloon-size images of viruses, bacteria and cells will reinforce biology lessons when residents visit the clinic, Bradley said. She plans to complete the project in time for the fall semester.

“We’re going to use it as a learning environment,” she said.

Bradley cares for children who have been removed from their homes by the court for abuse, neglect and homelessness. She works with teachers, social workers, dormitory counselors, physicians and psychiatrists

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to manage the physical and mental health care needs of the residents.

She provides training for staff, transports children to appointments, manages medications, supervises medical aids, and prepares chart audits and medical reviews. Bradley has made an impact, said Justin Dallavis, medical aide at Gillis Center.

“She has been a better planner, organized, structured and fun,” Dallavis said. “I’ve never seen her in a bad mood yet.”

Bradley said her goal was to transform the clinic into someplace cheerful, a place where she can listen and her patients can be heard. Understanding her patients and their history inspires her to be that someone who gives them attention they have not had in their lives, she said. The process has been challenging and exciting for Bradley, she said. She encourages an open-door policy.

“I want an environment that is more pleasant and not scary – a good feeling when they come in, a positive experience,” Bradley said. “Just making a difference makes it worthwhile.”

Linda Friedel l The Kansas City Nursing News

Linda Friedel can be reached at Linda.Friedel@npgco.com

Carly Bradley, RN, BSN, is nursing supervisor at Gillis Center, a residential treatment center for abused children. Bradley provides health care for the residents, trains staff members, transports children to appointments and prepares chart audits and medical reviews.

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September 2, 2013

5

Nurse practitioner is role model to many

September 2, 2013

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Jean Winfield taught nurses how to take blood pressure and perform basic nursing skills when she worked as a care assistant in the late 1970s. It did not take her long to realize she wanted to be the RN she was teaching.

“That’s when I realized I can do that,” said Winfield, RN, MSN, BCFNP APRN, nurse practitioner at South Town Health Care. “As a care assistant is when I developed a love of nursing. That’s when I realized I loved nursing. I went to be a nurse.”

She started out pursuing medical school originally, but Winfield said life happened.

“I got married and started making babies,” she said.

Once Winfield discovered her inner nurse as a CA, she got busy and earned her ADN, LPN and RN degrees within a few short years of her young adulthood. It wasn’t enough, Winfield said.

“I always knew I wanted to be an APRN,” she said. “You have to see your future. I’m going back. I realized I really would like a little more autonomy.”

Seventeen years after earning her advanced practice degree, Winfield still works with physician Sharon Harris, MD, of South Town Health Care, specializing in women’s health care. Winfield diagnoses, prescribes medicine and develops treatment plans for her patients. She is also the first assistant with the Da Vinci Surgical Robot, an extra skill set she wanted to acquire.

“I saw a need,” she said. “I thought it would be a nice opportunity to do something different to develop a new skill.”

After years of working with the same physician, Winfield considers herself lucky. The stability is there, she said, and so is the trust.

“I’m comfortable in my skin,” Winfield said. “I’m comfortable doing what I do. The trust factor is there.

You are trusted to make judgment on what’s best with the patient.”

Winfield says she has a passion for working with the adolescent to senior patients who see her for obstetrics and gynecology.

“We’re specialists,” she said. “I love working with women. I love sharing with women. I can relate.”

Winfield says having gone through many of the life cycles, she can empathize with her patients. She lets them know she can understand what they are going through.

“I have an opportunity to impact women of all ages,” she said.

In addition to her clinical expertise, Winfield has encouraged scores of patients to seek higher education, she said. Many have gone on to become nurses. Patients see her as a role model, she said. Many of her patients have never met an African-American nurse practitioner, she said. Winfield says if she senses a patient is a caregiver, she encourages her to think about nursing.

“I treat all people the same,” Winfield said. “I’ve been doing that my whole life. I think I’m culturally Linda Friedel l The Kansas City Nursing News competent. That’s why people enjoy Jean Winfield, RN, MSN, BC-FNP, APRN, is a nurse practitioner at South Town Health Care and coming.” president of the Greater Kansas City Black Nurses Association. Winfield has mentored nurses and Cassie Davis has been a long-time patients and led efforts for policy changes for minorities. patient of Winfield’s. She saw Winfield for prenatal visits with her first pregnancy and is seeing her for her second pregnancy. Davis said she appreciates the role of the nurse practitioner model and feels comfortable with Winfield.

“She takes more time out than the physician would,” Davis said.

Davis is a high-risk patient and said Winfield has advocated for her more than once.

“If a situation comes up, she’ll break it down,” Davis said. “She Be in the heart explains it in a way you can underof healthcare stand it. She’s such a sweet person.

She’s totally down to earth. It’s not Certified in as little as 8 weeks just a job to her.”

Winfield has been an active member of the Greater Kansas City Nurses Association since the organization launched in 1994. She has been president for a decade. The organization has given Winfield a voice. She has focused on health care disparities among minority populations, encouraged minorities into the proMEDS partners with fession of nursing and has mentored Herndon Career Center for new nurses. Winfield helps keep Excellence in Education the members fit, too. For the past 10 years she has taught “FAT (Flexible, Aerobics, Toning) is Fitness” classes twice a week through the organization.

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The Kansas City Nursing News

40

By Linda Friedel

“I have a special passion for the mission of the Greater Kansas City Nurses Association,” Winfield said.

Winfield travels to Washington D.C. annually for National Black Nurses Day on the Hill to advocate for nurses. She meets with nurses from across the nation and with legislators to address policies and issues which impact minority communities, especially African Americans. This year’s program included preventative care and discussions on the Affordable Care Act. African Americans are more at risk for chronic diseases such as diabetes and stroke, Winfield said. They have poorer outcomes with respect to diagnosis, treatment and recovery, she said.

“It’s minorities that have these diseases,” she said. “We die from it more. I am genuine in my efforts to impact my community.”

LaRhonda Smith, LPN, works with Winfield at South Town Women’s Health and has been a member of the Greater Kansas City Nurses Association for 15 years. Smith said

Winfield has the ability to build trust with her patients and understand them from their perspective.

“She has great interpersonal skills,” Smith said. “She goes above and beyond the call of duty when it comes to anything.”

Gladesia Tolbert, APRN, was in high school when she first met Winfield. She saw Winfield for an appointment and was impressed with Winfield’s skills as a nurse practitioner. Tolbert already had decided to pursue nursing, but it was Winfield’s example and encouragement that inspired her to pursue her master’s degree. Winfield encouraged her through nursing school and beyond. They are colleagues today in the Greater Kansas City Black Nurses Association.

“She motivated me,” Tolbert said.

“In the community, she always would give me words of encouragement. Her inspiration was very important to me.”

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Linda Friedel l The Kansas City Nursing News

Jean Winfield, RN, MSN, BC-FNP APRN, is a nurse practitioner at South Town Health Care.

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September 2, 2013

7

Nurse entrepreneur helps clients to age in place

By Linda Friedel The Kansas City Nursing News

Sherri Luitwieler applied her own brand of business acumen to a new company she launched last year.

Luitwieler founded Aging in Place, specializing in private duty care. She plans to raise the bar in an industry that she says will only grow. “It’s like playing in the sandbox all day,� Luitwieler, LPN, said. “If you do what you like, you’ll never work a day in your life. That’s what I feel like.�

Luitwieler has been in long-term care in one capacity or another for a decade. She got her start by giving around-the-clock care for a blind adult in the Kansas City area until he passed away. They bonded instantly, Luitwieler said. Since then, she has been admissions director at Manor Care, a regional director of sales and marketing with Preferred Care Partners and a regional sales and marketing consultant at LaVie Administrative Services. “I’ve always had a natural liking for the elderly,� Luitwieler said. “I love their wisdom, their stories.�

Aging in Place started organically, Luitwieler said, then grew. She has tripled her business since April but is committed to growing gradually.

She said the industry is filled with potential clients. Luitwieler holds to current statistics on the nation’s aging population. There were 55 million people in the country older than 65 in 2010. The 85-plus age group is the second fastest growing population. One million people older than 100 years are projected for 2025, and 75 million baby boomers will be in need of health care in their lifetime.

Luitwieler is hoping to get a foothold now. She has high expectations. “I’m trying to get in and get a good solid foundation,� she said. “Do it right, right from the start. I want to set a standard. I want to be a leader in the industry.�

Luitwieler is setting new standards of care in in-home services, she said. The biggest difference is how her clients will pay. Luitwieler does not require a minimum or maximum amount of hours per week of her clients. It is uncommon in the industry, she said. Instead, she charges a straight fee. Luitwieler says she

8

September 2, 2013

wants to provide services that families need, even if it means one hour per week. There is a demand for companies to offer one-hour blocks of time, Luitwieler said. “Patients should not be denied care because they don’t need the care for three hours or four,� she said. “The people that need help should be given it.�

With elderly patients, often family members need one or two hours of relief, she said. Many clients pay out of pocket, unless they carry longterm insurance. Luitwieler said she is focused on meeting the needs of elderly clients who need small blocks of time. She wants to build relationships. “It’s about meeting the need of the community,� she said.

Aging in Place offers companionship, transportation, picking up medicine, taking clients to doctor appointments and house cleaning.

House cleaning means more than Linda Friedel l The Kansas City Nursing News dusting, Luitwieler said. Aging in Sherri Luitwieler, LPN, founded Aging in Place, a private duty care business in 2012. Ken Place looks at the whole picture, Bergeron, of Leawood, Kan., was Luitwieler’s first client. she said. Staff members clean baseboards, scrub windows, clean microwaves, water plants or do anything clients need doing. Luitwieler exE pects her staff members to be doing PV S 1 something at all times to meet the FS client’s need. It is a company policy, L D Luitwieler said.

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former company Luitwieler connected with Bergeron. She began working directly for him and eventually moved in to provide around the clock care. While living and caring for Bergeron, Luitwieler said she had an epiphany.

“I was able to see the huge need for good quality in home care,” she said.

“That really gave me a bird’s eye view what was needed and from the family’s perspective.”

For several months, Luitwieler was Bergeron’s sole care-giver. Then she moved out and hired several care takers to help with Bergeron’s needs.

Aging in Place provides services from transportation to tube-feedings, extra meals, coordination of physical therapy appointments, house cleaning and pet care. His adult children were relieved to have the consistency she and her staff provided, she said. Bergeron became the gold standard for what it took to give quality care for someone in their home, she said.

“We are to do what they could do, but are not able,” Luitwieler said. “It was the experience of Mr. B.” After his stroke and months of rehabilitation, Bergeron still requires 14 hours of daily care, Luitwieler said. Bergeron fortunately has longterm care insurance, she said, which covers most of the costs of the service. It’s something she advises people in their 50s and 60s to consider acquiring.

“My mission is to tell as many peo-

ple as possible about their options,” she said. “Most people cannot afford it. Mr. B can afford it.”

Bergeron said he likes the fact he is getting professional help with Aging in Place. His grown children want to be helpful, he said, but they often do not know what to do to help.

He considers Luitwieler and her staff as part of his family. They have the professional expertise he needs, he said. It is reassuring to his children that he is getting the care that he needs, he said.

“They are so relaxed,” he said.

“They know we’re happy. It makes the kids relaxed. They don’t have the time. Once they watched Aging in Place, they are very comfortable.”

Unless caretakers have had decades of experience in private duty care, Aging in Place requires certified nursing assistants (CNAs), said Kellie Mintzlaff, RN, director of clinical services and chief financial officer. Luitwieler is an innovator, she said. Among other industry changes, Luitwieler requires staff members to wear royal blue uniforms. It adds to the spirit of professionalism, she said.

“It was something that looked professional,” she said. “It’s bright. It stands out. It’s meeting holistically – our clients and community. It’s not just a business model. It’s from the heart model.”

The uniforms have changed, but some things never will.

Linda Friedel can be reached at Linda.Friedel@npgco.com

Great care starts with great nurses.

From our community hospital roots six decades ago to today’s high-tech hospitals and clinics, our nurses have always been at the center of everything we do. More than 800 of these dedicated, spirited professionals work in our two regional medical centers and primary and specialty practices. Every day we are grateful they are on the frontline of patient care, focusing their compassion and healing energy on a single specialty: you.

Image above: Breaking ground for Olathe Community Hospital, opened in 1953

Linda Friedel l The Kansas City Nursing News

From left, Sherri Luitwieler, LPN, founded Aging in Place, a private duty care company to meet a growing demand among seniors. Kellie Mintzlaff, RN, is director of clinical services and chief financial officer.

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olathehealth.org/careers the kansas city nursingnews

September 2, 2013

9

Nurse practitioners aim for quality of life in hospice care Caregivers team up to focus on comforting patients, family with end-of-life special needs

By Linda Friedel The Kansas City Nursing News

Caring for patients in the end stages of life may not be for everyone.

Labor and delivery nurses help to bring new life into the world. At the other end of the spectrum, there those who specialize in helping patients through the dying process.

“It’s more about living, helping them live well for the time that they have left,” said Maria Ferrell, APRN, ACHPN, nurse practitioner at Kansas City Hospice & Palliative Care.

Ferrell has specialized in caring for end-of-life patients and their families since 2000 and has been with Kansas City Hospice & Palliative Care since 2005. Before landing in hospice care, Ferrell worked with patients in acute care in a hospital setting. She wanted to find something in a community setting, then she discovered hospice.

“In caring for patients during a time when they are vulnerable, they are looking for a lot of support,” she said. “It helps to remind you every day of the things that are meaningful in life. It’s very satisfying for me to help them at this time.”

Ferrell helps patients to better manage their symptoms such as pain and nausea. Not only do the patients feel better, but the families are grateful. It helps with the family’s stress level, she said.

“The families are very appreciative of anything we can do to help the patient do things they wanted to do before,” she said.

Hospice uses an interdisciplinary approach, Ferrell said. Physicians, nurses, chaplains and social workers team up to care for the entire family unit. When patients’ symptoms are managed through medication, they are more socially active with family and friends, she said. They may feel good enough for an afternoon outing of fishing or visiting a friend.

Hospice cares for patients with illnesses across the spectrum, Ferrell said. Some have accepted the terms of illness and done all the planning and paperwork and made plans for their funeral, she said.

10 September 2, 2013

Submitted photo

Submitted photo

Maria Ferrell, APRN, ACHPN, nurse practitioner with Kansas City Hospice and Palliative Care, has specialized in caring for end-of-life patients and their families since 2000. Ferrell has been with Kansas City Hospice & Palliative Care since 2005.

Maria Ferrell, APRN, ACHPN, nurse practitioner with Kansas City Hospice & Palliative Care, sees patients in their homes and at Kansas City Hospice House.

“Others are not as accepting,” she said.

Ferrell sees patients at the Kansas City Hospice House, located on Wornall Road in Kansas City, Mo., and in their homes, depending on their stage of disease. In the home setting, patients receive palliative care. They are still seeking aggressive treatment for a serious illness, she said.

Some of her patients in the home setting qualify as hospice patients.

“I first see them in the home setting,” Ferrell said. “Later as symptoms get out of control, they end up at our (Hospice House) home setting.”

Ferrell sees patients in a nine-county area on both sides of the state line. It can be a lot of traveling, but Ferrell says she does not mind.

She has support with her collaborating physicians.

“It’s something I enjoy,” she said.

“I do have a very close working relation with our physicians as well.

the kansas city nursingnews

We do a lot of collaborating back and forth.”

The biggest challenge in hospice care, Ferrell sees, is getting patients referred sooner. Often, they are referred from physicians late in their disease stage. Patients and families miss out on the support hospice is able to give, she said.

“Part of it is recognizing when patients are at a point when they are appropriate for referral,” Ferrell said. “The medical field doesn’t do a great job of prognosticating how long patients have to live.”

With cancer, it is easier to see when someone is declining, she said. Heart failure and chronic obstructive pulmonary disease (COPD) are more difficult to determine. It is looking at how frequent the patient is hospitalized, if they are losing weigh, and are in need of managing various symptoms. In end of life, does the family require

Submitted photo

Kaitlyn Balough, MSN, APRN, ANP-BC is a nurse practitioner with Kansas City Hospice and Palliative Care. Balough had a clinical focus in hospice and palliative care while earning her master’s degree.

emotional support? Are they calling with questions? Ferrell said hospice teams can help to supplement care that the primary care physician or specialists are providing.

“We can take more time,” Ferrell said. “We can save their physicians time. A lot of what we do is listening.

It seems like that is very helpful to the families. Listen to the difficulties they’ve had at this time. The primary goal is help them feel good as can as long as can.”

Kaitlyn Balough, MSN, APRN, ACHPN, nurse practitioner with Kansas City Hospice & Palliative Care, has cared for patients at the Hospice House for less than a year.

The former neuro-intensive care nurse had a clinical focus on hospice and palliative care while completing her master’s degree.

“That’s when I discovered I wanted to do hospice and palliative care,” she said. “That was my goal, to be a nurse practitioner in hospice. It felt right to me. I am not sure if everyone is comfortable taking care of those patients.”

The Hospice House is a beautiful facility, Balough said. It has a soothing, calm, and comforting atmosphere, she said.

“We get compliments on it every day on how homey it is and comfortable,” Balough said. “It’s completely different from the hospital, hustling and bustling everywhere.”

The average length of patients’ stay is between four and seven days, Balough said. Sometimes they are there for weeks. Patients have to be qualified for hospice. They have a terminal condition with an estimated prognosis of six months or less, she said.

“They have to have some symptoms we are actively managing through the disease process,” Balough said. “It is challenging to help patients and their families to cope with what they’re going through with their terminal condition and through a difficult time.”

The staff works to make it the best experience possible for patients and their families, she said. There are often a lot of people coming together at this time.

“They do a lot of reminiscing and sharing of life stories,” Balough said.

“We work a lot with a lot of medication to relieve their suffering.”

Submitted photo

Linda Friedel can be reached at Linda.Friedel@npgco.com

Kaitlyn Balough, MSN, APRN, ANP-BC, nurse practitioner with Kansas City Hospice & Palliative Care, helps to keep patients comfortable at the Hospice House on Wornall Road in Kansas City.

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the kansas city nursingnews

September 2, 2013

11

Nurses use mobile clinic to deliver care to veterans

By Linda Friedel The Kansas City Nursing News

A big rig makes a statement as it wheels into small towns in rural Missouri.

The outside is inked with portraits of American faces. The inside holds the power of healing. The driver pulls into a convenient location, then opens it door for business.

“We love the veterans,” said Dawn Graves, FNP-C, family nurse practitioner with the Mobile Medical Unit of the Kansas City VA Medical Center. “They are great. They are an appreciative group.”

Graves is part of a health care team that makes regular stops in towns such as Bolivar, Trenton and Carrollton, Mo. to care for its veterans. These veterans might not otherwise be seen by health care workers, Graves said. Veterans who served in World War II and Korea no longer drive. They have trouble getting to Kansas City to be seen by the VA medical center there. They live hours away in small town communities. They also see veterans who served in Vietnam, Afghanistan or Iraq. The drive is always a challenge.

“A lot of our vets are elderly,” said Angela Clark, RN, BSN, nurse manager of Primary Care, Community Base Outpatient Clinic and Mobile Medical Unit with the Kansas City VA Medical Center. “They are from rural areas. They hate to drive to Kansas City. They have to take a whole day off to get to the clinic.”

Clark oversees the Mobile Telehealth Clinic, which serves veterans from across the state of Missouri.

Currently she helps drive the 45-foot mobile unit staffed with a nurse and medical technicians who meet with veterans. Staff members trained through Metropolitan Community College to certify for a Class E chauffeur’s license, then take turns at the wheel. They motor in to community centers or hospitals in small towns where they park the converted RV for the day. They meet with veterans on their own turf.

“We’re trying to meet them where they are to get their care,” Clark said. “A lot of them were going without care.”

Providing care on the mobile unit helps keep them out of the hospital,

Submitted photo

Angela Clark, RN, BSN, is nurse manager of Primary Care, Community Base Outpatient Clinic and the Mobile Medical Unit with the Kansas City VA Medical Center. The mobile clinic travels to small towns in Missouri to give veterans access to health care.

Clark said. Staff members in the mobile clinic see patients for anything from annual physicals to something more serious. Many of the veterans have chronic diseases such as hypertension, congestive heart failure, diabetes or wounds, Clark said. Some are being seen for psychiatric care.

No matter what they are being seen for, Clark said, their reaction is always the same.

“It’s so rewarding,” she said.

“I have not been out on that unit without them giving that heartfelt thanks of how much they appreciate us being there.”

The mobile telehealth clinic is equipped with nearly everything you would find in a traditional health care clinic. It has a waiting room, a lab, two patient rooms and a room for patients with mental health care needs.

Nurses work side by side with technicians and psychiatrists, psychologists and social workers who meet with their patients in the mobile unit.

Nurses and nurse practitioners administer immunizations, lab workups, dressing changes, EKGs, shots and catherization. They see patients for specialty care, dermatology, cardiology, pulmonary and urology. The

RN works together with a nurse practitioner to see patients on the big rig or through a virtual system.

“I look for someone who has very strong assessment skills who’s able to work independently and be resourceful,” Clark said.

Clark is temporarily filling in as the unit’s RN and works together with Graves. Graves spends 40 percent of her time meeting with patients in the mobile unit and the balance of her time at a clinic in Excelsior Springs, Mo. On the mobile unit, she meets with patients face to face. In her clinic, she helps them virtually. The RN in the mobile unit uses a video camera to capture patients for Graves to see remotely.

“I do go out on the mobile unit also and do traditional hands-on care,” Graves said. “If we’re not doing it hands-on, we’re doing it through telemedicine, which is an interactive TV screen.”

Graves can hear vital signs, see into the back of a patient’s throat or view a rash with the aid of a nurse.

It was a little tricky getting used to the 10-second delay, but other than that the process is simple, she said.

If Graves needs a close-up image of a mole on an arm, the nurse can zoom

in. It’s using the technology to care for their patients, she said.

“It’s like Skype,” she said. “You are interacting with that patient.

You can see and talk to them. It is exciting. You get the technology to provide better care and better outcomes.”

The mobile clinic offers safe and convenient access to care, Graves said. Veterans deserve it, she said.

Graves did not serve in the military, but others in her family did. She spent four years in the Reserve Officers’ Training Corps (ROTC).

“My whole family has received services from the VA,” Graves said. “In helping them with that process, you get a feel for the VA. They need quality care. We try to provide that. It’s the continuity of care that we can provide.”

The staff is in charge of maintaining the mobile unit. Sometimes the satellite goes down in bad weather.

There can be a delay in the transmission of the satellite. The generator went out last week, Graves said.

“There are challenges,” Graves said. “We try to be their medical home.”

Linda Friedel can be reached at Linda.Friedel@npgco.com