Practice partnerships make perfect

Nursing clinical assistant professor Karen Cotler, pharmacy assistant professor Jennie Jarrett, and trainees Sooyoung Yeom and Stephanie Guerrero in front of the COIP mobile clinic.

UIC Nursing faculty and students are joining forces with other UIC healthcare professionals, bringing more nurse practitioners into the fight against the opioid epidemic and helping to improve pediatric dental care.

CONFRONTING ADDICTION

In Chicago, opioid-related overdose deaths increased by 50% during the first six months of 2020 over the same period in the previous year.

In her five years as a nurse on a stepdown unit at UI Health, Sooyoung Yeom, DNP ’21, FNP-BC, frequently cared for patients going through active withdrawal from substance use. The patients looked “miserable,” Yeom says, presenting with severe pain, nausea and discomfort. What was even worse, she says, was seeing the same patients land in her unit again and again.

“They keep coming over and over and over again,” she says. “I thought they would get some help and recover in a rehab program. But even if they get some help, they keep coming back.”

Yeom says she now believes that prevention and harm reduction are the biggest tools in the battle against opioid addiction, which is why she’s one of two nurse practitioners taking part in the inaugural year of a UIC Nursing-led training program to integrate work with patients with substance use disorders into primary care practice.

Program trainee Sooyoung Yeom, left, and College of Pharmacy faculty member Jennie Jarrett, right, interact with a patient from a mobile clinic, where they bring harm reduction services and primary care to West and Southwest Side Chicago neighborhoods.

The program, which received a $1.8 million grant from the Health Resources and Services Administration, is forging new ground as UIC Nursing’s first post-doctoral fellowship program focused on clinical practice, says clinical assistant professor Karen Cotler, DNP, FNP-BC, FAANP, one of the program’s co-leaders. And while it’s housed at UIC Nursing, the program is taking a distinctly interprofessional approach. The five-year grant is co-led by UIC College of Pharmacy assistant professor Jennie Jarrett, PharmD, BCPS, MMedEd, FCCP.

“No matter where [the trainees] go, they’re going to be integrated into this collaborative care model,” says Jarrett. “We’re going to train them to be phenomenal nurse practitioners, but also to work well in teams to really support patients in the best way.”

In addition to Yeom, Stephanie Guerrero, DNP ’21, FNP-BC, was also selected for the first year of the training program. The two will rotate through UI Health’s network of federally qualified health centers, Mile Square, which primarily serve the West and Southwest Sides of Chicago. They will also train at the Community Outreach Intervention Projects (COIP) field station, a needle exchange site and primary care clinic in the Austin neighborhood, and its mobile unit, which brings primary care and harm reduction services to patients in their communities. (Both are operated by the UIC School of Public Health and the mobile unit partners with Mobile Health Chicago and Family Guidance, Inc.)

Future years of the program will feature two or more trainees selected from a national pool.

“We want new providers to be out there working as harm-reduction providers [after they complete] the training program,” Cotler says. “We want them to be well-equipped, well-educated and fully comfortable treating people with an opioid addiction.”

No matter where [the trainees] go, they’re going to be integrated into this collaborative care model. We’re going to train them to be phenomenal nurse practitioners, but also to work well in teams to really support patients in the best way.

The program is targeting a critical problem that the U.S. Department of Health and Human Services has declared as both an epidemic and a public health emergency. There was a record high 96,779 drug overdose deaths from March 2020 to March 2021, according to provisional statistics from the CDC. That represents a nearly 30% increase over the prior year.

In addition to hands-on experience, the program also incorporates a didactic curriculum that teaches prevention and treatment of substance use disorder, including waiver training in Medically Assisted Recovery (MAR) and workshops on the intersection of substance use and serious mental illness.

“I think it’s very meaningful,” Yeom says. “I get to see this population in the outpatient setting and try to effect some change.”

PREPARING PEDIATRIC PATIENTS

A partnership between the UIC Colleges of Nursing and Dentistry will mean more children will be able to receive much-needed dental care more quickly.

Faculty Jacqueline Wolak Shanks and Celeste Schultz at the UIC Pediatric Dentistry Outpatient Care Center.

Patients travel from all over the state to the UIC Pediatric Dentistry Outpatient Care Center, the largest provider of pediatric dental care in Illinois.

The facility, which opened a year ago within the UIC College of Dentistry in Chicago, treats children with severe early childhood cavities. Because most of the patients are under 4 years old, they may need general anesthesia to tolerate the extensive dental work.

Previously, parents had to obtain required health screenings from their child’s primary care provider, sometimes leading to paperwork headaches and delays.

But now, UIC Nursing clinical assistant professors Celeste Schultz, PhD, RN-BC, CPNP-PC, and Jacqueline Wolak Shanks, DNP, FNP-C, are stationed there once a week to conduct physicals and take histories on-site.

Family nurse practitioner Jacqueline Wolak Shanks performs a required preoperative physical on a pediatric patient who is a candidate for outpatient dental surgery.

“This saves time for the families. They are able to leave the dental clinic with all [preoperative] documentation cleared and with a surgery date,” says Marcio da Fonseca, DDS, MS, head of the UIC Department of Pediatric Dentistry. “It is helping expedite the scheduling process so we can take care of the children more quickly.”

The center sees a high volume of patients; they’ve performed more than 800 general anesthesia surgeries in the last year, and have another 1,000 patients on the waiting list. This is because the center offers the rare combination of providing general anesthesia and accepting Medicaid patients, making it in-demand for children with severe dental needs, da Fonseca says.

Pediatric nurse practitioner Celeste Schultz takes the pulse of a pediatric patient as part of a screening for surgery. The patients need to be considered low-risk to qualify for the surgery.

Because it’s an outpatient center, patients need to be low-risk, and preoperative histories and physicals are important “to screen for anything that would add increased risk for adverse anesthetic events,” says Schultz, a pediatric nurse practitioner with 30 years of experience.

“If we identified, say, a heart murmur, or a child with a paralyzed vocal cord, they should be cared for in the hospital,” she says.

This saves time for the families. They are able to leave the dental clinic with all [preoperative] documentation cleared and with a surgery date.

The partnerships will also create meaningful clinical opportunities for nursing students, says Charles Yingling, DNP ’12, MS ’05, FNP-BC, FAANP, formerly UIC Nursing’s associate dean for practice and partnerships.

“This collaboration with our colleagues in the College of Dentistry is a win for everyone involved,” Yingling says. “We are improving access to care for children, creating opportunities for interdisciplinary collaboration between faculty, and providing interprofessional learning for dental and nursing students.”