Its 7 AM on a weekday in downtown Seattle, and a group of people slowly line up in front of the door to Pioneer Square Clinic.
Old and young, the group suffers from a wide variety of ailments and illnesses, but most have one thing in common: They are homeless.
Pioneer Square Clinic is one of a dozen sites where health care for the homeless is provided by Harborview Medical Center, the King County hospital, in partnership with the City of Seattle, YWCA, The Salvation Army, and other organizations.
The urban myth is that if youre homeless, the best place to be is Seattle, says Mary Larson, RN, BAN, who works as a triage nurse at the downtown clinic.
Larson, who became hooked on nursing for the homeless while working at a homeless clinic in high school, says she agrees with the myth.
We do an incredible job of it, she says. The resources Harborview has established for this population are incredible.
Each year, the clinics, respite centers, and nurses stations at homeless shelters provide health care to about 18,000 homeless patients, says Sandy Olson, RN, BA, manager of the programs. In January, Harborview received the prestigious Foster G. McGaw prize for its outreach efforts. The $100,000 prize, sponsored by the American Hospital Association and two foundations, is awarded annually to a healthcare organization that provides innovative programs that significantly improve the health and well-being of the community.
Olson says the homeless outreach program looks at all healthcare aspects of the homeless population.
Most of what weve done is try to target the at-risk population, she says.
Commitment is keyPioneer Square Clinic is decorated with artwork by Mary Larson, RN, BAN.
A dozen Harborview nurses, along with about 18 other nurses in the community, play a vital part in this outreach effort.
This outreach really represents their professional commitment, says Susan Kline, NP, an administrator with Healthcare for the Homeless Network in Seattle. Its also about the fact that these are very skilled nurses out there dealing with some of the most difficult client issues that exist.
The work can be isolating some of the nurses work alone in homeless shelters, while others take health care directly to the streets, Kline says.
Being on the front line of health care for this patient population also requires a strong medical background.
Often they are the only medical personnel in the building, Olson says. They have to have solid assessment skills.
Finding a connection
The nursing staff also must be able to balance providing good health care and education with the reality of their patients living on the streets or in a temporary shelter.
Sometimes its a matter of, do they come by and pick up their insulin, or do they get in line to get a bed for the night when its predicted to be 22 degrees that night, Olson says. Our nurses have to be innovative in how they approach care.
One such innovation started nine years ago when Larson began painting portraits of her patients.
It was a rainy day, and I just started painting from photographs of homeless men at the Washington, D.C., clinic where I first started working, Larson says.
Some of the paintings were hung in the Pioneer Square Clinic in Seattle, where Larson now works. She said patients immediately connected with them.
Patients would sit in the lobby and they would say, I just know they are homeless, even though there were no visible signs of homelessness, Larson says. Then, they asked me to paint their portraits.
Larson hung a few of the paintings at a local Starbucks for sale, but says she was unsure what to charge, even though she was going to donate the proceeds to the clinic. At the time, the clinic was out of new socks for their patients, a necessity for street living, so instead of asking for money, she asked for 500 pairs of socks.
The paintings sold immediately, and now the Pioneer Square Clinic and others around the country where her paintings are sold is well-stocked in clothing supplies including socks, shoes, and underwear, as well as sleeping bags and other needs of the homeless. Her website, www.marylarsonart.com, shows her work.
From the clinic to the shelterThe Pioneer Square Clinic was established in 1971.
The Pioneer Square Clinic, which began in 1971, sees patients with absolutely everything, Larson says. Uncontrolled diabetes, chronic obstructive pulmonary disease, asthma, and a range of foot problems commonly are addressed at the clinic, she says. Treatment after an assault also is common, she says.
Mary Pilgrim, RN, is one of a handful of nurses whose office is actually in a Seattle homeless shelter.
Our population is considered very vulnerable, she says. Most are mentally ill and not able to work because of their mental health or medical issues.
Pilgrim says she provides a wide range of medical services for the 300 homeless shelter guests from changing dressings to using protocols for medicine to treating flu symptoms and administering pregnancy tests. Her clients range from 18 to 80 years old.
I do whatever is needed that a walk-in clinic would do, she says.
For Larson, working with the homeless is as much an avocation as a vocation.
I fell in love with working with this population, she says. Its such a privilege to try to do something to help people who have found themselves in such a difficult situation.