Nurse practitioners from the VNA of Central Jersey have expanded their roles to bring healthcare to New Jersey’s medically underserved populations in HIV clinics, prisons, and schools. Their expertise has become crucial in filling gaps in care and providing the support struggling families need to be healthy and to stay on the job and in school.
“These communities depend on NPs; they make a huge difference in people’s lives,” says Eileen Toughill, RN, APN, VP of Research and Quality for VNA of Central Jersey.
A Healing HIV Moment
One such community service helps those with untreated or undertreated HIV. Helen Ferlazzo, RN, APN, believes that providers of care for people with HIV need to use every skill they have and jump on potential healing moments when caring for clients with HIV.
As program manager of the Ryan White HIV Program at VNA of Central Jersey Community Health Center, Ferlazzo helped to develop an HIV program that embraces a hard-to-reach population. Services are not labeled an “HIV clinic” because there is a stigma associated with HIV in the local community. This anonymity makes it easier for clients to take that first step through the door.
Another key element is the program’s “no appointment necessary” policy. At other HIV centers, clients may wait long periods for appointments or spend the day in the lobby, but Ferlazzo feels it is essential that providers see clients quickly. She says that when people with HIV carry a large burden of shame and stigma, they can become anxious, change their minds about seeking care, and leave.
Ferlazzo provides the full spectrum of primary care. “We can’t just move clients in and out because we are addressing a lot of issues,” she says. “I have to use every skill I have, because these clients often have other chronic conditions, such as asthma, diabetes, hypertension, and hepatitis.” Ferlazzo must also identify social, substance abuse, and mental health issues, which are often severe enough to have a negative effect on compliance with HIV treatment. These clients are referred to on-site psychiatric NPs.
Ferlazzo has worked at the clinic for six years and has become a well-known provider in the community, which is another boon for her clients. “Trusting healthcare providers is a big issue in this population,” she says. “A lot of providers come and go, but clients really know and trust me.”
An Unexpected Opportunity
For some hard-core juvenile offenders in New Jersey, prisons have become a place where their health issues are being addressed for the first time. “These kids often come from chaotic environments and healthcare hasn’t been a priority in their lives,” says Catherine Donohue, RN, APN, CPNP, an advanced practice nurse in Juvenile Detention Facility of New Jersey in Jamesburg. “Working here is an opportunity to reach a group that is really marginalized.”
Donahue treats teen offenders who have developed preventable “adult” diseases, such as type 2 diabetes, hypertension, and HIV and other sexually transmitted diseases. “These are conditions that I rarely had to deal with in the past as a pediatric nurse, and now I have had to expand my role to include them,” she says.
Doors Remain Open
Patricia Ruane-Garduno, RN, APN, FNP-C, an NP at the VNA of Central Jersey Community Health Center in Asbury Park, never closes the door on a sick patient. She serves a working poor, medically underserved population, who often live in overcrowded, dilapidated conditions, and have poor diets. This makes them more vulnerable to infectious diseases, such as TB, as well as acquired conditions, such as lead poisoning, obesity, diabetes, hypertension, and heart disease. “The lower the financial status, the sicker people are,” she says.
It’s common for an appointment with a sick child to turn into a visit for the mother, or even the entire family. “I never turn anyone away,” says Ruane-Garduno. She also works arm-in-arm with the local school system to create action plans for handling childhood chronic diseases at school, and has expanded her services to include underserved people who are mentally and physically disabled and living in group homes.
Win-Win in the Schools
As a VNA family nurse practitioner working within the Keansburg, N.J., School System, Marion Norman, RN, FNP, brings healthcare directly to a hot spot of pediatric needs. Throughout the last decade, VNA NPs like Norman have been broadening their roles in N.J. school systems that enroll children of underserved families. These include Asbury Park, Red Bank, and Wood-Ridge.
Children in these areas are often from working poor families and/or may be living in transient or substandard housing or homeless shelters. They may be children of undocumented workers who are not eligible for health insurance. “The continuity of life is very fragile for some of these families,” says Norman. “Things can fall apart quickly, and one of the first things to go is healthcare.”
NPs provide a healthcare safety net by evaluating sick children in school and writing prescriptions. They refer families to an accessible medical home and assist families in applying for state insurance programs. NPs provide valuable education programs to families, teachers, and the board of education about such topics as asthma, diabetes, obesity, and infectious diseases.
NPs identify and treat contagious versus noncontagious conditions within the school system. For example, they can diagnose and differentiate between infectious and allergic conjunctivitis and treat them quickly, which minimizes large-scale or unnecessary absences from school.
“Parents can get fined for letting kids miss too much school,” says Norman. “They want their children seen quickly, treated, and returned to school.” School-based NPs can now bill Medicaid as primary providers under a pilot program, which should help to expand the program. “This program is a service that keeps the kids in the classroom, learning. It’s a win-win all around,” says Donohue, who also works as an NP in the school system.
Catherine Spader, RN, is a contributing writer for Nursing Spectrum.
To comment on this story, e-mail [email protected]
To learn more about the APN practice, go to Nursing Spectrum’s CE program at: www.nurse.com/ce/60156.