By Heather Stringer
Healthcare is undergoing a transformation as providers and caregivers increasingly value the importance of community care. Nurses are at the forefront of this trend as they develop innovative ways to bring their expertise into their communities. These four nurses span four different specialties — geriatrics, mental health, home health and school nursing — and are recognized as leaders who excel in their fields. They were among the winners of the recent Culture of Health: Breakthrough Leaders in Nursing Award from the Future of Nursing: Campaign for Action, a joint initiative of AARP, the AARP Foundation and the Robert Wood Johnson Foundation. Below they share how they promote change and better serve the needs of their patients and communities through research initiatives, interventions and educational programs.
Leanne Lefler: Change agent for the geriatric population
Leanne Lefler, PhD, APRN, worked in cardiovascular care for 17 years when she decided to enroll in graduate school. Throughout her years at the bedside, she couldn’t ignore that older female patients suffered more complications after heart surgery than their male counterparts, and she felt compelled to find solutions.
“As soon as I figured out that I could change health outcomes by doing research, I immediately knew what I wanted to do — pursue a career in academia,” she said. “I’m always partial toward those who need the most help, and I wanted to do whatever I could to help populations in this country that are marginalized.”
Now an associate professor in the College of Nursing at the University of Arkansas, Lefler is conducting research studies focused on improving cardiac health in older adults, funded by the National Institutes of Health. In March 2015, she finished a three-year clinical trial aimed at improving their physical activity. As part of the study, she designed an intervention in which older women learned realistic ways they could improve their health with exercise. “I felt like the intervention really changed the beliefs of these women about what they could do to stay healthy,” Lefler said. “It was sometimes simple changes like gardening more vigorously or walking through a grocery store longer than usual. I believe women are often leaders in their communities, and if I can influence their beliefs, they can have a large impact.”
Lefler also is passionate about making healthy living more accessible in marginalized communities. “We used to blame individuals for their health problems, but health is really influenced by communities and peers,” she said. “Many communities have limited access to healthy food or places where they can exercise for free. I hope my research can help us move toward new policies and infrastructure.”
To promote change, Lefler worked with the Arkansas Action Coalition — one of the state coalitions connected to the Future of Nursing: Campaign for Action — to write an educational grant promoting nurse practitioner education in rural parts of Arkansas.
Although Lefler waited 17 years to return to school for a graduate degree, she does not encourage others to delay when it comes to advancing their education. “Pursuing more education is advantageous because nurses are trained to lead and the quality of care improves when nurses are better educated,” she said. “I believe nurses are the ones who can be the leaders in this movement to make health a shared value of all Americans.”
Erica Joseph: Bringing health to the severely mentally ill
Erica Joseph, DNP, APRN, PMHNP-BC, spends the vast majority of her working hours visiting severely mentally ill patients, and she couldn’t be happier with her choice of specialties. “Before I started going into the community, these families didn’t have much support and there were many cases of noncompliance that ended in hospitalization,” said Joseph, an adult psychiatric mental health NP in the Southeast Louisiana Veterans Health Care System. “By going to their homes, I can see exactly what is going on.”
In many cases, she said, there are factors preventing compliance, such as lack of financial resources, transportation or understanding about the disease. After Joseph completed her NP training, she applied to work at the VA. She expected to start in a primary care role, but there was an opening in mental health to serve severely mentally ill patients.
Eager to learn more about how to help this population — which included patients suffering from chronic paranoid schizophrenia, bipolar disorder and post-traumatic stress disorder — Joseph enrolled in a post-master’s adult psychiatric mental health program at Southeastern Louisiana University. “Once I started caring for this population, I just wanted to learn more and more in order to help them function as well as possible,” she said.
After completing the program, Joseph earned a doctorate of nursing practice from Southern University in Louisiana, and now she is enrolled in a PhD program at the same school.
By listening to patients and family members discuss their goals and challenges, she discerns how to facilitate better outcomes. This may include educating them about topics such as medication dosage and side effects and suicide warning signs.
After working with several patients who had expressed suicidal intent, Joseph launched a project to evaluate a computer-based suicide prevention training course in VA primary care outpatient clinic settings. She also applied for a minority fellowship program through the American Nurses Association. The program was supported by the Substance Abuse and Mental Health Services Administration. Joseph was selected to be a minority fellowship scholar, which will give her the opportunity to receive guidance from mental health experts during her PhD program.
In the future she hopes to find ways to offer psychiatric services such as crisis intervention and substance abuse programs in rural communities where access to care is scant. Although Joseph is highly motivated to make an impact, she acknowledges her mentor has been instrumental in helping her realize her potential as a nurse. “I met my mentor in my DNP program, and she advised me to apply for the Minority Fellowship Program,” she said. “She was thinking of ways to help me move forward in the profession and be a nurse expert, and I’m eager to see where this opportunity takes me.”
Lucia Alfano: A personal story of overcoming odds to impact community health
Lucia Alfano’s chances of earning a college degree seemed slim when she dropped out of school after seventh grade. She grew up in poverty and had limited skills in reading, writing and math.
Seven years later a friend suggested the idea of nursing school, and Alfano agreed to enroll in community college after earning her high school equivalency diploma. After she labored through several remedial courses to learn basic skills, she was ready to take her first nursing course. Immediately, Alfano fell in love with learning. She knew she’d found her calling when she had an opportunity to use her coursework knowledge to help patients during clinical rotations. “After I had a community health rotation with a public health nurse, I knew that was what I wanted to do,” said Alfano, MA, RN. “I really enjoyed the one-on-one time with the patient, and it seemed much more intimate to be in their environment than the hospital setting.”
Alfano later started working for the Visiting Nurse Service of New York, and quickly discovered she was passionate about finding ways to improve quality of care. She led the implementation of a community health program for seniors in an area of Manhattan with a high population of retired individuals. When she moved to Westchester County, N.Y., Alfano learned a high percentage of Hispanics needed health services in the county. In response, she founded the National Association of Hispanic Nurses Westchester Chapter to address Hispanic health disparities and increase the number of Hispanic nurses in the county.
Throughout her training and time in nursing, Alfano nurtured a growing desire to work in the world of academia, where she could influence future nurses. She realized this dream two years ago when she accepted a faculty position at Concordia College’s nursing division in New York. “Public health nursing needs to be prioritized in nursing schools today,” she said. “Due to the fact that I have so much public health experience, I integrate community and public health concepts into all the courses I teach.”
Now she’s enrolling in PhD programs, and hopes to use her expertise to eventually remove barriers preventing new graduates from entering the field of public health. “I believe we need to stop doubting that we can prepare nurses during nursing school to become public health nurses,” Alfano said. “We need to transform nursing curriculum in order to achieve this, and I plan to be a leading force in the effort to accomplish this.”
Andrea Tanner: Transforming community health via the school system
Andrea Tanner, MSN, RN, NCSN, enjoyed working in pediatric oncology during her first year as a nurse, but she craved more time to educate and invest in patients and families.
Fortunately, she decided to drive her husband to a church camp and attended a meeting that would change the course of her career. Once she arrived, she sat next to a woman who worked as a school nurse and knew of two colleagues who were retiring. “It had always been something I was interested in, particularly because it would give me an opportunity to work in the community setting,” Tanner said. “But I thought there was no way anyone would hire me because I had very little nursing experience.”
Tanner applied for a school nurse position in New Albany Floyd County Schools and got the job. Although Tanner said the term “school nurse” can conjure images of someone sitting in a health office dealing with cuts and stomach aches, this is a far cry from her job description. Much of her time involves care coordination with other healthcare providers for children with multiple health issues. She also educates families, teachers and administrators about topics such as nutrition and exercise and emergency response protocols.
Tanner knew she wanted to learn more about her specialty and enrolled in a school and public health graduate nursing program at the University of Missouri in 2005. “I wanted to get a broader view of how I could connect student health to community health and be the biggest change agent possible,” she said.
Two years ago she discovered an opportunity to make a larger impact when she saw an advertisement from the National Association of School Nurses. The organization was looking for nurses who were interested in becoming epinephrine experts. “Anaphylaxis is always on the forefront of our minds as school nurses with all of the allergies children can have,” Tanner said.
Historically children with a known allergy had their own epinephrine available at school, Tanner said, but increasing numbers of schools are starting to stock epinephrine so it’s available for children who are not aware they have an allergy. These children may experience their first reaction at school. She was accepted into the NASN program and now trains nurses throughout the state about the use of epinephrine in schools. Tanner also has collaborated with the American Academy of Pediatrics to develop procedures and a national policy about this issue.
Her long-term goal is to provide resources in the community to break the cycle of preventable diseases and empower children to be healthier earlier. “What’s rewarding for me is seeing an ‘aha’ moment when students realize they can take some control of their situation and make a change for better health,” she said.
Heather Stringer is a freelance writer.
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