Empowering, energizing and exhausting are terms sometimes used by family nurse practitioners Tim Rausch and Ricky Norwood to describe work with underserved populations. Both agree it is also rewarding.
Rausch, RN, MSN, FNP, sees patients at the UCLA School of Nursing Health Center at the Union Rescue Mission in downtown Los Angeles. He provides primary care for patients who often are homeless. Presenting with an acute need such as an abscess, the flu or a headache, his exams often reveal patients have undiagnosed chronic diseases. “They might have hypertension with a pressure over 200 [systolic], or blood glucose above 400,” Norwood said.
Most clients, he said, also have mental health or substance abuse concerns. Poor health literacy often adds to the issues these clients face.
While some patients return for chronic disease management, he said others never come back. Averaging 15 patients a day, Rausch performs well-child exams and screenings along with adult care.
The patient base is somewhat similar at the Sacramento County Health Center where Norwood, DNP, MSN, RN, FNP-BC, sees patients. The county clinic is associated with the Betty Irene Moore School of Nursing at UC Davis in Sacramento through a first-of-its-kind cooperative agreement. As an assistant clinical professor with the SON, Norwood works in the clinic’s new Healthy Partners program. The program, according to the county’s health and human services website, provides primary and preventive healthcare to low-income, undocumented adults residing in Sacramento County.
Long, but rewarding days
“We work very long, but rewarding days,” Norwood said. “I come in energized and leave exhausted.” He said 80% of patients have never had healthcare, so he performs a thorough history and physical exam, then proceeds with care based on the findings. Most patients are Hispanic, require an interpreter, and common findings include diabetes, hypertension and thyroid disease.
Norwood said he takes true pleasure in this work, because as a child growing up in Mississippi, he had no healthcare access. “I understand these patients’ need and issues,” Norwood said. Likewise, Rausch, a former ICU and critical care nurse, chose to specialize in primary care for underserved populations because he believes it helps prevent hospitalization, and even disability and death for many of his patients.
He first sampled the work as an NP student on rotation and is convinced it’s an exceptional experience for NP students. “Students very quickly become immersed in the social determinants of health,” Rausch said. “Instead of learning about lab values and diagnoses, they’re learning what got these patients to where they are and how that impacts [the patients’] health. Students learn how to develop strategies for patients that empower them to take control of their health, It’s a unique kind of experience.”
Norwood, who will begin precepting NP students at the Sacramento clinic this summer, agrees. “You can’t get a better model of care than this,” he said. “It’s totally holistic care.”
Skills required to serve the underserved
Success in treating underserved populations demands energy and top skills, both NPs assert. Rausch said a natural affinity toward patient education is also valuable.
“So many of the issues involved with poor health in this population are due to poor health literacy,” Rausch said. “As we give them the knowledge they need about their conditions, and encourage them to return for follow-up care, we can prevent really bad outcomes that will land them in the ER or a hospital.”
Being creative and committed to find a way to connect with each patient and develop a relationship is also necessary.
Norwood added, “If you want a job that will challenge you on a daily basis, give you an opportunity to lift up others and give back, you’ll never have a dull moment. You’re rocking and rolling from the time you start until you leave.”
The investment of skills and patient connection pays off, according to Rasuch. “In the end, it’s rewarding to know that we are helping the patients who otherwise may not be receiving care,” Rausch said