Every morning starts the same way for Veteran Kenneth Tutt, age 79. At 8:00am he makes a phone call to Nurse Practitioner Rhonda Weinhold. Weinhold is a VA Home-Based Primary Care (HBPC) provider. She has been working with Tutt for four years. Together they review his weight, blood pressure and sugar levels. “There is no doubt in my mind I would not be here if it was not for this program,” said Tutt.
Home-Based Primary Care is a VA program bringing primary health care into Veterans’ homes. HBPC provides integrated, patient-centered care for Veterans with complex medical needs. Veterans in the program are assigned a primary care provider like Ms. Weinhold, based at the Staunton, Va., community-based outpatient clinic. “The families, the caregivers in the home, they really depend on us,” she says. “A lot of our patients consider us part of the family.”
“So Many Medications!”
Recently, Weinhold began something new for Tutt and several other patients that has helped to reduce their medications and resulted in higher satisfaction with their quality of life. Not long ago, she attended a VA Geriatric Scholars Program class, which inspired her to develop a medication management program to review patient medication prescriptions. The idea came in part from a HBPC routine: setting up monthly medication boxes. “We love doing it, but we noticed our patients were on so many medications. We just thought, are there medications we could potentially get rid of that actually might be doing more harm or that are not needed?”
She teamed up with HBPC team member Jena Willis, Doctor of Pharmacy (PharmD), to develop the idea. The review, it turns out, often results in a reduction of medications. Weinhold says it is good because, “Research shows the more medication patients are on, especially for the elderly population, the greater the risk for falls.” In fact, Tutt admits to having fallen at home a few times in the past. They consolidate the medication de-escalation recommendations, adding them to each patient’s electronic health record. Tutt, like most HBPC patients, takes a lot of medications for a variety of health conditions.
asked veterans, “How do you feel about trying to get off some medicine?” Tutt
thought, “It was a terrific idea.” The project has helped Tutt feel he’s got a
better chance of being the person he’s always been. “I’ve been an outdoor
person all my life,” said Tutt, who served in the Navy from 1958 to 1970. “I
garden, I raise flowers. I’ve had to cut back, but I’m still mobile.”
HBPC: Keeping Patients Safe in their Homes
“Our goal with Home-Based Primary Care is patient safety,” said Weinhold. “We’re there to keep them safe in the home and to keep them in the home as long as possible.” As they fine-tuned their process, Weinhold brought others onboard. It was a team effort. Three registered nurses met in person with 80 patients over six months. “We were able to reduce the number of medications an average two medicines per patient,” said Weinhold.
After their success in Staunton, they were able to coordinate with Salem VA Medical Center (VAMC) pharmacy residents’ grand rounds presentation on the de-escalation of therapy for the medical department there. The Salem VAMC is Staunton’s Community-Based Outpatient Clinic’s parent facility. The residents added the information to their presentation as an introduction to the rest of the medical facility. “The most rewarding thing is providing improved quality of life for our patients, whether it’s three more days, three more years, or 30 more years,” said Willis.
Maureen Jerrett is a contract
writer for VA Geriatric Scholars Program
UNIVERSITY PARK, Pa. — An anonymous Penn State donor couple has made a gift of $5 million to endow a scholarship for students with financial need in the College of Nursing. This is the largest single gift the college has received in its six-year history. In addition, the University is matching the gift 1:1, bringing the scholarship endowment total to $10 million. Students from western Pennsylvania and rural regions of the commonwealth will be given first preference for the awards.
“The College of Nursing’s potential for impact on the health of communities across the commonwealth is vast, and these donors have recognized that potential through this remarkable gift,” said Penn State President Eric J. Barron. “Their support will help to address the commonwealth’s pressing need for health care professionals and allow recipients to forge meaningful careers in nursing, transforming their own lives. We’re very grateful for this generous gift.”
College of Nursing undergraduates who must meet the cost of a Penn State degree with loans graduate, on average, with an educational debt of more than $42,500. Recipients of the scholarship, however, will receive annual awards of up to $10,000. This will significantly reduce their debt and allow them more latitude to choose jobs in high-need but lower-paid geographic areas and medical fields that present the most urgent need for nurses.
“The extraordinary couple who made this gift have been impressed by the excellence of Penn State’s nursing programs,” said Laurie Badzek, dean and professor of the College of Nursing. “In particular, they appreciate our work to prepare a generation of nurses with a solid grounding in geriatrics and community health.”
“Nursing is a discipline that touches everyone’s life at some point, and these generous donors are helping to ensure better care across the commonwealth,” said Susan Kukic, director of development and alumni relations for the college. “While they have chosen to remain anonymous, they are important role models whose vision for the future of our students and our college will, I hope, inspire others to consider how they can support excellence in nursing and nursing education.”
For information on this scholarship and the nursing program at Penn State, visit here.
Job shadowing is a long-standing tradition. High schools often have dedicated shadowing days, during which students can come and spend time with people working in careers that the students find interesting. While a few hours isn’t really enough to know if you like, love, or hate a job, it’s a start.
In healthcare, it can be especially important to spend time shadowing. In fact, PA schools want applicants to have hundreds of hours of documented shadowing time. I’m certain medical schools now want the same. I don’t know about other healthcare fields, such as dentistry, physical therapy, or pharmacy, but I suspect they want to see it as well.
We have created a system where shadowing is expected for acceptance in professional schools even as some hospitals make it very difficult (or impossible) to shadow. In some instances, it’s about concerns over privacy. In others, it’s simply that the number of people who desire to shadow is so large that it’s very difficult to get a time slot. And in others, it’s that there are medical, PA, or nurse practitioner students and residents rotating through the hospitals as part of their graduation requirements. In other words, it’s just dang crowded. As such, high school or even college students, trying to shadow, are at the bottom of the list.
In many career fields, it’s easy enough to shadow. If mom is an attorney, her son or daughter can sit in the courtroom or come to the office. If dad is a plumber, it’s easy enough to tag along and watch (or practice on projects at home). Teachers encourage students to shadow, and assorted business people do as well. Law enforcement often allows ride-along sessions. Even moms or dads in military careers have days when family can come on base and see what life is like in their jobs. I could go on, but the fact remains that from what I’ve seen, it’s much easier to shadow in other fields than in medicine. (If I’m wrong and this is a new trend everywhere, please leave a comment and educate me!)
The problem with medical careers that require graduate degrees is that the path to those schools is long, arduous, and expensive. And they require careful planning, sacrifice, and intentionality to create a resume and application that is more likely to stand out from the others. In this case, it would make so much more sense for shadowing opportunities to be much more available and easy to access.
It’s extraordinarily hard for a student to know if he wants to commit to 14 years of education based on a couple of hours walking around in a clinic. Admittedly, I have had some shadowers who probably got the message pretty quickly. Once I had a university student who followed me in the ED for four hours. At the end, he said, in a fatigued voice, “Don’t you guys ever sit down?” Not the perfect attitude if you really want to go into medicine. (Although maybe he ended up a radiologist with a nice chair in a dark room.)
We need to offer more shadowing, not less. Especially in an era of growing physician shortages in both primary care and specialties. We need to encourage students to pursue careers that have made our lives so rich and meaningful. And we need to urge hospitals, clinics, and offices to make those opportunities available as well.
we want good healthcare; heck, if we want healthcare at all, we have to
have physicians, PAs, and all the rest. And in order to have those
essential persons, as it stands, they’ll have to shadow.
Every other job field seems to get it.
It’s time we do too.
Edwin Leap, MD,
is an emergency physician. He practices full-time in a rural community
hospital in South Carolina. He has spent many years practicing in rural
and critical access facilities, including work as a locums provider for
Weatherby Healthcare. He is a writer and blogger. He and his wife have
four children. See more at edwinleap.com.
This post appeared on KevinMD.
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