Pro bono is defined as “being, involving, or doing professional and especially legal work donated especially for the public good.” Pro bono work has traditionally been relegated to attorneys. This was before the increasing cost of health care, the number of uninsured patients, and the economic slowdown. Now, more and more nurse practitioners are providing discounted rates, offering free services, or volunteering their time to free clinics and charities.
Let’s examine pro bono work and things you should consider when deciding how much pro bono work is appropriate for you. We’ll also delve into the advantages of pro bono work: for the patient, our societal image, and for you, both personally and professionally.
Why Should You Consider Pro-Bono Work?
Statistics indicate that roughly 10% of Americans under 65 do not have health care coverage, with a full 45% stating that they cannot pay for such coverage. Due to this, some 79 million Americans have medical bills that they cannot pay, and they are dealing with medical debt, which can destroy their credit rating and make it impossible for them to secure a new credit card, refinance the mortgage on their house, or apply for a personal loan.
As nurse practitioners see more patients struggling to pay for their health care, some providers, like Dr. Mary Newman, have started discussing their patients’ financial conditions during routine office visits. Additionally, many have cut fees or have devised creative payment arrangements. Dr. H. Lee Adkins of Ft. Myers, FL, for example, charges a flat fee to patients with chronic illnesses that covers monthly office visits, routine labs, and some vaccinations. Others are basing their costs on a sliding scale, providing free telephone consultations, or seeing two members of a household at the same time and charging for only one office visit. Still others donate their time to charitable organizations that run free clinics for uninsured or underinsured individuals.
The Many Options of Pro Bono Work
According to the AMA Journal of Ethics, when deciding whether to take on pro bono work, you have many options to consider:
You may decide to devote all of your time to underprivileged patients. Should this be the case for you, transfer all of your affluent patients to colleagues … but be aware of the consequences of your actions. While you may experience a great deal of satisfaction serving those in need, you will also have to make financial sacrifices, including giving up your expensive office for something more modest.
You may conclude that you want to help the indigent but just can’t afford the tremendous reduction of income to do it full-time. Set aside one day a week to treat the uninsured or those on Medicaid in your office, or work one day a week at a free clinic. The option of working in a free clinic would allow you to volunteer your time without your having to also volunteer your staff’s services.
Maybe serving the underprivileged is just too costly for you at present, but you would like to pursue it in the future. While you gain financial stability and shore up your expenses in preparation for the big jump into pro bono work, you can convince a colleague to accept low-income patients or advocate for better access to health care services within your local community.
How much pro bono time you volunteer should be ethical and appropriate for you. Just keep in mind your professional responsibility and recognize your conscience. What do you need and aspire to be as a nurse practitioner? Also consider your personal situation and finances.
If you wish to serve the underprivileged population, but you just can’t justify the loss of income at the moment, there are things that you can do to make yourself better able to take the plunge in the future. For one, take a good look at how you use your supplies and resources. You may find that through hospital resource management, a system whereby you more effectively utilize your resources, you can remain financially solvent while devoting time to help those who need it most.
When you decide to volunteer your time and do pro bono work, you are allowing an economically disadvantaged patient to seek health care who might otherwise go without. A 2018 survey showed that roughly 40% of Americans passed up a medical test or treatment that was recommended within the past year because of the exorbitant cost, even when they were injured or suffering from an illness. Additionally, over 30% took less prescription medication than prescribed or did not fill a medication at all due to cost.
Regardless of your personal decision whether or not to pursue pro bono work, a highly debated topic is whether, like attorneys, providers should be required to do pro bono work by the medical societies to which they belong. At this time, most perform at least some pro bono work, but it often goes unrecognized by the public. Society as a whole used to admire doctors, but due to malpractice suits and increasing public scrutiny, the reputation of health care has been severely tarnished. Requiring pro bono work could restore some of the faith the public once had in providers.
You expand your network of other medical professionals.
You gather positive exposure for your personal business.
And if you prefer to donate your time in a nonclinical way, that is also possible. You can join the board of directors of a non-profit group, for example, or mentor others. Hippocrates, the founder of the Hippocratic Oath, stated that one of the primary responsibilities of a medical professional was to be a teacher. If you choose to mentor junior nurse practitioners, for example, you will help them with their personal growth and make them better nurses.
There are so many in society who cannot afford health care insurance and are drowning in medical debt. Medical professionals can improve patients’ health without adding to their financial burden. And it can also do you a world of good, both personally and professionally.
The VA focuses on making it easier for veterans to see their doctors and get to their medical appointments year after year. Not only does this result in better health for millions of America’s heroes, but it improves the working environment for employees across the nation.
Here are four ways that VA has been working to improve access to care in 2020:
1. Expanding and investing in telehealth
The VA is on track to set an agency record for telehealth care this year. Prior to COVID-19, VA had a robust telehealth system in place. Nearly two-thirds of our primary care and mental health providers had seen patients over video. Because of this, we were able to quickly ramp up our telehealth capabilities to meet increased demand.
In the first half of 2020, Veterans attended about 25,000 telehealth video appointments each day, a 1,000% increase from the previous year. As of July, we had already surpassed the number of telehealth encounters in 2019 by 7 million.
Telehealth is especially beneficial for Veterans who find it difficult to travel or those who live in rural areas far from care centers.
“VA is committed to offering Veterans the health care they deserve, whenever and wherever they need it,” said VA Secretary Robert Wilkie in November 2019.
2. Tracking access to care data
We’re keeping an eye on the numbers all the time, including maintaining a website that shows how quickly Veterans can expect to be seen, satisfaction with care, comparisons between facilities and more.
Our data-driven approach first started out by looking at wait times, but we’ve cast a wider net.
In a recent roundtable discussion, participants agreed that other important metrics to focus on include coordination and continuity of care, quality of care, compassion of care, and whether their needs were met in a timely manner.
“It’s fair to say that VHA is a leader in assuring timely access to care through a coordinated combination of virtual and in-person care,” said roundtable participant Susan Kirsh, M.D., VA’s acting assistant deputy under secretary for health for access to care.
3. Offering transportation to VA facilities
It can be hard for some Veterans to travel to their appointments due to age, illness, disability or location.
The Veterans Transportation Service (VTS) can provide transportation at little to no cost to many Veterans who cannot get to their appointments on their own.
VTS has established a network of transportation options in 47 states and Puerto Rico through joint efforts with VA’s Office of Rural Health and other organizations.
4. Focusing on groups with increased access to care issues
Veterans are a diverse group, and some have a harder time accessing care than others. We are working to meet the unique health care needs of several groups of Veterans through specific programs aimed at studying, understanding and improving their care.
Since women are the fastest growing Veteran group, we have created the Women Veterans Health Program that focuses on issues like comprehensive primary care, reproductive health and women’s health education. Designated women’s health providers coordinate care for female Veterans to ensure they receive equitable, timely care from a single primary care provider.
Other specialized programs have been developed for caregivers, combat Veterans, homeless Veterans, returning service members, rural Veterans, and seniors and aging Veterans.
Work at VA
Consider a career at a health care system that’s committed to providing easy access to patients.
In normal times, transition-to-practice programs help new nurses gain confidence, skill, and proficiency as they move into their careers. But during the days of COVID-19, those programs can gain even more significance.
Recently, a panel discussion held at the ANCC Virtual Summit outlined how four transition-to-practice programs adapted during the pandemic. At least one program, the OhioHealth Acute Care Advanced Practice Provider (APP) Fellowship, provided staff to help care for COVID patients at the height of the pandemic.
The program, which runs roughly 10 months, prepares NPs and PAs to provide acute, critical care, and trauma services. The five-year-old program enrolls 10 APPs per year, according to Todd Fuller, MSN, ACNP, program director, based at OhioHealth Riverside Methodist Hospital in Columbus, Ohio.
The program has two parts. The first provides broad experience in critical care, while the second is reserved for the fellows to focus on a specialty once they secure a position in the system.
In March, “the two ICUs that are the main ICUs for our system at Riverside were ground zero for COVID at the time,” he notes. Facing a shortage of staff to care for COVID patients, the system called on three of the ten APP fellows to provide help in critical care. “These APP fellows are more trained than anybody to be able to best take care of these patients,” he notes. They were able to take a more independent role while also receiving supervision from their preceptors.
At the time, the staff was down three full-time employees. The APPs helped save overtime and minimize fatigue on team members. They were able to help split up extra night shifts and extra weekends and “take a lot of the burden off of the rest of the team that they were already going to be working with.”
The curriculum offers such features as a large number of CMEs, a high-tech high-fidelity simulation facility, procedure training, and an ultrasound curriculum.
Beside the OhioHealth program, the ANCC session provided information about transition-to practice programs from Huntington Hospital (Pasadena, CA), Mayo Clinic, and NewYork-Presbyterian Hospital. The ANCC Virtual Summit was held this year in lieu of the ANCC National Magnet Conference.
There’s no question that job searches have become increasingly virtual. Email, digital job boards and even video interviews are quickly replacing physical resumes, classified ads and traditional interviews. Virtual job fairs are the latest development in this trend, and they’ve seen another bump in popularity due to travel restrictions and physical distancing.
While they lack face-to-face interaction, online career fairs offer more flexibility and less time commitment. If you are seeking a position in another city, you can chat with recruiters without leaving home.
VA is one of many employers moving to online career events, including job fairs, for the remainder of 2020. We host events through Brazen, a popular virtual job fair software, and take part in virtual events hosted by other groups. For instance, we recently participated in a health care technology management virtual career fair for biomedical engineers.
What to Expect
If you’ve never been to a virtual job fair before, the prospect of attending one might feel a little confusing and even daunting.
Like a traditional job fair, virtual career fairs bring together employers and job seekers for a set period of time on a particular date. But instead of face-to-face interaction, you’ll connect via text, web chat, video conferencing or email.
“Make sure you find a virtual career fair that is a good match. You want to attend one for the occupation you’re seeking,” recommended Mike Owens, recruitment marketing program specialist at VA.
Once you’ve found a fair that interests you, the first step is to register and upload a resume. VA’s virtual career fairs are free to job seekers.
From there, every virtual career fair is set up a little differently depending on the host.
VA’s online career fairs include a 10-15 minute pre-scheduled text chat with a recruiter, during which you can learn about jobs that are available in your area and get tips on submitting a stand-out application.
“To make the most of your appointment, ask as many questions as possible to the VA reps and make sure you prepare them ahead of time,” Owens said.
You can use a smartphone, tablet or computer with a reliable internet or wireless connection to connect. Our virtual career fairs are compatible with all internet browsers but work best with Chrome.
For job fairs with multiple employers, you might see a simple list of employers while others will use virtual environments to simulate a real-world career fair. While you can often move at your own pace, some fairs have specific times for chats, webcasts or online presentations with companies.
This is part of a monthly series about side gigs—nurses with interesting side jobs or hobbies. This month, we spotlighta nurse who is also a model.
When Sara Marlow Hunt, DNP, FNP-C, was just 12 years old, she wanted to get into acting. So when Barbizon Modeling opened a branch and offered classes near her home, her parents signed her up.
“It taught me about self-care, skincare, exercise, and how to break into modeling and acting. I wasn’t really interested in modeling at the time, but was told modeling was often a stepping stone to acting,” recalls Hunt. Soon after, Barbizon signed her as a model at their agency, and she got her first paid modeling gigs. At age 13, she signed with Cast Images Talent Agency, a larger modeling agency and began taking more acting classes and going on commercial auditions in addition to modeling/talent castings.
“My first paid job was as a hair model for Sebastian when I was 12,” recalls Hunt. “I loved it so much and was instantly hooked.”
Hunt quickly started working with talent agencies nationwide such as Mitchell Model Management, Soma Models, Coast to Coast, MDT Agency, Renee Godin Agency, and others. She even competed in the Elite Model Search in competition for a $1 million modeling contract and won the regional contest.
Like many other models in the United States, Hunt has a regular “day” job. A Board-Certified Family Nurse Practitioner and licensed Public Health Nurse, Hunt works at MinuteClinic.
In terms of her modeling career, Hunt has been represented by at least one agency since she began. “If you have a professional agency, it’s a good idea to hold on to them because you may not get one again,” explains Hunt.
For the past couple of years, Hunt has been having children, and although she was pregnant at the time of this interview, her agency knows that if an opportunity for a pregnant commercial print of pregnant fit model to keep her in mind. Primarily, Hunt works in Sacramento and San Francisco, California.
Hunt has done runway for brands such as Chaiken, Missoni, Dockers, and Levi’s; fitness modeling for Nautilus Fitness Equipment; promotional modeling for Pantene, CoverGirl, Olay, Febreze, and Swiffer; and she’s modeled for companies like Zobha and Charlotte Russe.
“I feel really lucky to have been able to work in this industry at all, much less to do crossover work,” says Hunt. “But my favorite is still acting, and I’ve done a couple commercials, music videos, and a short film.”
Hunt says that her biggest challenge in working as a model is that it’s always contract work, so there is no guarantee of work, no benefits of any kind, and you always risk not getting paid.
“It is risky work. If you need a reliable income, modeling and acting are not the way to go,” says Hunt. “Most people have flexible day jobs that allow them to go on castings and auditions. People always forget the amount of work that goes in behind the scenes—auditions, staying fit, audition outfits, flexibility with your time, professional photos, practice—before you even get one job. So, you can go on numerous auditions and still not get a job. Each audition/casting is a gamble and it can get expensive fast. Paying for gas to the audition, parking, commute time, and clean/professional clothes for auditions can rack up fast without a reward. Also, there is always a risk your agency could drop you and you’re out of work.”
Obviously, there are rewards for Hunt. “I think the greatest reward is that it can be very fun, creative, and push you to do things that scare you,” she explains. “I would always get so nervous for runway shows or taping on camera, and I think it has been good for me to overcome those. I’ve had the opportunity to meet many great people.”
Hunt also wants to dispel a stereotype about modeling.
“People only see famous actors and models, but most aren’t and most have regular day jobs” says Hunt. “There is a stereotype that models are vapid and are poorly educated, but that couldn’t be further from the truth in my personal experience. Models whom I’ve worked with have are exceptionally bright, hard-working, modest, kind, and business savvy. Some are engineers, some have been doctors, and some went to college, but chose to model full time.”
During a patient interview, making the best possible use of your time and establishing rapport are key. If your patient doesn’t feel heard, they will shut down and your opportunity to gain valuable information can be lost. Managing your time properly and exercising good communication skills will help you to gather the clues you need to learn about a patient’s symptoms, understand how they’re responding to medication and treatment, and identify potential problems before they become emergencies. Here are three tips for conducting a productive patient interview.
1. Update History Before the Appointment
If at all possible, have someone from your office contact your patient before their appointment. Ask patients to bring in a list of any concerns or complaints to the interview, and make sure your office personnel takes down any new issues. Have this visible to serve as a trigger for your conversation with your patient.
Studying up on patient’s new concerns will allow you to start a trail of data. Illnesses leave clues, but if you don’t have time to hear the story, you will struggle to find the answer and may wind up referring the patient to a specialist for a visit they didn’t need.
This gathering of history is a good time to collect some basic data as well. Encourage the staff to make the call to do their best to find out the basics. You need to know the
of your patients, and this information can be hard to share face to face. A phone interview before your appointment may make your patient a bit bolder.
2. Don’t Disrupt the Interview by Stopping to Take Notes
During your face to face conversation with your patient, don’t take notes. Keep your patient at a comfortable eye-level throughout the interview and communicate directly. Let them tell their story, record the conversation, and use a medical transcriptionist to provide you with a written narrative of the entire conversation.
By reviewing the whole story that your patient shares with you, you can start to determine the source of their concern. A properly transcribed patient interview will give you the chance to take notes; remember to note things like the patient dropping eye contact, any faltering, or signs of confusion.
Using a transcriber gives you time to enter the patient’s symptoms into your mental computer. Not only do you hear their responses, but you also get to read them back as well. With this format, you can feed your problem-solving, diagnostic brain from both the visual and audio side, constructing a narrative you can study from all angles.
3. Use Your Follow-up Conversation to Build Rapport
When you’ve reviewed the nurse-patient communication fully from multiple directions, schedule a follow-up conversation to discuss some of the points that came up during your interview. Even if you’re only meeting over the phone, the follow-up can
Increase a patient’s willingness to provide you with more detailed information
Increase their trust in you
Encourage them to share more in subsequent conversations
One of the few constants among people of all age groups is that those who don’t feel heard stop talking. Worse, they may stop listening before they stop talking. If you’re frustrated with patients who don’t take sound medical advice, be aware that you may be dealing with a patient who’s felt left out of their own healthcare for years.
Is that your fault? Probably not, but it is now your problem. Poor communication will result if you’re only allowed 15 minutes to discuss something that’s hurt for 30 years.
The lack of confidence in the scientific community stems from a lack of understanding of the scientific method. Observing, asking, and data gathering is what the patient interview is for. Your interview will produce more and better quality data when a patient doesn’t feel rushed and isn’t worried that they’re wasting your time if they need to talk longer. The more time you can make for the interview, the greater your chances of uncovering valuable information and providing your patients with the care they deserve.