In addition to her dedication to helping others as a surgical trauma nurse at Indianapolis University Health Methodist Hospital, Nurse of the Week Colby Snyder believes in being a good citizen. “It’s really on us, the younger generation, to push for change…” she says, so in addition to helping people register to vote this year, Snyder volunteered at one of Indianapolis’ polling places during the general election. The mounting pandemic spurred a special call for younger poll volunteers, and she quickly stepped forward: “There was a huge push for younger people to work this year, just to help protect that [elderly] age group.” She reflected, “I don’t know, I just wanted to help wherever I could.”
Snyder’s professional and civic duties ended up coinciding during her shift at the polls, though, when a voter collapsed while waiting on line. “I heard a little bit of commotion but didn’t think anything of it,” she says, “and then I turned and saw someone sitting on the floor.” The person on the floor was a female voter. When Snyder came over and asked how she was doing, the voter said that she had not eaten all day and felt light-headed. After Snyder brought her some apple sauce, she recounted, the voter “[said] she wanted to lay down and was pretty shaky… as soon as she went to lay back she went limp.” The poll volunteer-slash-trauma nurse tended to her unexpected patient until the EMS team arrived.
The incident at the polls was Snyder’s second recent foray into nursing outside her usual 12-hour shifts at the hospital. She says, “This happened to me two weeks ago in Kroger!” As she was grocery shopping, Snyder heard someone calling for help and saw a fellow customer laying in the aisle. “He had labored breathing at first and then it stopped,” she recalls. Snyder gave the man chest compressions while they waited for the EMTs: “As soon as EMS was called, I knew they’d be there soon. But prior to them arriving, he started to breathe again.”
Since her experience at the polls, Snyder has been fielding calls from reporters, friends and co-workers, but she says that she simply did what came naturally to her. “It’s strange to be getting all this acknowledgment because you don’t think you did anything special really,” she remarked.
To see a video interview with Colby Snyder, click here.
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.
When South Texans have tattoos that are holding them back, they seek out Nurse of the Week Loretta Kent. After nearly 30 years as an ER nurse, the 72-year-old Texan founded a non-profit tattoo removal clinic to help parolees, abused women, former gang members, and others shed visible mementos of a past they want to leave behind. “Help” is the operative word for Kent, who sees the job as a logical second act to her nursing career: “You don’t become a nurse because you don’t want to help others,” she laughs.
Kent stressed, “If you have a tattoo that you love and is not causing you any problems, I think you should keep them. I am not saying anything is wrong with those. But if you have one that is unwanted, know that it will hold you back in life. If it is keeping you from getting a job or causing you a problem in your personal life, covering it up won’t do the trick…” As for the physical pain of removing those past mistakes, she smiles, “Most women handle it very well. Men, on the other hand…”
After a plastic surgeon she had worked with closed his tattoo removal clinic, Kent opened her own Southwest Tattoo Removal Program in 1917. Her primary aim is to eradicate ink that can prevent people from moving on with their lives. In fact, those who are unemployed, on probation, or parole can begin the removal process free of charge. “Then,” Kent says, “I expect them to start looking for a job and, when they can, start bring me $35 per treatment. It is other people who don’t fit that scenario that pay for the full service that helps me provide the service for the people I can help and who can’t afford it. I decide case by case. I have to hear their story. I can usually tell what their situation is based on the tattoos they want to remove and we just start a conversation from there. You ask, ‘Well why charge $35?’ People don’t think as much of things that are given to them for free. If they are able to start paying a few dollars here and there when they can afford to do so, then it will mean more for them. Plus it also cost a lot of money to do this!”
Kent’s approach to tattoo removal is practical, sympathetic, and nonjudgmental. She believes that early bad choices should not automatically define the person you are now. “[Tattoos acquired in] prison and previous life don’t have to introduce you to other people first before you get a chance to be who you are. I’ve also helped abused women who have been stamped or marked during the history of their bad relationships. It is not a good memory… every time you see it it brings up those memories and you shouldn’t have to look at that every time you take a shower.”
Infectious disease specialists at the CDC and other organizations are placing an increasing emphasis on the use of contact tracers to rein in a resurgence of the virus as states reopen businesses and reduce social distancing measures. Speaking to Stat News, Tom Frieden, president and CEO of the nonprofit Resolve to Save Lives and a former director of the Centers for Disease Control and Prevention, describes contact tracing as a series of “four key actions: test, isolate the infected, contact trace, and then follow up the contacts. And each of those four things needs to be going really, really well and at a massive scale.”
Good contact tracers have emotional intelligence, close listening skills, caring combined with straight talk, and a flair for patient education. Of course, these are also key characteristics that inspire so many Americans to place their trust in nurses. In a country that regards privacy as an unwritten constitutional right, it is essential that contact tracers be capable of inspiring trust, so it is not surprising that boards of public health across the US try to fill these positions with people who have nursing experience.
School nurses sidelined by school closures, nurses on furlough due to holds on elective medical procedures, and a wide range of former nurses are lending their skills to the massive public health effort. Massachusetts contact tracer Celia Gillis was clearly drawing on her past as a nurse in Boston when she spoke of her new job to Boston Magazine: “It’s been eye opening. You have to sort of establish a relationship with them before you start asking for names and phone numbers, because sometimes people don’t want to share that information with a stranger. So you start with a larger conversation. What are their symptoms? What difficulties are they having? What can we do for them? We’re asking so much of them. Like, “We just need you to stay home for 14 days.” That’s a lot to ask for some people!” She’s helped people obtain medications, food pantry deliveries, and even diapers, and says, “By the time you get to the part where you’re asking about contacts, they’re more comfortable with you and they understand that we’re here to help, too, we’re not just trying to get something from them.”
Out-of-work school nurses are often key players on contact tracing teams. Their availability owing to school closures has turned them into a prized commodity, and many are now working as contact tracers for public health departments serving communities in states such as Alaska, Ohio, and Maryland. Patty Comeau, a former school nurse in Methuen County, Massachusetts, told Boston 25 News that she’s on familiar ground in her new job: “School nursing is very similar to public health nursing in that we manage outbreaks of contagious diseases and we contact parents and we send out notifications.”
With communities attempting to reopen, contact tracers are in greater demand than ever, as their ongoing efforts help to reduce the spread of the virus before it imposes an unmanageable strain on hospital systems. Looking toward summer, Abram Wagner, research assistant professor of epidemiology at the Michigan School of Public Health, notes, “Robust contact tracing will be a key component of returning to work, school, and other aspects of life safely before a vaccine is developed.”
I recently visited a friend while they were in the hospital and during my visit, I stopped by the coffee shop. As I sipped my coffee, I listened to the calls the nurses were receiving on their unit-specific mobile phones. While I can appreciate that a phone makes for better communication between the nurses and hospital staff, I can also appreciate that the same staff are unaware that the phones are inadvertently putting patients at risk.
During the hours I spent with my friend, I was inadvertently present for phone conversations, all on speaker, regarding what patients required pain medication and their room numbers, whose test results were received and their result, what patient was being combative and needed sedation, and who required pain medication. I heard patient names, room numbers, physician names, and patient conditions. And I learned that the wife of the gallbladder in 100B called. Needless to say, it was an interesting and enlightening time. Let me just say that when HIPAA became de rigueur, nurses would have been fired for less illicitly passed information than I learned that afternoon. You weren’t allowed to utter a patient name or room number anywhere where other patients or family members or the public in general were located. If overheard or reported by fellow staff, you were terminated.
The nurses carrying on these conversations were on a break from their units, attending a Nurses Week event, but I’m sure these conversations occur all day long, no matter where the nurse is… in report, at the bedside, at lunch, even in the bathroom. While I’m sure the latter is at most inconvenient and intrusive, the prior is downright dangerous. I’m sure if they even get a break off the unit, the phone goes with them and so does the stress.
We teach students and new nurses to prepare medications where they are not distracted, to check everything multiple times. We never tell them “OK, let’s see if you can titrate this medication while a disembodied voice is telling you about another patient who urgently needs you.” We also don’t teach them that while they are attempting to complete complex therapy requiring their undivided attention while keeping a field clean or sterile, that they will be called multiple times about multiple patients. Several studies have noted that these distracted nurses are at higher risk of committing a medication error or an error of omission.
Do they change gloves and wash their hands after handling the phone? Do they ignore the calls when they are in the middle of changing a dressing or toileting a patient? A 2009 study in Turkey found that 94.5% of health care workers’ cell phones tested positive for bacteria including the MRSA. Further, it was found that mobile phones were only cleaned per policy 10.5%. That leaves a staggering 89.5% that were NEVER cleaned! You don’t need to be an infection control nurse to figure out that the mobile phones carried by nurses and other staff are contaminated with nosocomial pathogens that place both the staff and their patients at risk. So along with the importance of hospital staff washing their hands after patient care, they must also be mindful of hand hygiene between patient care and handling of their mobile phones.
Although many hospital systems have implemented policies with regards to mobile phone use, hopefully to increase patient safety and confidentiality, they need to be reviewed and reinforced periodically. It is easy to become desensitized to our actions and those of others in the health care field and it is pretty glaring when violated. Policies should include when the phone should be in silent mode, when and how phones should be cleaned, and how calls to nurses should “roll over” to the nurse’s station—especially when staff are involved in patient care activities. The policy should also include enforcement and the consequences of policy violation.
I knew something was wrong when she was late for work. She hadn’t called out and hadn’t texted anyone where she was. I peeked into her office. I wasn’t looking for any clues about where she was or anything; I was looking for her in an empty room. What struck me was how neat the otherwise messy work place was. It was as if she was going on a trip and wanted to leave the office orderly in case anyone came in while she was gone. The loose ends were tied up. Thankfully, she was not successful in her suicide attempt.
Everyone claimed to not know anything, but we knew the whole story, pieced together from social media posts. We were all quiet and looking at each other like we were examining each other to see if anyone else was at risk for committing suicide. One nurse said, in typical off-color nursing humor: “We know what we are going through ourselves, but you never know if the person next to you is circling the drain.” We all nervously giggled. The comment hurt to hear…but it was accurate, stripped down to the basic cutting truth. We really don’t listen to the answer of a tossed out “how are you”? We are so concerned with ourselves and our own issues that we rarely take the time to reach out to someone else.
Prompted by what happened, the hospital presented education on suicide prevention. I didn’t want to attend. Why bother? I’d been depressed after my mother died, I’d been through treatment, and you couldn’t tell me anything I didn’t already know, but a friend of mine did attend and she was very moved by what she had heard. She shared with everyone on the unit what she felt was the most important takeaway: do not be afraid to ask someone if they want to harm themselves or commit suicide.
During a private conversation, this friend came right out and asked me if I ever thought of commiting suicide, if I’d ever been depressed. I didn’t look her in the eye when I said that in the past I had thought of what the world would be like without me in it, particularly after my mother had died. I told her that I had felt like I was surrounded by blackness, like I was sitting in the bottom of a well and I couldn’t get out. I had sought help and was diagnosed with depression. When I saw tears in her eyes I immediately regretted what I had said because I didn’t want anyone to know that I had been depressed—that there was a chink in my armor. She told me that she had learned that people who are depressed verbalize that they are in a very dark place, feeling like they are surrounded by nothingness and blackness with no way out. My friend kept looking at me like she was really seeing me and asked me to make her a promise. She made me promise that if I ever felt like that again, that I would tell her. My mental fingers were crossed. Strong people don’t reveal weaknesses and we certainly don’t share feelings—we just tamp them down, deny them, and keep going. I didn’t need help and besides, I was thinking, what could you do for me? But the concern and the tears in her eyes really stayed with me.
The truth was that I was sitting at the bottom of that well. Work and life and just the energy required for living were becoming too much again, but my friend had opened the door to the darkness and a little bit of light had shone in. Several weeks went by and we were talking on the unit about work related issues and I causally asked my friend if she remembered making me promise to tell her if I ever felt like I was sitting in the blackness. Tears filled her eyes again when I told her that I was back in the well again. I watched as she went to the computer, made an entry, and handed me on a piece of paper: the link to the employee assistance program at our hospital. She stayed with me while I contacted them and I was seen by a counselor the next day.
am aware that we all do not know someone we feel comfortable talking to, but in
our busy days of being a nurse and caring for patients and caring for ourselves
and our families, we need to be able to recognize when one of our colleagues is
reaching out, however silently, for our help.