In early 2016, Mt. Sinai Hospital* approached the Visiting Nurse Service of New York (VNSNY) to propose that VNSNY offer home care services to post-operative transgender patients. This was the genesis of VNSNY’s Gender Affirmation Program (known as GAP), which to date has provided home care to over 400 transgender patients. *a strategic partner of VNSNY
DailyNurse recently interviewed Shannon Whittington, RN MSN PCC C-LGBT Health, the Clinical Director of GAP at VNSNY. We asked her about the nature of gender affirmation treatment, the home nursing care that VNSNY provides, and the outstanding LGBT-friendly services that VNSNY offers to patients across the Tri-State New York area.
What is gender affirmation surgery (GAS)?
A surgical procedure that creates or removes body
parts that align with the patients’ gender expression. E.g. vaginoplasty,
phalloplasty, metoidioplasty, facial feminization, breast
Is this the same thing as “sex-change surgery?”
SW: It is the same thing but we don’t use the terms “sex-change
Gender Affirmation or Gender Confirming surgeries are the correct terms now. Understanding that this is a linguistically fluid language, words and meanings are always changing and we need to be mindful of correct terminology.
What are the components of the VNSNY Gender Affirmation Program?
The program emphasizes home care following surgery from other providers. I train clinicians (nurses, social workers, physical
therapists, home health aides, speech and occupational therapists) in cultural
sensitivity as it particularly relates to transgender patients. The training is extensive and they are also
educated in how to teach the patients to care for their new or altered body
parts (i.e. penis, vagina, breast, face)
DN: How did you come to specialize in the treatment of Gender Affirmation surgery patients?
SW: Fortunately, I was chosen for this project by my
manager. I had no idea what I was saying
yes to but this has literally changed the trajectory of my career path. I discovered a passion that I did not know I
What sorts of clinical training do nurses in the program need to take care of
GAS post-surgery patients?
They need to know what to assess for and what is
normal and what is not. They learn about
vaginal dilation because the patients who undergo vaginoplasty must do this on
a regular basis. Patients come home with VACs, JP drains, foleys and supra
pubic catheters. Although the nurses are already familiar with these devices,
they need to teach the patients how to manage them. The clinicians are also
trained in social determinants of health for this cohort.
DN: What sorts of cultural issues do nurses need to learn about before tending to a GAS patient?
SW: We really need to understand that these patients, like all
of our patients, are patients first who happen to be transgender. We must
respect their chosen names, their pronouns and their gender expression. We
focus on getting them better and integrated back into society. It’s a beautiful
thing to witness and an honor to be associated in such a transitional journey.
DN: How does the Gender Affirmation Program reflect the larger VNSNY commitment to LGBT patients?
It reflects our commitment to this population on an
agency wide basis. What is great is that
we are now getting non-operative transgender patients who are seeking home care
services for reasons other than gender affirming surgeries. They feel safe here and seek care outside of
gender affirming surgeries.
We are initiating various ways to continue to be inclusive along
the binary spectrum by hiring gender non-confirming and non-binary individuals.
These individuals have a lot to offer and need to be the best expressions of
themselves in their work environment just like the heteronormative society we
all live in.
And can you tell us something about the SAGE training in your organization?
All divisions of the Visiting Nurse Service of New York have been awarded Platinum
certification (the highest level possible) from SAGE, the world’s largest and oldest organization dedicated to
improving the lives of LGBT older people.
than 80 percent or more of VNSNY’s clinical and other staff have received SAGE Care LGBT cultural competency
training, further establishing VNSNY as a
preferred health care provider for New York City’s LGBT residents.
SAGE training is designed to increase awareness among VNSNY clinical and
administrative staff of cultural issues and sensitivities around sexual
orientation and gender identification, so as to ensure a welcoming and
respectful health care environment for all individuals within the LGBTQ
Among other things, the training stresses the importance of approaching each patient in a non-judgmental fashion and never making assumptions about anyone’s sexual orientation or family structure. We want every patient to feel they can be totally open about who they are with every member of our GAP team who walks through their door.
Coming in March 2020!
Annals of LGBTQ Public and Population Health
The mission of Annals of LGBTQ Public and Population Health is to bring together state-of-the-art cross-disciplinary scholarship which seeks to enhance the health and well-being of sexual and gender minority (SGM) individuals at the population level with an eye to the intersectional identities that SGM people possess.
We are interested in papers that advance education, policies, laws, and approaches to enhance SGM care and SGM health.
Our Nurse of the Week is Frank Baez, a 2019 graduate of the New York University (NYU) Rory Meyers College of Nursing who moved to the US from the Dominican Republic before working as a custodian at NYU, and eventually studying at, and graduating from, NYU Nursing.
After moving to the US from the Dominican Republic at 17 years old, Baez began working as a custodian at NYU Langone Hospital. Responsible for helping to support his mother and siblings, he needed a more steady job than his supermarket gig.
Baez’s brother worked as a patient transporter at Langone and helped Baez apply for the same job. He wanted to do something more patient focused, and was successful in landing the new role. Baez then attended Borough of Manhattan Community College to earn his associate’s degree, then Hunter College to get his bachelor’s degree in Spanish literature with a minor in biological sciences.
As an employee at NYU, Baez was then able to attend NYU’s accelerated nursing program at a 60% discount. Many students find it difficult to balance their personal lives and academic lives while in nursing school, but Baez earned his degree while working as a custodian at the same school.
Baez tells nyunews.com, “It was really rough; it was tough; it wasn’t easy, of course. But it was good because I was able to support my siblings and mom, the four of us. All of us were working in the house to stay afloat. Working and studying at the same time was difficult but manageable—but you have to pay rent, you have to survive.”
Baez now works as a nurse in the NYU Langone Cardiothoracic ICU. He says: “At work, I see the housekeeper. I see the patient transporter. I see the clerk. I’ve been in each and every one of those roles. I’ve been there before. I have been there throughout my life and it makes me who I am today—to be able to be compassionate to everyone and caring, and it makes me feel like there is always an opportunity for growth.”
As a nursing student, Baez was thankful for resources like NYU’s Men in Nursing mentorship program, which provided him with one-on-one tutoring. Now, Baez sees opportunities to expand these kinds of resources to better serve nontraditional students like himself. He is especially interested in providing more scholarships to help students invest in their futures.
To learn more about Frank Baez, a 2019 graduate of the NYU Rory Meyers College of Nursing who worked as a custodian at NYU, before eventually studying at, and graduating from, NYU Nursing, visit here.
The Nurse Practitioner Association New York State (NPA), the only statewide professional association of nurse practitioners, has named Janice Ceccucci, DNP, FNP-BC, Nurse Practitioner of the Year, and Daniel Babcock, MS, FNP-C, NP Student of the Year. The awards were presented at The NPA 35th Annual Conference, held in Verona, NY, and were attended by nearly 500 NPs and NP students from across the state.
Stephen Ferrara, DNP, FNP, FAANP, Associate Dean of Clinical Affairs at Columbia University School of Nursing and Executive Director of the Nurse Practitioner Association New York State, said, “As health care professionals committed to excellence in patient care, nurse practitioners are redefining their role. We’re extremely pleased to recognize Janice Ceccucci and Dan Babcock for their dedication and service.”
Forensic NP and Professor at SUNY Polytechnic Institute Is NP of the Year
Janice Ceccucci is an outstanding Nurse Practitioner and SANE (Sexual Assault Nurse Examiner). Ceccucci began her career working with sexual assault victims in the Emergency Department. Recognizing that there were gaps in services, particularly for child sex abuse victims, she decided to pursue forensic nursing. She is committed to ensuring services for child sex abuse and physical abuse patients are widely available.
“Janice takes nursing to the next level,” says colleague (and nominator) Elizabeth Spooner Dunn. “Her passion for the profession, dedication to her patients and commitment to excellence make her not just a trusted colleague but an example and mentor to all.”
has also received the Joan Unger Memorial Award given by the New
York State Coalition Against Sexual Assault for demonstrating excellence and
innovation in services offered to the community in sexual assault. She has also
been published by the Journal of Forensic Nursing and
is co-founder of Forensic Nurse Practitioners of Schenectady.
On Call, Inside and Out of the Hospital
Outside the confines of Saratoga Hospital, Ceccucci is on call at home 36 hours a month to provide teleconsulting services to hospitals in remote areas that lack access to sexual assault nurse examiners (SANEs). In addition, she conducts sexual assault exams for pediatric patients at child advocacy centers—a service that Ceccucci and a colleague introduced in 2011 to better serve sexually abused children.
A leader in promoting the profession to the next generation, Ceccucci is an assistant professor at SUNY Polytechnic Institute. She is also the co-director and developer of Saratoga Hospital’s Advanced Practice Provider Fellowship Program, which mentors new nurse practitioners and physician assistants, also known as advanced practice providers. And, in case that was not enough to take on, Ceccucci is an assistant professor of nursing for SUNY Polytechnic in Utica and helped pilot a hybrid program that delivers live streaming and on-campus classes.
“I wouldn’t want to do anything else.”
Ceccucci received her master’s degree as a Family Nurse Practitioner from SUNY Poly in 2009, and was awarded her doctorate in Nursing Practice from State University of New York Upstate Medical University in Syracuse in 2016.
“I’m proud to be the recipient of the NP of the Year. There are so many wonderful opportunities in nursing. For newer NPs, I would advise they take advantage of every opportunity that presents itself. I love being an NP. I wouldn’t want to do anything else,” Ceccucci said.
For further information on Janice Ceccucci, visit here.
NP Student of the Year Dan Babcock
Dan Babcock is an Air Force veteran and a former professional fire officer and paramedic who is currently a full-time Graduate Family Nurse Practitioner Student in the Decker School of Nursing at Binghamton University. He holds a BS in Nursing from Empire State College and as a Registered Nurse has worked in the emergency department and diagnostic imaging. After retiring as a lieutenant from the City of Binghamton’s Fire Department with 20 years of service, he decided to become a nurse practitioner. As Babcock grew up in rural Delaware County, New York, he has a particular interest in improving the health of the poor, rural and vulnerable populations that influenced his early life.
an honor to be awarded NP Student of the Year. I chose to become a nurse
practitioner because I love being challenged and love the relationships I form
with my patients. Aside from the need for primary care providers, I chose
family practice to give me a solid foundation for medical mission work. My wife
and I do mission work in Guatemala several times a year, and I would like to do
medical missions as a nurse practitioner,” Babcock said.
Nurse Practitioner Association New York State
Nurse Practitioners (NPs) are registered nurses who have completed advanced education, at a Master‘s or Doctorate level, plus additional clinical preparation. These professionals are authorized to independently diagnose illness and physical conditions, perform therapeutic and corrective measures, order tests, prescribe medications, devices and immunizing agents, and refer patients to other health care providers.
The Nurse Practitioner Association New York State (The NPA), the only statewide professional association of nurse practitioners, promotes high standards of healthcare delivery through the empowerment of nurse practitioners and the profession throughout New York State. For more information, visit: www.TheNPA.org.
Federal, private funders bet food-as-pharmacy programs will deliver healthcare cost savings
When low-income patients with high blood pressure fill their “produce prescriptions” at certain New York City pharmacies, they walk away with $30 in vouchers to spend on fresh fruits and vegetables at the city’s farmer’s markets.
The city’s “Pharmacy to Farm
Prescriptions Program” has reached more than 1,000 hypertensive SNAP
recipients since it launched in 2017, and has grown from 3 to 16 participating
pharmacies. It is set to report outcomes data next year.
The program is supported in part by
a grant from the U.S. Department of Agriculture (USDA), which is poised to make
an even bigger impact on the food-as-pharmacy programs that have been growing
in popularity. The 2018 Farm Bill established a national Produce Prescription Program
that sets aside millions in grants each year.
With diet-related illnesses like
heart disease and obesity costing hundreds of billions of dollars each year in
the U.S., other funders are also expecting a healthy return-on-investment (ROI)
in these programs, which means more initiatives like New York City’s may find
the means to thrive.
Not Just for SNAP Recipients
USDA has been supporting projects to increase healthy food consumption among SNAP recipients since 2014, under the Gus Schumacher Nutrition Incentive Program (GusNIP, formerly the Food Insecurity Nutrition Initiative). The bill now guarantees GusNIP can administer $25 million in produce prescription grants—not just for SNAP-based programs—for the fiscal year beginning in 2018, jumping to $45 million for the 2019 fiscal year and rising to its cap of $56 million in 2023. The first grants will be awarded in October.
Food Hub in Charlottesville, Virginia, currently receives funding
from local businesses and philanthropies, but has applied for a federal grant.
Its Fresh Farmacy program
provides low-income patients who have chronic disease with produce from local
farmers. Participants pick up their “shares” every other week during
the growing season.
“We have seen first-hand the
impact of incorporating healthy food to manage weight, maintain healthy blood
glucose levels, and reduce the risk of diabetes complications,” said
Patricia Polgar-Bailey, a nurse practitioner at the Charlottesville Free
Clinic, which participates in Fresh Farmacy.
Non-Profit and Private Sectors Pitch In
Federal dollars aren’t the only way to keep food-as-pharmacy programs afloat. Wholesome Wave, a non-profit that was co-founded by Gus Schumacher, has been supporting produce prescription projects since 2010.
Wholesome Wave gets money from
philanthropies and corporate partners – including Target, Chobani, and Humana,
to name a few – to foster such programs.
“There are non-profits and
private-sector supporters trying to prove the model in the interest of getting
insurers and the healthcare industry to really step up,” said Julie
Peters, director of programs at Wholesome Wave.
An example of the organization’s
support: it’s putting money into a produce prescriptions pilot for diabetes at
Community Health and Wellness Partners (CHWP) in Logan County, Ohio, which is
also supported by state and federal dollars.
Healthy Food = Healthier Lives
Once a month, participants attend nutrition classes taught by staff dietitians, and subsequently receive vouchers for up to $120, depending on family size, to purchase produce at local grocery stores or farmer’s markets.
Among those who have completed three
months of classes, HbA1c has already declined 0.6 percentage points on average,
said Jason Martinez, a clinical pharmacist at CHWP who has analyzed preliminary
data from the program.
Will these improvements translate to
reduced healthcare costs? That has been the case at Geisinger Health System’s Fresh Food Farmacy initiative. The program
focuses on patients with type 2 diabetes who experience food insecurity. In
addition to 15 hours of disease and nutrition counseling, participants get
enough healthy food for 5 days of the family’s weekly meals.
Over 18 months, participants’ HbA1c
levels fell 2.1 points on average, compared with declines of 0.5-1.2 points for
those taking two or three medications only. Along with improvements in weight,
cholesterol, and hypertension, that has translated to an 80% drop in healthcare spending for 37 of about
200 participants who were insured by Geisinger, according to early data.
“We know the cost of the program, all-in, for the food and the clinical care is around $2,500, so it’s reasonable to assume that there’s an ROI that we would experience with that,” said Allison Hess, vice president of health and wellness at Geisinger. She’s hopeful that ROI will convince insurance companies “to potentially fund this as part of a benefit package.”
Similarly—albeit hypothetically—a recent simulation study of
Medicare and Medicaid recipients predicted that providing a 30% subsidy on
fruits and vegetables would prevent nearly 2 million cardiovascular events and
save almost $40 billion in annual healthcare costs.
The three-year grant was provided by the US Health
Resources and Services Administration and will allow UB to train over 50 students
studying psychiatric mental health nursing, psychology, social work, and more.
UB will partner with nine local primary and behavioral health care sites to
launch the Opioid Workforce Expansion Program (OWEP), an interdisciplinary,
state-of-the-art addictions training program.
Chang, PhD, principal investigator on the grant, associate dean for research
and scholarship, and Patricia H. and Richard E. Garman Endowed Professor in the
UB School of Nursing, tells buffalo.edu, “This
grant fosters academic and practice partnerships with experts in addictions
care in an effort to create a cohesive and interdisciplinary addiction training
program. Aside from the benefit to our students, our clinical partners will
also have access to enhanced addictions offerings and opportunities to consult
with experts either in-person or using telehealth technology.”
According to the American
Society of Addiction Medicine, nearly 259 million opioid pain medication
prescriptions were written in 2012. Opioid death rates in Western New York are
among the highest in the state, and vulnerable communities in the region lack
access to addiction treatment and care. By leveraging relationships with community
partners, OWEP aims to ultimately place behavioral health professionals at care
sites in these communities.
To learn more about the $1.35
million grant awarded to the University at Buffalo School of Nursing to increase
the number of behavioral health professionals treating opioid and other
substance use disorders in Western New York, visit here.
of the Week is Czarina
Cecilio, a 33-year-old registered nurse (RN) at Weill Cornell Medicine’s Multiple Myeloma
Center in New York City. Multiple myeloma (MM) is a type of bone marrow
cancer and in addition to performing her nursing duties, Cecilio is also
responsible for a lot of paperwork because the medication administered to many MM
patients is experiencing a national drug shortage.
Cecilio works 10-hour shifts on a regular basis,
helping keep her patients comfortable in the midst of this drug shortage. Cecilio’s
role at the Multiple Myeloma Center is Clinical Nurse Liaison. She serves as
head RN of the practice and her responsibilities include educating patients on their therapy regimen and helping them get
medication, supervising medical technicians, and keeping the clinic workflow
However, she also spends a lot of
time on the phone with manufacturers and drug providers in an effort to secure
treatment for her patients. Many MM patients are treated with an intravenous immunoglobulin (IVIG),
but production for the medication has slowed, causing increased demand.
Cecilio tells businessinsider.com, “With myeloma, it’s an incurable disease, [but] it’s treatable, so that’s why we see these patients all the time. You get to build a relationship with these patients.”
Cecilio didn’t always want to be a nurse. She received
her undergraduate degree in anthropology and then decided to go into medical
research. She eventually ended up in an entry level nursing job as a medical
technician, but found herself unable to answer many of her patients’ questions regarding
their care, so she decided to go to nursing school. Now, she loves her work as
a nurse in the multiple myeloma clinic because it allows her to form bonds with
patients who are typically receiving long-term treatment.
To learn more about Czarina Cecilio, a registered
nurse at Weill Cornell Medicine’s Multiple Myeloma Center in New York City,
read Business Insider’s coverage of their day spent shadowing her here.