Amid Overdose Crisis, Harm Reduction Groups Face Local Opposition

Amid Overdose Crisis, Harm Reduction Groups Face Local Opposition

Casey Malish had just pulled into an intersection in the 2nd Ward when a woman with tattoos and pinkish hair unexpectedly hopped into the back seat of his gray Mazda. He handles outreach for the Houston Harm Reduction Alliance, a nonprofit that helps drug users like her stay alive.

The woman, Desiree Hess, had arranged to meet with him, but Malish, as usual, wasn’t sure what to expect on this recent afternoon. Hess told Malish to take her to near the Value Village thrift store before she explained why she was so frantic.

Earlier that day, around 2 a.m., Hess said, a woman — a “teeny-tiny little girl” — overdosed in the warehouse where Hess was hanging out. No one there could find naloxone, a medicine that reverses opioid overdoses, and the woman’s lips turned blue. Hess said she blew into the woman’s mouth, trying to keep her alive, while others covered her with ice. Finally, someone found some naloxone, often referred to by the brand name Narcan, and sprayed the medication into her nose. After the woman regained consciousness, Hess made a decision. Originally published in Kaiser Health News.

“I knew I had to call Casey,” the 39-year-old recalled, “to get more Narcan.”

Malish drives city streets handing out needles, naloxone, cotton balls, and condoms from the trunk of his sedan. But the Houston Harm Reduction Alliance, which tax records show operates on less than $50,000 annually, can afford to pay Malish only a couple of thousand dollars every now and again. His full-time job is as a research assistant at the University of Texas Health Science Center at Houston.

Malish — a 31-year-old who said he had a problem with alcohol and opioid pills and then heroin before giving them all up nearly 10 years ago — estimated he can reach only about 20 people like Hess a month. Meanwhile, drug overdoses killed 1,119 people in the city last year, according to the Houston Police Department.

President Joe Biden wants to expand harm reduction programs like the one Malish works for as part of a broader strategy to reduce drug overdose deaths, which surged to more than 107,000 nationwide in 2021. But the $30 million plan faces a complicated reality on the ground. In Houston, as in many parts of the country, harm reduction programs operate on the fringes of legality and with scant budgets. Often, advocates like Malish must navigate a maze of state and local laws, fierce local opposition, and hostile law enforcement.

Regina LaBelle, who served as acting director of the Office of National Drug Control Policy until November, credits the Biden White House with being the first presidential administration to openly embrace harm reduction to curb drug overdoses. She said that the $30 million, tucked into the $1.9 trillion American Rescue Plan Act, is still just a first step and that too many groups rely on an unstable patchwork of grants.

“You shouldn’t have to hold bake sales to get people the care that they need,” said LaBelle, who now directs an addiction policy program at Georgetown University.

Plus, the administration faces limits on what it can do when programs face blowback from state legislatures and local leaders. “What you don’t want to do is have the federal government coming in and imposing something on a recalcitrant state,” she said.

Both Republican- and Democratic-led states have legalized aspects of harm reduction, but many remain resistant.

By 2017, all states and Washington, D.C., had loosened access to naloxone, according to Temple University’s Center for Public Health Law Research. Yet, fentanyl test strips — which help people avoid the powerful synthetic opioid or take more precautions when using it — are illegal in about half of states. According to KFF, seven states don’t have a program that provides people with clean needles, which help prevent the spread of HIV and hepatitis C, as well as bacterial infections and embolisms that develop when overused, weak needles break off in a vein. And New York is the only city operating injection sites, where people can use drugs under supervision, although Rhode Island has legalized them and the Justice Department has signaled it may pave the way for more sites to open.

Texas is among the states that have been slow to embrace the interventions — and hasn’t expanded eligibility for Medicaid, so Texans with low incomes have limited access to recovery programs. During the 2021 legislative session, lawmakers scuttled a bill that would have rescinded criminal penalties for possessing drug paraphernalia, items such as clean syringes and fentanyl test strips.

That means the Houston Harm Reduction Alliance operates in a “legal gray area,” said Malish. Although it has tacit support from the Houston police and other local entities, the nonprofit could face trouble if it strayed into a neighboring city.

“Programs that facilitate addictions by providing the tools people need to continue using drugs are not helping our community,” Texas Sen. Ted Cruz, a Republican, wrote to KHN in an email. In February, Cruz criticized Biden’s grant program by saying it would fund “crack pipes for all” in a retweet of a story on a conservative website. Fact checkers debunked the story’s claim, but it continues to provide fodder to opponents of harm reduction practices in state and local governments, even in places where overdose deaths are quickly rising.

Louisiana allows local officials to decide whether to authorize syringe exchange programs, but only four of the state’s 64 parishes allow the services. “We know in the public health space how these programs save lives,” said Nell Wilson, project director for Louisiana’s Opioid Surveillance initiative. “But being a more conservative state, a lot of the problem is battling against wide-ranging misconceptions not based in fact.”

In Kentucky, local public health departments run harm reduction programs, said James Thacker, a program manager at the University of Kentucky’s harm reduction initiative. In some parts of the state, local law enforcement agencies support programs. In others, they enforce laws that consider fentanyl test strips illegal drug paraphernalia.

Harm reduction programs face backlash in progressive places, too, such as San Francisco, where some residents believe they foster drug use.

Still, state and local harm reduction groups say the Biden administration’s $30 million grant isn’t enough money to expand their programs to reach the number of people who need help.

“We were disappointed by that number,” said Cate Graziani, co-executive director of the Texas Harm Reduction Alliance, which sought the maximum $400,000 in funding but wasn’t among the two dozen organizations to receive grants. Her group planned to distribute the funds to local outposts such as the Houston Harm Reduction Alliance.

“These programs are still running on a shoestring,” said Leo Beletsky, a public health law expert at Northeastern University. “That is not how public health is supposed to be done.”

Advocates for harm reduction don’t believe such efforts alone will suddenly halt overdose deaths. Addiction is a complicated, chronic disease. And in 2021, overdose deaths jumped 15% from a year earlier, according to the Centers for Disease Control and Prevention. Today, illegal fentanyl and its analogs from Mexico and China have tainted the street supply of counterfeit pills, heroin, and even stimulants like cocaine and methamphetamine, causing both casual users and those with long-term addiction to overdose and die.

“No one thing is going to solve the overdose crisis, but this is going to save a lot of people’s lives,” Dr. Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health, said about harm reduction efforts.

Many of Malish’s clients talk about wanting to quit drugs. People who use syringe services programs are five times as likely to start treatment and three times as likely to stop using drugs, according to the CDC.

As Malish drove Hess past the Value Village to the abandoned strip mall where she usually lives, she said she plans to start methadone treatment for heroin addiction as soon as she can get an ID the city offers to people without housing.

“I’m so sick of seeing my friends die,” said Hess.

When she got out of Malish’s car, he loaded her arms with boxes of syringes, sterile water, injectable naloxone, tourniquets, and fentanyl test strips for her to share with others.

Hess then asked Malish if she could take two quarters she found in the seat cushions of his car to buy drinking water, before walking through the mall’s double doors.

Nurse of the Week: “Nurse Hero” Must Be Part of Stephanie Esterland’s Job Description

Nurse of the Week: “Nurse Hero” Must Be Part of Stephanie Esterland’s Job Description

It was a little before 5 a.m. when Nurse of the Week Stephanie Esterland, RN, OCN, and her son happened upon on the accident, just as a young man staggered out of his wrecked, burning car and collapsed near it.

“You could feel the heat from the car. It sounded like there were fireworks in it.”

The oncology nurse – who has become accustomed to pitching in at such scenes – immediately parked her car behind the other vehicles of onlookers stopped alongside the country road and went to help, disregarding her son’s shouted warnings. “He was five, ten feet from the car. You could feel the heat from the car. It sounded like there were fireworks in it,” she recalls.

Worried that the car might explode, Esterland, her son and a bystander moved the young man away from the vehicle. Then she held his head steady — his clavicle was broken — and kept him talking so he’d remain conscious.

“I kept asking him who he was and asking about his family. I could tell his ankles were broken, his arm had to be broken, he had blood coming out of his mouth,” she says.

She’s not sure how long it took for paramedics to arrive from a nearby firehouse. “Five, ten minutes … it could have been longer.”

The paramedics took over for Esterland, an off-duty police officer checked the car for other passengers — fortunately, there were none — and the firefighters put out the car fire.

Only when Esterland arrived at work did she realize she had the young driver’s blood on her blouse.

At which point, Esterland finished taking her son, whose car had broken down, to work. Had she not been driving him, she wouldn’t have been on the road that early and arrived in time to help. Then she went on to her job as a cancer nurse navigator at the RUSH University Cancer Center clinic in Lisle.

She later learned that the young man, who had run into a tree, survived the accident, which took place early last June in a rural part of the far western suburbs. He’s credited her for helping save his life.

In recognition of her response that morning, Esterland received the Oncology Nursing Society’s Frontline Care Award on April 28 during the society’s annual conference, held in in Anaheim, California. The American Red Cross of Greater Chicago also honored her with the Healthcare Hero award during its annual Heroes Breakfast, which was held on May 11 at the Hilton Chicago.

She previously received the DAISY Award for Extraordinary Nurses from the DAISY (Diseases Attacking the Immune System) Foundation, which honors nurses who provide exceptionally compassionate and skillful care to patients and families. “Her nursing instincts kicked in, and she did not even consider doing anything besides helping the victim,” her fellow nurses Colleen Bruen, RN, BMTCN, cancer nurse navigator and lymphoma clinic coordinator, and Denise Hauser, RN, OCN, cancer nurse navigator, wrote in nominating Esterland for the award.

An unstoppable hero at work, too

Only when Esterland arrived at work did she realize she had the young driver’s blood on her blouse. Undaunted, she made a quick trip to Walmart for a new shirt and returned to the clinic. “She never considered leaving work, despite all that had already happened within just a few short hours,” Bruen and Hauser wrote.

“Most people would not run toward a burning car,” they continued. “Most people would not help a stranger bloodied from a traumatic accident. Most people would not be able to compose themselves to go on to work and function at a high level. But no one else is Stephanie.”

Remarkably, Esterland has come to the aid of strangers in crisis before. While she and her son were driving near a home on another early morning, they found a man left unconscious in the middle of another country road after a fight, and she called 911 for him. When a 20-something audience member went into a seizure at a concert, she gave his friends direction until paramedics arrived. (Rumors that she also fights crime, however, have not been confirmed.)

For all her improbably frequent heroism, Esterland makes her greatest impact in her day-to-day work, which she divides between the Lisle clinic and the cancer center’s main location on the RUSH University Medical Center campus. She calls patients with cancer ahead of their first appointment to assess their needs and arrange for them to be met. Esterland provides ongoing education for patients and families about the disease and treatment options and tracks patients’ medications to ensure uninterrupted care.

“Stephanie is a caring and empathetic nurse who places patients and families above her needs, and indeed places humanity above her own needs and safety,” says Sharon Manson RN, MS, OCN, associate vice president, oncology nursing, RUSH University Cancer Center.

“Her patients love her, and the compassion she shows in their care is unparalleled. She maintains the highest standards of nursing, critical thinking and leadership qualities,” says Parameswaran Venugopal, MD, the Elodia Kehm Chair of Hematology, professor of medicine and director of the Section of Hematology.

From dropout to doctorate

Her desire to help people drove Esterland to overcome setbacks to her childhood dream of being a nurse. She dropped out of high school and had three children before going back to school at age 26 and earning her Bachelor of Science in nursing.

She’d planned on being an obstetrics nurse, but an in-law with head and neck cancer persuaded her to specialize in oncology instead. Esterland previously worked at RUSH Copley Medical Center and joined the cancer center nearly two years ago after working for another organization. “I’m back at RUSH, and it’s great,” she says.

She loves working with patients from their diagnosis through the treatment process. “You help with every aspect — biopsies, imaging, you provide education, symptom management for their chemotherapy, and you see them do well, or at the other end, you provide palliative care,” she says. “It’s every step of nursing. You get every facet.”

Esterland’s greatest achievements may yet lie ahead of her: She just was accepted to RUSH University College of Nursing’s Adult-Gerontology Primary Care Nurse Practitioner Doctor of Nursing Practice program (RUSH provides prepaid tuition for their nurses).

New Grad Residency Program Takes Nurses From Books to Bedside

New Grad Residency Program Takes Nurses From Books to Bedside

Few, if any, new nurse graduates walk onto a hospital unit on their first day brimming with confidence, much less clinical expertise. Thus, new grad residency programs help transition nurses from the world of textbooks to the realities of the bedside.

At UMass Memorial Health, new grads can find a wealth of support in the organization’s graduate residency program, which accepted its first cohort in 2007.  Two campuses, University and Memorial, host the program.

Year-long program

The one-year program has various components. During the first 13 weeks of the program,  new grads are establishing their foundational practice, notes Karen Uttaro, MS, RN, NPD-BC, NEA-BC, senior director, professional practice, quality and regulatory readiness, UMass Memorial Medical Center. Nurses are placed in a unit, based on their skill set and where a position may be vacant, and assigned a preceptor.

Working with the preceptor, they refine the skills learned in nursing school. What’s more, the new grads meet weekly with fellow new grads and members of the nursing leadership team. The 13 weeks are an average time, which can be tailored to individual needs until a nurse can practice independently.

Besides working with a preceptor, the new grads attend class weekly, where “we have a chance to emphasize key components around clinical skills,” says Uttaro. “It’s that sense of community and support. And that’s the undercurrent and the foundation of our program, to really make sure that they feel supported,” she says.

After that first 13-week component, new grads have a monthly three-hour check-in. Instructors review a topic, such as mock resuscitation, or bring in a subject matter expert, notes Uttaro.  “It’s really building on their knowledge and skills throughout that whole first year,” she says. Finally, at the end of the year, the new grads have conversations about their professional goals to foster life-long learning.

Learning from each other

Not only do the new grads learn from the seasoned nurses, but the reverse also is true, notes Uttaro. “Our seasoned nurses know the new grads will teach them just as much as the seasoned nurses are going to teach our novices because they have strengths in both generations.” For instance, baby boomers and Gen Xers may not be as strong in evidence-based practice and where you find those resources, Uttaro notes, whereas Gen Z’s and millennials are very savvy with that information. “It’s establishing that common ground that they’re going to get something from each.”

One new grad who went through the program, Brittany Garlisi, BSN, RN, says that she was under the misconception of the old axiom that “Nurses eat their young.” But when she was paired with one of the oldest nurses on her unit, “I was pleasantly surprised to find that they were one of the most kind and nurturing teachers I could have had.”

Striking gold

As a new grad, Danyel Stone, BSN, RN, CCRN found support in the program. Having graduated from nursing school in December 2020, she started in the new grad program in March 2021.

“It’s a lot to start off as a new RN, especially because I feel like 80-90% of the job you will learn in person while you’re working,” she says.  “Starting off as a new nurse, I was very, very nervous going into it. And I think that being part of the residency program really helped me stay grounded.”

Coming from a previous career as a securities broker, Garlisi felt anxious about working as a new nurse. “I felt that even though I had the book knowledge, I did not have much of the practical knowledge. So it made me very nervous to be doing a lot of things for the first time as a registered nurse as opposed to being oriented and having a support network to really teach me.”

“I thought I was just signing up for some kind of mentorship but I really felt that I struck gold. It really was way better than I could have anticipated.”

Growing program

Typically, notes Uttaro, each cohort has 50 new grads. Each year, the hospital supports three cohorts, one starting in March, then August, then December.  This year, Uttaro expects to have as many as 150 new grads, with a target of 200 to 250 new grads in 2023.

Impact of COVID

As with virtually every aspect of healthcare, COVID threw a wrench into the residency program.

The cohort that was to start the program in March 2020 couldn’t go onto the units. Instead, the new grads worked as a prone team. “We found a different role for them to leverage their nursing knowledge,” says Uttaro. “And we were able to foster skills like leadership and teamwork and communication.”

Because many new grads lost out on clinical time during COVID, notes Uttaro, the program re-emphasized skills the grads didn’t get.

Measuring success

The program can measure success in two ways, notes Uttaro. First, in November 2021, the program achieved accreditation from the ANCC Practice Transition Accreditation Program (PTAP). “So we have the external validation that our program is evidence-based and meets the rigorous criteria of that organization,” Uttaro says.

Second, retention of new grads pre-pandemic was 100% at the one-year mark, 92% at the two-year mark, and 88% at the three-year mark, according to Uttaro. “We retained our novice nurses for the long haul,” she notes.  “I think it’s really planting the seed and being that coach for them that keeps them in our village,” she says.

Fostering respectful communication is one hallmark of the program. “Most of the bad things that happen in healthcare are a result of communication breakdown,” Uttaro says. “In this program, and throughout the organization, we emphasize asking questions in a respectful way. If it doesn’t feel right in your gut, you don’t need to know why, you just need to know whom to talk to. Being able to say, ‘I think something isn’t right,’ really reinforces that communication is essential to all aspects of your practice.”

Healthcare is a very complex environment right now, notes Uttaro, “and making sure that the new grads are positioned for success is our top priority.”

In the Wake of Uvalde, Trauma Surgeons Share Experience of Mass Shootings with Congress

In the Wake of Uvalde, Trauma Surgeons Share Experience of Mass Shootings with Congress

When Dr. Roy Guerrero, a pediatrician in Uvalde, Texas, testified before a U.S. House committee Wednesday about gun violence, he told lawmakers about the horror of seeing the bodies of two of the 19 children killed in the Robb Elementary massacre. They were so pulverized, he said, that they could be identified only by their clothing.

In recent years, the medical profession has developed techniques to help save more gunshot victims, such as evacuating patients rapidly. But trauma surgeons interviewed by KHN say that even those improvements can save only a fraction of patients when military-style rifles inflict the injury. Suffering gaping wounds, many victims die at the shooting scene and never make it to a hospital, they said. Those victims who do arrive at trauma centers appear to have more wounds than in years past, according to the surgeons. Originally published in Kaiser Health News.

But, the doctors added, the weapons used aren’t new. Instead, they said, the issue is that more of these especially deadly guns exist, and these weapons are being used more frequently in mass shootings and the day-to-day violence that plagues communities across the nation.

The doctors, frustrated by the carnage, are clamoring for broad measures to curb the rise in gun violence.

Weeks after the Uvalde school shooting, what steps the country will take to prevent another attack of this magnitude remain unclear. The House on Wednesday and Thursday passed measures aimed at reducing gun violence, but approval in the Senate seems uncertain at best.

Many physicians agree something substantial must be done. “One solution won’t solve this crisis,” said Dr. Ashley Hink of Charleston, South Carolina, who was working as a trauma surgery resident at the Medical University of South Carolina in 2015 when a white supremacist killed nine Black members of the Mother Emanuel African Methodist Episcopal Church. “If anyone wants to hang their hat on one solution, they’re clearly not informed enough about this problem.”

The weapons being fired in mass shootings — often defined as incidents in which at least four people are shot — aren’t just military-style rifles, such as the AR-15-style weapon used in Uvalde. Trauma surgeons said they are seeing a rise in the use of semiautomatic handguns, such as the one used during the Charleston church shooting. They can contain more ammunition than revolvers and fire more rapidly.

Overall gun violence has increased in recent years. In 2020, firearm injuries became the leading cause of death among children and adolescents. Gun-related homicides rose almost 35% in 2020, the Centers for Disease Control and Prevention reported in May. Most of those deaths are attributed to handguns.

study recently published by JAMA Network Open found that for every mass shooting death, about six other people were injured. Trauma surgeons interviewed by KHN said the number of wounds per patient appears to have increased.

“I feel we are seeing an increase in the intensity of violence over the past decade,” said Dr. Joseph Sakran, a trauma surgeon at Johns Hopkins Hospital in Baltimore. He cited the number of times a person is shot and said more gun victims are being shot at close range.

Survival rates in mass shootings depend on multiple factors, including the type of firearm used, the proximity of the shooter, and the number and location of the wounds, said Dr. Christopher Kang of Tacoma, Washington, who is president-elect of the American College of Emergency Physicians.

Several recent shootings have left few survivors.

The perpetrator of the Charleston massacre shot each of the nine people who were killed multiple times. Only one of those people was transported to the hospital, and, upon arrival, he had no pulse.

Last year, shootings at three Atlanta-area spas left eight dead — only one person who was shot survived.

The chaos at a mass shooting scene — and the presence of an “active” shooter — can add crucial delays to getting victims to a hospital, said Dr. John Armstrong, a professor of surgery at the University of South Florida. “With higher-energy weapons, one sees greater injury, greater tissue destruction, greater bleeding,” he added.

Dr. Sanjay Gupta, a neurosurgeon who is chief medical correspondent for CNN, wrote about the energy and force of gunshots from an AR-15-style rifle, the type also used in the recent mass shooting in Buffalo, New York. That energy is equal to dropping a watermelon onto cement, Gupta said, quoting Dr. Ernest Moore, director of surgical research at the Denver Health Medical Center.

Medical advances over the years, including lessons learned from the battlefields of Iraq and Afghanistan, have helped save the lives of shooting victims, said Armstrong, who trained U.S. Army surgical teams.

Those techniques, he said, include appropriate use of tourniquets, rapid evacuations of the wounded, and the use of “whole blood” to treat patients who need large amounts of all the components of blood, such as those who have lost a significant amount of blood. It’s used instead of blood that has been separated into plasma, platelets, and red blood cells.

Another effective strategy is to train bystanders to help shooting victims. A protocol called “Stop the Bleed” teaches people how to apply pressure to a wound, pack a wound to control bleeding, and apply a tourniquet. Stop the Bleed arose after the 2012 shooting at Sandy Hook Elementary School in Newtown, Connecticut, where 20 children and six adults were killed.

The CDC, which in the past two years has been able to conduct gun research after years of congressional prohibitions, has funded more than a dozen projects to address the problem of gun violence from a public health perspective. Those projects include studies on firearm injuries and the collection of data on those wounds from emergency rooms across the country.

For some doctors, gun violence has fueled political action. Dr. Annie Andrews, a pediatrician at the Medical University of South Carolina, is running as a Democrat for a seat in the U.S. House on a platform to prevent gun violence. After the school shooting in Uvalde, Andrews said, many women in her neighborhood reached out to ask, “What can be done about this? I’m worried about my kids.”

Dr. Ronald Stewart, chair of surgery at San Antonio-based University Health, told KHN that the people shot in Uvalde had wounds from “high energy, high velocity” rounds. Four of them — including three children — were taken to University Hospital, which offers high-level trauma care.

The hospital and Stewart had seen such carnage before. In 2017, the San Antonio hospital treated victims from the Sutherland Springs church shooting that left more than two dozen dead.

Two of the four Uvalde shooting victims have been discharged, University Health spokesperson Elizabeth Allen said, and the other two remained hospitalized as of Thursday.

It will take a bipartisan effort that doesn’t threaten Second Amendment rights to make meaningful change on what Stewart, a gun owner, called a “significant epidemic.” Stewart noted that public safety measures have curbed unintentional injuries in car crashes. For intentional violence, he said, progress hasn’t been made.

 

  • KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
Rochelle Rindels Trains CNAs to Become MVPs

Rochelle Rindels Trains CNAs to Become MVPs

Patients lean on them every day, and Certified Nursing Assistants (CNAs) contribute so much to the nursing field—yet they rarely seem to receive the credit they truly deserve. Even when writing this story, autocorrect kept changing CNA to CAN [Microsoft Spelling Checker, are you listening? –editor], and this seems an ironic reminder of the way CNAs can be overlooked.

Two years ago, the Evangelical Lutheran Good Samaritan Society started a CNA Training Program. Rochelle Rindels, MSN, RN, QCP, vice president of nursing and clinical services for the Good Samaritan Society, headquartered in Sioux Falls, South Dakota, took time to answer our questions about the program. Rochelle Rindels, MSN, RN, QCP.

What follows is our interview, edited for length and clarity.

When did Good Samaritan start its CNA Training Program? How many students are enrolled currently?

Since its inception in May of 2020, we’ve enrolled more than 600 students into the Good Samaritan Society CNA Training Program with a 91% success rate for students that sit for the certification exam.

Investing in our own team members is extremely important to us. I started as a CNA and progressed through different nursing licenses and degrees and am grateful for the support I received from my employers. We have experts who contributed to the curriculum build for the CNA program, and we recognized the value in training our CNAs in our buildings, familiarizing them with the residents they will care for throughout their employment.

The health care system has experienced a shortage of trained caregivers for critical roles for some time; nurses and nurse aides are among the fastest growing occupations, but supply is not keeping pace.

Building and strengthening the worker pipeline is essential to support current staffing patterns, paramount to any future staffing enhancements and foundational to drive further improvements in delivery of care and services to residents.

We do not want to lose the heroes who answered the call to serve and continue to step up to care for our nation’s seniors in a time of crisis. We need to retain these caregivers, so they are not facing job loss, and residents in nursing homes are not facing the loss of caregivers who know them and love them.

We have proactive strategies in place to ensure we have the positions we need to continue to provide care as close to home by investing in growing our own frontline nurses, one being our CNA Program.

How does the program work? Do students attend in-person, online, or a combination of both? Do they attend full or part-time? How long does it last?

Our CNA program is a hybrid program. The curriculum consists of online coursework and in-person skills lab and clinicals, which allows the student to apply skills and knowledge in a care setting. Full-time and part-time options are available for employees to complete the 80-hour program.

Students receive training in our locations while they are working for us and earning a paycheck. They are trained in person by preceptors and nursing team members who are also their coworkers. The students also get to know the residents who they will continue serving after they graduate and pass certification.

What does a CNA do in health care, and why is it important for aspiring nurses to train as one?

 A CNA is more than the title alludes to–nurse assistant. CNAs are absolutely the eyes and ears of our nurses and assist in completing nursing interventions. They are intimately involved with residents’ day-to-day care and needs, and they build lasting relationships with residents and their families. They complete daily activities of living with residents, perform dressing, bathing, and meal assistance. CNAs assist with restorative interventions to help residents maintain function and document important needs and data points related to the resident’s overall condition. They are a valued and essential part of the care team.

Why is this program important? What does it offer that makes it different from others?

The nurses who work for the Good Samaritan Society tell us they find their jobs incredibly rewarding. It’s hard work, but they believe they are called to do their roles. They build special relationships and friendships with their coworkers, and their residents become family. It’s the experiences like celebrating birthdays and anniversaries as well as the wisdom they gain from their residents that makes being a nurse such a rewarding career.

If someone wanted to get into the program, what would they need to do? What steps would you tell them to take?

 Applying to the program is easy! Anyone interested can apply to a nurse aid position and upon hire will automatically be enrolled in the CNA training program. We offer the internal program in six of our states, including South Dakota, North Dakota, Iowa, Minnesota, Florida, and Tennessee. We are currently in the application process in five more states.

Is there anything I haven’t asked you about that is important for our readers to know?

I personally grew up with the Good Samaritan Society. My mother spent nearly 40 years as a nurse at Good Samaritan Society–Luther Manor in Sioux Falls, South Dakota. I remember performing ballet recitals and Christmas programs for the residents and staff. My mother and I have just one of many Good Samaritan Society stories of family working together. It’s that sense of calling and the family-like connection to residents that makes our culture so unique.

We’ve supported our people with investments to maintain the stability of our workforce and new programs to support employee well-being. These investments have paid off–our turnover rate is below the industry average and we were a Forbes top midsize employer in 2021.

In 2021 alone, we invested $15 million in direct care wages, and we recently announced a $5 million investment in starting wages.

We’re focused on how we can create positions that allow for more work-life balance for our people who are carrying out our mission every day. As a large organization, we have opportunities to solve for some of these things. But at the end of the day, we still need meaningful policies and long-term solutions to support and address our workforce needs now and in the future.

Nurse of the Week Nicole Bock Makes House Calls: “My Office is Everywhere”

Nurse of the Week Nicole Bock Makes House Calls: “My Office is Everywhere”

When they hear “ding, dong!” at their door, many of Nicole Bock’s patients are old enough that they might expect to see a cosmetic salesperson or vacuum huckster cooling her heels on their doorstep, but having a Nurse make house calls sounds like a blast from an even more distant past.

In fact, while “working from home” is the norm for many now, Nurse of the Week Nicole Bock, RN does her work from other people’s homes as an essential nurse.

“I go around and see patients in their home and help them with any nursing needs they have,” says the RN case manager – and Daisy Award winner.

Always on the road – “My office is everywhere!” she says – the Good Samaritan Society – Home Care (Robbinsdale) team member in Minnesota cares for a handful of patients every day.

“You kind of get to see them on their turf a little bit instead of in the hospital,” Bock says. Teaching others about their medications, taking care of wounds, and lab draws are just some of the tasks the eight-year nurse is counted on to complete.

Bock might not have become a roving photojournalist as originally planned, but she is certainly a hit as a Roving Nurse. She pivoted to a nursing career after her four-year degree in photojournalism produced few opportunities… and a lot of patients are very grateful for her career pivot.

On getting a Daisy: “I was beyond shocked!”

Patient Nancy D. Loehr says Bock “makes me feel comfortable and I feel I can ask her anything.”

Elevating people’s health is Bock’s goal. Elite at taking care of clients, she was nonetheless surprised when honored with The DAISY Award for extraordinary nurses: “I was beyond shocked. I had no idea. Beyond shocked,” she says. “Very honored and I love that they felt that I was worthy of this.”

Going above and beyond for those she cares for and for her teammates is why she’s getting well-deserved recognition. Simply put, “I like helping people,” Bock says.

“She’s very special to us”

Linda Stokes says Bock’s care for her husband Otis, who is fighting cancer, is keeping her family safe and putting them at ease.

“She’s very special to us. Good Samaritan was just good to us period,” Linda says. “It’s hard when you don’t know or understand anything about medicine. To have someone who comes in and doesn’t talk down to you explains to you simply what you can do but clearly cares about what she’s doing.”

That effort prompted Linda and Otis to type up a letter of gratitude.

“Nicole said whatever you need is what we will do when we come into your home. Period. Everyone who came in on this team walked in and said I want you to know I’ve been vaccinated. I’ve been boosted,” Linda says.

A humble team player, Bock says the kind words mean a lot.

“It makes it all worth it just knowing that people appreciate it and I’m making a difference,” Bock says.

Listen to the Chapter Podcasts for Jonas and Kovner's Health Care Delivery in the United States


Gain a better understanding of the current state of the US health care system and how it might impact your work and life.

You have Successfully Subscribed!