Every morning starts the same way for Veteran Kenneth Tutt, age 79. At 8:00am he makes a phone call to Nurse Practitioner Rhonda Weinhold. Weinhold is a VA Home-Based Primary Care (HBPC) provider. She has been working with Tutt for four years. Together they review his weight, blood pressure and sugar levels. “There is no doubt in my mind I would not be here if it was not for this program,” said Tutt.
Home-Based Primary Care is a VA program bringing primary health care into Veterans’ homes. HBPC provides integrated, patient-centered care for Veterans with complex medical needs. Veterans in the program are assigned a primary care provider like Ms. Weinhold, based at the Staunton, Va., community-based outpatient clinic. “The families, the caregivers in the home, they really depend on us,” she says. “A lot of our patients consider us part of the family.”
“So Many Medications!”
Recently, Weinhold began something new for Tutt and several other patients that has helped to reduce their medications and resulted in higher satisfaction with their quality of life. Not long ago, she attended a VA Geriatric Scholars Program class, which inspired her to develop a medication management program to review patient medication prescriptions. The idea came in part from a HBPC routine: setting up monthly medication boxes. “We love doing it, but we noticed our patients were on so many medications. We just thought, are there medications we could potentially get rid of that actually might be doing more harm or that are not needed?”
She teamed up with HBPC team member Jena Willis, Doctor of Pharmacy (PharmD), to develop the idea. The review, it turns out, often results in a reduction of medications. Weinhold says it is good because, “Research shows the more medication patients are on, especially for the elderly population, the greater the risk for falls.” In fact, Tutt admits to having fallen at home a few times in the past. They consolidate the medication de-escalation recommendations, adding them to each patient’s electronic health record. Tutt, like most HBPC patients, takes a lot of medications for a variety of health conditions.
asked veterans, “How do you feel about trying to get off some medicine?” Tutt
thought, “It was a terrific idea.” The project has helped Tutt feel he’s got a
better chance of being the person he’s always been. “I’ve been an outdoor
person all my life,” said Tutt, who served in the Navy from 1958 to 1970. “I
garden, I raise flowers. I’ve had to cut back, but I’m still mobile.”
HBPC: Keeping Patients Safe in their Homes
“Our goal with Home-Based Primary Care is patient safety,” said Weinhold. “We’re there to keep them safe in the home and to keep them in the home as long as possible.” As they fine-tuned their process, Weinhold brought others onboard. It was a team effort. Three registered nurses met in person with 80 patients over six months. “We were able to reduce the number of medications an average two medicines per patient,” said Weinhold.
After their success in Staunton, they were able to coordinate with Salem VA Medical Center (VAMC) pharmacy residents’ grand rounds presentation on the de-escalation of therapy for the medical department there. The Salem VAMC is Staunton’s Community-Based Outpatient Clinic’s parent facility. The residents added the information to their presentation as an introduction to the rest of the medical facility. “The most rewarding thing is providing improved quality of life for our patients, whether it’s three more days, three more years, or 30 more years,” said Willis.
Maureen Jerrett is a contract
writer for VA Geriatric Scholars Program
The Department of Veterans Affairs runs the nation’s largest health care system, but that doesn’t make it immune to the severe nursing shortage the U.S. is facing today. Not only are there not enough nurses, but medical facilities across the nation are seeing a higher turnover rate for these critical staffers. In 2018, the rate was 17.2 percent, according to one study.
It may be years before we find a permanent answer to this problem, but in the meantime, the VA Medical Center in Tomah, Wisconsin, has taken a series of steps that has cut our turnover rate by more than half. Here’s how we did it.
We started seeing nurse recruiting challenges about five years ago, and decided we needed to be proactive about ways to retain the nurses we had. After researching the issue, we created what we call the Nursing Stay Interview process.
Under this system, nurses are interviewed by their nurse managers after being on the job for 30 days, and then again after 90 days.
Some of the questions they are asked include:
- What, if anything, would you change about your job?
- What things would you like to learn more about or what experiences would you like to acquire?
- What things demoralize you and make you long for the weekend?
The questions led to free-flowing conversations that helped staff discuss concerns and ideas with top leaders, and helped those leaders fix problems that kept these nurses at their jobs, serving Veterans.
After the first year of the Nursing Stay Interview process, turnover dropped by 52 percent in Tomah, Wisconsin.
Before we took this process on board, nurse managers recommended nurses stay in their units for a year before transferring to another unit – the idea was to prevent disruptive changes in staff.
But after our interviews began, managers could see examples of nurses who were hired into a unit that wasn’t the best fit, and more quickly move them to other units that align with their individual strengths and career goals. Instead of keeping nurses in units where they didn’t feel fulfilled and increasing the chance that they leave, the system helps us put them in units where they want to work.
We’ve since honed the process to ask specific questions of our nurses after 30 days, 90 days, and annually in order to make sure we’re identifying problems that could prompt them to become frustrated with their jobs.
Part of the process involves educating our nurse managers on how to conduct these interviews, and making sure they make the rounds to interview all of their new hires.
The process has been so successful that we’ve broadened it further to include LPNs and CNAs, and have included staff who provide mental health services such as social workers, psychologists, peer support specialists, and others.
Many might guess that nurses would tell the VA that they aren’t making enough money. But not a single nurse had that complaint. Instead, many said they were uncomfortable with coming to work and not knowing if they were going to spend their shift on their regular unit or if they were going to be floated to another unit for coverage.
After hearing that feedback, we created “pods” — a mental health pod, an acute pod, and two long-term care pods. We knew it may have been unrealistic to completely prevent floating, but we committed ourselves to reducing it as much as possible.
Nurses also told us that what we were doing for new employee orientation and nursing core orientation was not setting them up for success. As a result, nursing leadership met with the education department to adjust the curriculum to be more discipline specific so that RNs could get the orientation in education before starting.
As we evolve, we always let the staff know that changes are being made “because of the information we received from the stay interviews,” so they understand that their voices are being heard.
Marissa Dobratz is an RN who started her position in April and has already taken part in two stay interviews. She says she likes the process because “it offers an opportunity for a person to be part of the change. And, if you feel like you’re part of the change, you’re more likely to stay.” She had previously worked for an employer that did not offer such interviews and says that facility has a large turnover problem.
What we built in Wisconsin has worked so well that we shared it with other parts of the VA, including medical centers in Oklahoma and Texas.
It always makes sense to listen to your employees. But especially at a time when nurses are in such short supply, we’ve found that taking time to ask questions, listening to the feedback we get, and then acting on that information is going a long way toward retaining these valuable staff members.
Rutgers University–Camden recently announced a new program which will prepare military veterans for civilian careers as nurses who will care specifically for other veterans. The program is funded by a three-year, nearly $1.5 million grant from the Health Resources and Services Administration (HRSA) under the U.S. Department of Health and Human Services.
Military veterans are uniquely equipped to care for other veterans thanks to their shared experiences like overseas deployments, a demanding lifestyle, and challenges such as health problems or needing to find a new career when they transition to civilian life.
The new program being offered at Rutgers University–Camden is the only program of its kind in the Delaware Valley and the state of New Jersey. The program is called Veteran Nurses in Primary Care and focuses on understanding veterans and preparing veterans for a career as a civilian. The program will also focus on providing education to community-based primary-care registered nurses and other clinicians, nursing faculty, and clinical instructors to help meet the needs of veteran clients.
Kevin Emmons, a Rutgers School of Nursing–Camden clinical associate professor and a U.S. Army veteran who currently serves as a member of the Army Reserve, tells news.camden.rutgers.edu, “We recognized a need for health-care services for veterans that would help bridge the relationship between them and the health-care provider. One of the best ways to do that is by having the health-care provider, and in this case the nurse, be a veteran themselves. This can instantly build a bond between the veteran client and nurse.”
Applications are currently being accepted for the first cohort of students who will begin taking classes in the fall semester. The first cohort will include eight students, the second year of the program will increase the number of students to 12, and the third year of the program will accept 18 students.
Rutgers University–Camden is the only higher education institution in New Jersey to earn the distinction of being named as a Purple Heart University by the Military Order of the Purple Heart. The honor recognizes the university for its services to veterans and their families. Veterans participating in the program will receive comprehensive support to assist them in their students, including mentors and advisors from the School of Nursing and the university’s Office of Veterans Affairs.
Rutgers School of Nursing–Camden students usually perform their clinical rotations in community and hospital settings, but through the Veteran Nurses in Primary Care program, students will learn while working at the Camden County Department of Health and Human Services, Cooper University Hospital, the VA Medical Center in Philadelphia, and Volunteers of America’s Home of the Brave program.
To learn more about the Rutgers University–Camden’s new program which will prepare military veterans for civilian careers as nurses who will care specifically for other veterans, visit here.
You entered the field of psychiatric nursing because you wanted to make a difference in the lives of patients. As a psychiatric nurse with VHA, you’ll do that and more. Not only will you play a critical role in changing the lives of Veterans, often in the most challenging stage of their life, but you’ll work with their network of family and friends to provide whole healing and a successful outcome. Learn more about the specific Veteran populations you’ll be working with and the opportunities for making an impact.
1. The families of Veterans
VA offers a range of family services for Veterans and their family members, including family education, brief problem-focused consultation, family psychoeducation, and marriage and family counseling. Our psychiatric nurses play an integral part in facilitating these services, working with all members of the family to provide holistic solutions.
2. Homeless Veterans
VA is the only Federal agency that provides substantial hands-on assistance directly to homeless Veterans. As a VHA psychiatric nurse, you’ll have the unique opportunity to step outside the hospital walls and treat Veterans who would not otherwise seek help. Additional VA assistance programs where you can make an impact include:
- Drop-in centers where Veterans who are homeless can shower, get a meal, and get help with a job or getting back into society
- Transitional housing in community-based programs
- Long-term assistance, case management and rehabilitation
3. Veterans with Serious Mental Illness
Veterans diagnosed with Schizophrenia, Schizoaffective Disorder and Bipolar Disorder work with VHA psychiatric nurses on a variety of treatment plans, including psychosocial rehabilitation and recovery services to optimize functioning. In addition, you’ll be a part of our Mental Health Intensive Case Management team. The team of mental health physicians, nurses, psychologists and social workers helps Veterans experiencing symptoms of severe mental illness cope with their symptoms and live more successfully at home and in the community.
4. Veterans adjusting to civilian life
The transition process from military to civilian life is a challenging one, and our psychiatric nurses are there from the beginning to provide crucial support. At our 300 community-based Vet Centers, our staff provides adjustment counseling and outreach services to all Veterans who served in any combat zone. Services are also available for family members for military-related issues, and bereavement counseling is offered for parents, spouses and children of Armed Forces, National Guard and Reserve personnel who died in the service of their country.
5. Older Veterans
To provide specialized care for our older Veterans, we’ve developed VA Community Living Centers (CLCs). Here, you will treat older Veterans needing temporary assisted care until they can return home or find placement in a nursing home. Our staff also works on ensuring that Veterans can safely live independently by screening for dementia and general assessments that help us decide whether the Veteran can make informed medical decisions.
As a psychiatric nurse at VHA, the work you do will deeply affect the Veteran, their family and generations of families to come. View our Nursing positions or, Join VA in making a difference in one of the many other health care fields available.
This story was originally posted on VAntage Point.
CPR in a restaurant on a woman not breathing
Here is just one story about how VA nurses excel in their occupation, on and off duty.
VA Nurse Karen Brodlo sat in a restaurant enjoying her dinner when she heard someone yell to call 911.
She looked up to see an elderly woman had collapsed and was not breathing. The woman was having dinner with her husband when the night took a turn for the worst.
Brodlo quickly jumped in action. As a VA nurse for 23 years and in the nursing field since 1969, it was second nature. She identified herself to the crowd as a nurse and assessed the situation. Right away she noticed that the woman was positioned incorrectly. She quickly made the adjustments and started to administer CPR.
She continued manual CPR process until the rescue team arrived. She then turned her focus to the husband who was nervous and scared for his wife’s well-being. She tried to calm him down as the rescue team continued to work to save the woman’s life.
She remembers the worst part being, not having the equipment she needed. She suggested to the restaurant after the incident that a general-use defibrillator would be a useful addition. Just as most businesses have fire extinguishers, a defibrillator should also be a requirement. Just as easy to use, it’s better to have and not need it than to need it and not have it.
After much praise came her way for saving a life, Brodlo said, “I just did what was right. No accolades are needed for doing my job.”
The restaurant now gives her star treatment. The daughter of the woman she saved sent a bouquet of flowers along with a heartfelt thank you card calling Brodlo her mom’s “Guardian Angel.”
Brodlo is a nurse at the Captain James A. Lovell Federal Health Care Center in North Chicago.
As a caring nurse who adores her job, she followed up on the status of her honorary patient. Sadly, a couple of weeks after the incident, the woman passed away from further complications, but the family was overwhelmingly grateful.
The last days with any family member or loved one is crucial. If it wasn’t for the quick actions of nurse Karen Brodlo, they would have missed out on the opportunity to say their last goodbye.
This story was originally posted on VAntage Point.
In 1975, with the Vietnam War still fresh in the minds of the American public, most high school senior graduation plans did not include joining the U.S. Army. But for eighteen-year-old Virginia “Ginny” Warren, the North Texas daughter of a cotton farmer, the Army looked like an ideal path. Much to the chagrin of her father, Ginny Warren had just set forth on a 44-year journey from soldier to VA Nurse.
“The Army offered me a way to broaden my horizons and to learn,” said Warren, Nurse Manager at VA North Texas Health Care System.
Warren began her military career with two-years in medical administrative field before spending the next twenty-two years as a medic with the U.S. Army Reserve’s 94thCombat Support Hospital, based in Seagoville, Texas. With a primary mission to take a 150-person deployable hospital anywhere in the world and be ready to receive casualties within 72 hours of arrival, Warren continuously trained for the opportunity to apply her talents while developing a new passion to become a Registered Nurse (RN).
Through her career in the Reserves, the Army sent Warren to licensed vocational nurse (LVN) training and Warren quickly realized she had an aptitude and attitude for nursing. Warren went on to attend the University of Texas at Tyler School of Nursing to become a RN and was subsequently commissioned in the U.S. Army Nurse Corps.
“I had to find my place as a new nurse and new military officer,” said Warren. “I had a lot to learn, but I felt I had a lot to offer as well.”
After becoming an RN, Warren brought her health care experience to VA and joined another family of nursing professionals at VA North Texas in 1997.
In 2003, Warren’s Reserve unit was called upon to deploy to Landstuhl Regional Medical Center to treat wounded servicemembers straight from the battlefields of Iraq and Afghanistan. The ability to muster tremendous internal strength and compassion, coupled with her many years of training to deploy on a moment’s notice, was exactly what the soldiers, Marines and airman she treated would need to make their next journey back stateside to recover with family and friends.
“I vividly remember leaning over this big sergeant, hugging him, and whispering in his ear that it would be okay, and the pain won’t last,” said Warren.
Warren would go on to give more than 40 years in uniform, retiring as a field grade officer in 2015.
With over 22 years of service as a VA nurse, Warren now walks the inpatient wards of the Dallas VA Medical Center where she once served as junior nurse, as a manager and mentor to a new generation of nursing professionals who rely on her expertise and experience to care for many of the 134,000 active patients who use VA North Texas for their health care each year.
“Nursing is not just a career, it’s a passion and a devotion,” said Sheila Wise, VA North Texas Nurse Manager, and herself a retired U.S. Army Nurse. “To bring that passion and devotion to the service of our Veterans the way the Ginny has, and continues to do every day, for as long as she has, makes her an inspiration and a guiding figure for our nursing team. She makes all of us better.”
While eighteen-year-old Ginny Warren could have never foreseen the impact she would have on our nation through her service to military servicemembers and Veterans over 44 years, the nearly 3,000 nurses who apply their skills at VA North Texas are glad that the cotton farmer’s daughter left home to make the journey of a lifetime.
“Nursing has always been where I could pour my heart and soul,” said Warren. “I can’t imagine doing anything else.”
This story was originally posted on VAntage Point.