Sarah: This is at the core of care, a podcast where people share their stories about nurses and their creative efforts to better meet the health and healthcare needs of patients, families and communities.
I'm Sarah Hexem, Hubbard, Executive Director of the Pennsylvania Action Coalition and the National Nurse Led Care Consortium.
As part of our special COVID-19 vaccine confidence efforts, we're creating a series of podcast episodes that could be helpful to nurses at this time and the communities they serve. We've heard perspectives from nurses around the country.
And for this episode, we'll talk about the role of community partnerships and vaccine distribution with two nurse practitioners based in Topeka, Kansas. Patrick Muchina is the family nurse practitioner manager at Pine Ridge Family Health Center. And nurse practitioner Amanda Hartman works part time caring for patients there. Dr. Hartman was part of the team that started Pine Ridge and she teaches at Washburn University School of Nursing.
We should note that Pine Ridge serves as a clinic for Topeka Housing Authority residents and as a training site for student nurses.
At the end of the episode, nurse practitioner Sydney Engel joins us from Milford, Massachusetts. We'll talk about how she and her colleagues are working through vaccine access issues facing their patients, many of whom are new immigrants.
But to start: Amanda Patrick, before we dive into talking about vaccines, can you share a bit about your background with us? We're wondering how you got into nursing and what led you to where you are now.
Amanda: I have been a registered nurse for 18 years. And I do believe nursing is a calling and my call to nursing aim at a very young age, my father passed away with malignant melanoma when I was nine. He was in his mid-30s. So a very young, otherwise healthy man. And that was a very trying process to live through at a young age.
And what I remember most about his treatment at the end was the nurses, the hospice nurses, and how excellent they were, to me and my family. And, really, that is what inspired me to pursue nursing.
I've been a family nurse practitioner for almost 10 years at this point, having worked in the emergency department, urgent care and family practice settings. My call to teaching came from just my experience completing my master's, and then my doctoral degree with Washburn University. Just the attention that I received from the staff and faculty there really inspired me to do the same.
Sarah: Could you just speak a little bit to you know, what led to the partnership between Washburn and the typical Housing Authority?
Amanda: So, the partnership between Washburn School of Nursing and to pick a housing authority occurred as part of a grant project. Washburn University School of Nursing received a grant to help develop curriculum for DNP students with an interprofessional focus and a community-based mindset.
So, there were two parts to that grant process. And I helped with both the curricular changes that were implemented, and ultimately the design of what has become this clinic. As we were looking at our surrounding community here in Topeka, it just happens that Topeka Housing Authority was recognizing a pattern with their residents – as far as, there's no clinics over here in this area where we're located, and transportation is absolutely an issue for their residents.
So, they recognized a need. And they have a history of being very progressive and imaginative in problem solving. And it was really what we call a serendipitous meeting of the minds that we had a project to do, and they had a need to fill. And it all just the stars aligned for us,
Sarah: Patrick, so you've worked in nursing homes, the ICU critical care and now you're the lead nurse practitioner at Pine Ridge. What inspired you to start your nursing journey?
Patrick: I started nursing journey as a CNA. At first, I had gone to the field of software engineering. And when I was studying on that, I couldn't feel it.
So, I say let me try the nursing field because I knew I had passion. So I said, let me start as a nursing aide, I started as a nursing aide in a nursing home. When I started working in nursing home, I kinda feel this was my calling. The people I was working with, I felt I'm making a difference in somebody’s life. For example, I could meet people of different color, different origin, especially African American. And when I took care of them, they trusted me because they look like them. And also, I came to realize that there was shortage of African American men in nursing field. So that gave me the passion to continue. So, I went ahead and did RN. And now I'm a nurse practitioner at Pine Ridge Family Health Center. So, I kind of feel I'm making a big difference in trying to bridge the gap when it comes to providers in African American community.
Sarah: So, I know, Washburn and to pick a housing authority already had a solid relationship with Pine Ridge. How has the collaboration expanded during the pandemic? And do you have plans to continue that with the COVID-19 vaccine distribution?
Amanda: At our clinic, we are limited on space. So, we did not have the space to qualify for the Pfizer or Madonna vaccine. We do qualify for Johnson and Johnson, and our application is in and I believe approved. It's been challenging to acquire the vaccine for our location.
As far as expanding our partnership, you know, we will continue to use our both undergrad and graduate students to help administer that vaccine here at the clinic.
Sarah: And what are the kinds of considerations that our clinic needs to take into account? You mentioned space and, you know, what are what are those considerations that go into the application?
Patrick: When it comes to the supplies and requirement for the vaccine, one thing is refrigerator, there is a recommended refrigerator for vaccine. And also, we have to have a capacity of how much we can store at a peak and how many people we can be able to supply vaccines to.
Right now, we are able to store capacity of about 2,000 people. We can store vaccine for that capacity. And also, we have given our information about the refrigerator. And also, when it comes demographic, the group of people we are seeing, especially. We are serving people of low-income all the way from the kids, newborn all the way to the adults,
Sarah: You know, wanted to learn a little bit more about how you've engaged other community stakeholders. What does that look like and you know who has been involved in this effort to support testing and vaccination efforts?
Amanda: We have been well supported by Shawnee County, and they have widespread testing efforts that are easily accessible. So, I don't feel like access to testing has ever really been a huge issue for us. With the additional grant money that was allocated to the clinic from Washburn, we were able to acquire our own rapid testing here in the clinic, which has been hugely helpful. Folks can just walk down the street and we can get them tested and have a result in a relatively short amount of time. But as far as like the more accurate PCR testing, really I feel Shawnee County has done an excellent job of being mindful of location placement and accessibility for everyone in Topeka.
Sarah: So I was wondering about other non-clinical or community-based sites, non-clinical vaccination sites, libraries, faith-based groups, folks helping with public education. What does that community response look like?
Amanda: I would say mostly it has been hospital driven honestly with through Stormont Vail [Health] and Shawnee County Health Department being the main voices here to speak to the faith-based groups. We do have a local community clinic that is faith-based and they are offering the vaccine as of several weeks ago.
Sarah: Have you heard of any effective community strategies to help people register for the vaccine to get into those slots, particularly folks who are struggling with that technology aspect?
Patrick: When it comes to technology, we have been seeing a lot of geriatric patient[s] and most of them that have been challenge on how to go to the internet and get the information. So what we have been doing is like when we have an appointment with the patient who we know they are challenge or they can’t access the internet, we try to ask them during the appointment if they have gotten their COVID vaccine and what challenges they are facing. If they can’t access the Internet, we can try and locate any vaccine center around the community and try to make an appointment while they are still at the clinic either by calling them and letting them know what is the time, they will be supposed to go to the appointment. Or if that doesn't work, we usually follow up, we'll call around, make sure the patient get an appointment, and then follow up with them later, make sure they were able to go to the appointment.
Amanda: So we're doing a lot of the legwork for the patient when we can identify folks that have that barrier. I will say Shawnee County has been really cognizant of that barrier. And they do offer just a general phone line. So folks can use the old-fashioned phone and just call in and get an appointment. But you know, again, there are some folks that just don't know that number, don't know how to access that number. So obviously, we can serve as a conduit to providing them that information, and making sure they have the ability to call.
Sarah: Similarly, we've heard issues about transportation. So have you seen that come up for your patients? And do you have any strategies that you're considering using when you're providing vaccines? We've heard about mobile clinics like mobile vans that are going out into the community. Any examples around transportation?
Amanda: Prior to COVID, we had employed our own transportation person here for our clinic. But honestly, with the concerns of COVID and being in a confined space like a vehicle, we have not re-instituted that as far as a deliverable that we offer here at the clinic. To be honest, I can't recall off the top of my head any mobile options other than there is a wide variety of site options for the shot being administered in the community. And geographically to peak is not super large. So yes, I absolutely think transportation is an issue for some of our folks. And I imagine that is a barrier that we will help overcome. But I do think Shawnee County has really been cognizant of trying to space out their areas for testing and administration.
Patrick: So when it comes to transportation, that actually is a big problem or issue or concern with the patient we are seeing here because they are low income. And most of them, they don't have a car. Some of them they walk to the clinic. I can remember of a patient who came and she was worried of how she would get to the hospital or the vaccine center. So all we had to do we called the hospital, the vaccine center and just inquired if they were offering any transportation option. And, actually, they did. They might use like a public transportation, which was still covered and was supported by the Shawnee County true.
Sarah: That's one of the innovations of this partnership in general is that you have this clinic that's what the Topeka Housing Authority. So could you sketch for us just a little bit, you know, where are you located? What is the proximity to the residents of the Topeka Housing Authority?
Amanda: We are located within a Topeka housing entity. Our clinic is a renovated home that someone used to live in. So we're in the Pine Ridge community. Topeka housing authority has multiple locations around town. But again, geographically speaking, Topeka is relatively small, so nothing is ever very far truly. We are smack in the middle of an actual living, breathing neighborhood. We work amongst where our patients live.
Sarah: We have heard a lot about vaccine hesitancy, the desire to cultivate vaccine confidence. And that's sometimes coming from a distrust in the government and medical establishment, particularly among communities of color, and persisting inequities, generally, and then healthcare delivery specifically. So we'd love to hear about what you're seeing among Pine Ridge patients at the health center. And how are you talking that through with them?
Amanda: I would say the main takeaway, or my main talking point, is leading with empathy. It's easy for me to have trust in the government and a medical system because of my experiences with it. But I also understand that's not everyone's experience. And, in fact, the people we serve – rarely do they have the same experience that I get to have. So I really try to lead from that perspective.
Sarah: And Patrick, what about you?
Patrick: It has been a challenging when it comes to offering a COVID vaccine to the patient. So, the first thing is understanding the patient point of view, accessing their knowledge, what do they know about the COVID vaccine, getting the reason behind why they don't want to get it. Is it a cultural thing? Is it the I'm scared because of the side effect? So, most of the patients I've been talking to, especially African American, and the low-income patient, is that they are scared of the side effects. Most of them they're thinking they're getting the virus itself. So, educating the patient about how the vaccine works, and why they are getting the vaccine. And also comparing the risk versus the benefit. You explain to the patient, if you get a vaccine then your chances of not getting the COVID are very high. And also, us as the health care workers leading by example. So, in my patient come to me, I'm like, “This is how you're going to feel this or what to expect.” So, they can have more trust you as a provider, because you're explaining it to them.
Sarah: Patrick, earlier, you had talked about the importance of having providers who look like the communities that they're serving. I'm curious if you've seen that play out at all, in these conversations.
Patrick: I've seen patients come to the clinic, especially young men, African America, and they tell me, I haven't been to a doctor for 10 years. And the reason behind it is because they say they don't trust the system. They don't trust the healthcare system. But when they come to the patient who looks like them, they feel they more trust them, they're more willing to listen. If you say, “Hey, I need to take your labs, I need to check your wellness, I need to make sure you're doing okay,” they're more agreeing to your plan or agreeing with you on what you want to do to them.
Sarah: I'd love to hear what you're hearing from students and colleagues, whether they're encountering mistrust or hesitancy or even holding those views themselves. Have you seen that through your conversations?
Amanda: It's been a mixed bag. I have seen other medically inclined colleagues, say some things that make me question their understanding of the whole process and how things work. It's hard not to be disheartened by that. But I very proudly proclaim that I am vaccinated and how thankful I was to receive it as quickly as I did, and how thankful I am to participate in Washburn's efforts to vaccinate the student body and the faculty, and how excited I am for the potential that we have here at Pine Ridge [with] our allotment of vaccine and what that will bring for the future.
Yes, there are risks, but the benefits far outweigh them. And really nothing is without risk. And if it gets us back to a more standard approach to our life, I am very willing to not only take it myself, but administer it to you.
Patrick: We have had colleagues who have been comparing their past experience, for example, with flu vaccination. They say, “When I get flu vaccination, I get sick.” And then when it comes to COVID, they see all the side effects. That kind of turns them off of accepting the COVID vaccine.
Sarah: We have been asking, for the very reasons that you stated: Did you get the vaccine? How did that go for you?
Patrick: Yes, I was among the first healthcare workers to get the COVID vaccine because I didn't want to take a chance. So especially working in the hospital, we were more exposed to COVID and you couldn’t call in and all that because, you know, people depend on you to go to work and help on the COVID. So, I wanted to protect myself. I know when I protect myself when you're protected everybody around me, which includes my family, too. So, when I got the COVID vaccine, mine was okay. I'm lucky I didn't have extensive side effect or [get] sick for a few days. The first shot I got, I was okay. But when I got the second one within, the 24 hours, I was feeling fatigued, tired. And that went off just after 24 hours and I was okay. So, I'll say it was a good experience for me. So
Sarah: How about Amanda?
Amanda: I had a very similar experience. I was able to get my vaccine in the first tear here for Shawnee County. And the first shot was very uneventful. Just a little localized arm soreness. And shot number two, I definitely had the body aches and fatigue and headache. But it was all very manageable. And you know, I just kept telling myself: “This is good. This means my immune system is working like it should.” So, that was a helpful reminder to myself.
Sarah: You’ve spoken about Shawnee County and there efforts. And that sounds like they've been really ahead of the curve when it comes to COVID-19 efforts and education. What have you seen being successful, like one of the trusted sources that your clients or your colleagues are consulting?
Amanda: Here in Topeka, as much as I hate to say it, Facebook is a very powerful entity. And a lot of the local news stations will post information, not always an unbiased approach, and I read the comments, for better or worse, just so that I can have kind of an expectation of what is it that what is the general public feeling. It is still really a mixed bag. I feel like if people are committed to their viewpoint, no matter what information you give them, that's a commitment that sometimes is hard to breakthrough. We all have that autonomy over our own body. So we will always respect that. But overall, I think people are interested in learning it, it surprises me how many people are sharing those stories or commenting on those stories or liking those posts. I mean, people are paying attention. So, I think that's great.
Patrick: I've been talking to a lot of my patients just to follow evidence-based or peer-reviewed articles. And also using the website like CDC. Here in Kansas, we have Kansas Department of Health. Because what I realized is some of my patients, they come to me, and they say they found something on the internet search, and the information is sometimes biased. That's what I've been trying to tell my patient. So most reputable websites like CDC, health department website. In the news, too, they can give good information. And if you're working somewhere your employer, too, they should provide good information about where to get the COVID vaccine and all that.
Sarah: How do you think that this pandemic is going to impact your approach to practice moving forward? What are your hopes for how the pandemic might shape healthcare delivery more broadly, in the future?
Amanda: Personally, I think it has forced all of us to proceed with kindness, because we're all under large amounts of stress. I think it has really highlighted that there isn't a lot of difference between most of us, we all want the same things, we all want to be healthy. We all want to be able to go to work and pay our bills and have a nice life. I've been fortunate because I'm not in a hospital setting. That doesn't mean it's not stressful in our clinic, seeing our community being impacted by COVID. I would say from a faculty perspective, though, my students are on the front line working in the hospital. And that has been extremely challenging. So it's been kind of a double-edged sword. I'm really excited and happy that I'm not on that front line. But you also have this feeling of guilt, because we are all helpers by nature. And you know, are we doing all that we could be doing? So it's just been a really, it's been a roller coaster of emotions.
Patrick: COVID vaccine has shed light on how healthcare inequality is in our community. What I'll say is that COVID has shown that it doesn't differentiate from race, color, your political party affiliation. It affects everybody. We are all in this together.
Sarah: What do you recommend when you're talking to your students or your colleagues that are experiencing this stress? How do you manage that? Or how do you encourage others to manage that?
Amanda: Honestly, debriefing sessions. And it's really challenged, I guess, my perspective of that professionalism, facade, almost that we put on as providers and as faculty members, and as preceptors. Really kind of letting that guard down and just saying, “Hey, you know, I'm a human too, with emotions. I get it. If you need to sit down, so we can talk through what you're feeling. Let's just sit down and talk.” That informal debriefing has been, I'd say beneficial for everyone, myself included.
Sarah: And Patrick, any other thoughts on the stress question, managing stress
Patrick: When it comes to managing stress, especially on health care workers, I'll say please take your me time. Take a vacation with your family somewhere, you need some time to rest. And also forget about everything just for your personal health.
Sarah: This was such a great conversation, and I really want to thank both of you for being here.
Amanda/Patrick: Thank you very much. Thank you.
Sarah: And now we're going to hear from a nurse practitioner in Massachusetts about her experiences helping patients overcome obstacles to getting vaccinated.
Sydney: My name is Sydney Engel. I am a family nurse practitioner providing primary care at a community health center in Milford, Massachusetts, which is about an hour outside Boston.
I am doing a mix of telehealth and in-person patient visits. At the moment, I am split 50/50. So when I am remote, it's almost entirely over the phone only. And that is because our patient population, trying to get them set up with zoom has been incredibly difficult. We use translators for a lot of the patients.
My patients are predominantly from Brazil, Ecuador, and Guatemala. I do have some patients that come from Mexico, some from the Dominican Republic, that from Puerto Rico, I also have some from Egypt.
Healthcare in each of those countries depends dramatically on what resources you have. So even though I have many patients from Brazil, their prior experiences with health care may vary dramatically based on what their socioeconomic status was, when they were living in Brazil.
I would say that the predominant response that I've gotten from these populations, relative to my American patients, is one of enthusiasm and excitement. I would say that there is actually less vaccine hesitancy and more trust. Maybe as Americans, we've kind of lost track of what could be our lives without those vaccines. And I think for some of my patients, they haven't – [in] their countries, the access to vaccines isn't as widespread.
When my patients are concerned about the vaccine, they are concerned about the side effects, and they want to talk through it. But most of the time, I think in every case that I've had where I've talked with a patient about their concerns about the vaccine, they've ended up saying yes. And I don't think it's anything I'm doing at all. I think that it's that this population is very much just wanting to have a chance to have their questions heard and addressed by a medical professional.
We don't have a portal for people to sign up. It's entirely manpower. So the nurses and the medical assistants at our office have been doing tireless work to call patients and get them scheduled into vaccine slots. But that means that if there isn't a slot available, we can't just tell the patient, “Oh, like sign into the portal and check again tomorrow.” That means that someone else has to then go back and call them another day. So, being sure to stagger things so that there are slots available becomes important.
Our COVID vaccine clinic at our clinic is only weekdays and only between 9am and 3pm, which is obviously not going to work with everyone's work schedule. I think that transportation is definitely also an issue. There are resources available and we try to connect people with it. But many of my patients struggle with how to get to the clinic. And being in the middle of the state, our bus system definitely isn't as strong as what you would have being in Boston or another major city.
A lot of my patients are, to some extent frontline workers. But not in the sort of industries that were most prioritize things like foodservice or education. Most of my patients work in things like house cleaning – which still requires them to be around people, but isn't necessarily a prioritized group.
As much as we as a community health center, can speak to our patients and discuss their individual fears. We are not for the most part insiders to their community, which is a huge issue with many community health centers. That in order to get staff you end up recruiting people who aren't members of the community. So I certainly hope that within the populations that I work with, there are community leaders, whether formally or informally, that are spreading awareness and addressing concerns. I'm not sure whether or not that's happening.
I'm hopeful that coming out of this pandemic, the interconnectedness of humanity from a health perspective increases our emphasis on providing access to everyone.
CREDITS
Sarah: Our special vaccine confidence series was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention or CDC. The CDC is an agency within the Department of Health and Human Services, also known as HHS. The contents of this resource do not necessarily represent the policy of CDC or HHS and should not be considered an endorsement by the federal government.
Stay tuned for more episodes coming up. We'll be exploring vaccine confidence, best practices, misinformation, hesitancy, partnering with community-based organizations, and how nurses can share their vaccine experiences.
And for more information about related upcoming webinars and where to find COVID-19 resources, log on to nurseledcare.org and stay up to date with us on social media @NurseLedCare.
At the Core of Care is produced by Stephanie Marudas and Emily Previti of Kouvenda Media and mixed by Brad Linder.
I'm Sarah Hexem Hubbard at the Pennsylvania Action Coalition. Thanks for joining us.
This project was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention (grant number NU50CK000580). The Centers for Disease Control and Prevention is an agency within the Department of Health and Human Services (HHS). The contents of this resource center do not necessarily represent the policy of CDC or HHS, and should not be considered an endorsement by the Federal Government.
