I have had lots of quality clinical experiences recently, and I thought I would share!
Last week, I completed my community & public health clinical. I went to three sites each week, each with different yet overlapping aggregates within the city. I put a lot of work into one of the sites, which was a unique faith-based organization that provides housing for 16 families, 40 single men, and 16 single women. One of the directors wanted us to work on bringing a TB testing clinic to the residents. All of them are at risk from their previous homelessness and current community living setting. Currently, they don't have a process for verifying the TB status of the residents. I agreed to take on the project, and I had no idea what I was getting myself into! Here's about how this whole process went:
Week One: Find the contact info for the TB case manager at the county health department. Find contact info for a local clinic that provides health care for the homeless, then find out they don't open until 1pm (very convenient, right?). Research training requirements for being able to read/administer TB testing to be able to provide free and easy help for the (potential) clinic.
Week Two: Finally talk to TB case manager. Apparently, she doesn't know much about this housing. I relay numbers and overall ideas to her. She has to go to the nursing directors. Leave multiple messages for the local clinic for the homeless.
Week Three: TB case manager says the clinic may be possible! I answer more questions about the details of the housing and residents. More failed attempts at contacting the clinic by phone and email.
Week Four: Health department says they don't have enough funding to provide enough tuberculin tests to cover the residents. They don't get funding from the state or federal levels for TB testing. Finally get in touch with the local clinic. My contact says that they are trying to set up a mobile clinic, and could include our site. He is going to forward my email to his boss. [Later we get turned down by them.] In perfect timing, nurses from our health center on campus offered TB certification for the nursing students! I am now TB certified until 2014!
Week Five: The health department had surplus influenza vaccines, and offered to have a mini flu shot clinic at our site! The residents are required to go to community meetings in the morning. There are two large groups: one for men, and one for women & families. Another nursing student and I worked together, and we taught the groups about influenza & the vaccine and TB. After we were done, other nursing students, the TB case manager, and another nurse from the health department, were all set up and ready to run the mini flu shot clinic. More residents than expected get the flu shot, and there were many questions about getting tested for TB!
Week Six: The health department had expressed early on that they wanted the site to develop and establish a process for testing new residents to prevent the need for a large clinic again. I came up with a draft for the site that included steps they needed to include. The director I worked with throughout this whole ordeal graciously thanked me. Even though the clinic failed, she was able to meet the TB case manager and show her the needs of the residents.
And that folks, is the state of public health in the United States! No funding for TB testing and a nursing student being the liaison between the health department, housing for the homeless, and a local clinic for the homeless.
Coming full circle, I worked along a nurse on an intermediate care unit on Friday from 7pm to 7am. I was actually on the same unit for both my clinicals last semester, so it was great to be back! It was overwhelming at first because we had four patients, and one of those was an admission right at the beginning of our shift. The day before, I had been reviewing practice NCLEX questions and one mentioned a hyperosmolar hyperglycemic state. I had no idea how that was treated....but I do now! Our admission was diagnosed with a hyperosmolar hyperglycemic non-ketotic state. Nothing like studying for NCLEX with a live patient!
I have another night shift on the intermediate care unit Monday night. The third week in March I start the clinical for psychiatric nursing. It's hard to believe these are my last clinicals!!
