Ramblings on Expanding Nursing Practice

 

 

I asked Martha Barry who worked with me at the Erie Family Health Centers in the early 80s, to remind me if the Certified Nurse Midwives delivered babies.

 Here’s what she said:

The model for the Certified Nurse Midwives (CNM) when I arrived was outpatient care only. The CNM did all of the New OBs and sorted out the high-risk patients and cared for the other patients throughout their pregnancies, post-partum and follow-up gyn care. Prenatal care was intense case management. (We took) a lot of care and time to be sure no one fell through the cracks and got “lost to follow up.” Luckily, we could utilize the community health RNs to help find patients who did not show up for a visit. At the beginning, Medicaid was not widely available to all low-income pregnant women and especially not to non-citizens. The patients would be on a payment plan and would need to pay by “7-months” and it was a deal that included their prenatal, postnatal and delivery costs. I remember patients bringing their money stuffed in their bras to pay up at that 7-month mark. Deliveries were at Ravenswood Hospital. I wish I could remember the cost. The consulting OB physician would come to Erie for a few hours each week.

I also remember a few patients who worked at the live poultry plant and they said that although they had no health insurance, the boss would pay their delivery fees! 

I was preparing for my talk to the first class of AdvancingPractice, a one-year fellowship to develop quality care and nursing leadership at the clinic I had worked in over 30 years ago and written about in my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers.

I read Martha’s words to the group of eight APRN Fellows especially showing the generosity of the poultry plant employer. Then I told the Pigeon Lady story from my book that ends with a neighborhood funeral home director footing the bill for the wake and burial of one of our patients. He then turned around and donated that amount back to the clinic. (It’s complicated) I wanted to stress the interrelatedness of the surrounding community on the health care clinic. 

Part of my presentation was to discuss the historical context of the advancement of nurse practitioners and nurse midwives (collectively labeled Advanced Practice Registered Nurses, APRN).

One of the handouts for the class (Expanding Access to Primary Care: The Role of Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives in the Health Center Workforce, National Association of Community Health Centers, September 2013) plunged me back to the time I and other new APRNs in the Chicago area were struggling to justify our right to practice to the full extent of our training.

How much had I forgotten—maybe wanted to forget. For example, back in 1957 the American Nurses Association developed a definition of nursing that would retard the advancement of nursing practice for decades: nurses were neither to diagnose nor prescribe. And some groups of nurses called us “little doctors” and didn’t support developing educational programs in nursing colleges.  

I hope the new Fellows I spoke to learned from my presentation something about the historical context of the role, the significance of the role in the community setting and the potential of the APRN career choice. 

I close with a quote from the NACHC fact sheet:

An expanded role for nursing is an idea deeply rooted in nursing’s past and from it, much can be learned for today. Indeed, nurses should take this historical opportunity to think creatively about recycling elements of past practice for today’s unique context—perhaps initiating state-of-the-art nurse-run clinics in rural and inner city areas; reaching others by telenursing; and collaborating with designers in technology firms to create Apps and other high tech solutions to bridge gaps that exist in healthcare today. To do so, they must first read and understand the impact of the historical antecedents, cornerstone documents, and legislative acts that contribute to the nursing profession’s rich history. 

 

Expanding Access to Primary Care: The Role of Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives in the Health Center Workforce, National Association of Community Health Centers, September 2013, Page 9


 

 

Back to where it started: Chicago

I flew into cold, snowy Chicago last week to discuss my book at the main facility of Erie Family Health Centers. This felt like a dream as I stood behind the lectern gazing at the audience that, believe it or not, included a few familiar faces from some thirty years ago. I had been invited to read from my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers.I was discussing EFHC’s humble beginnings to this group of employees seated in the conference room on the third floor of an impressively designed modern building.

The main clinic that I remember was housed in a community center. Children’s laughter in the after-school program and the sound of the ball dribbling on an indoor basketball court easily penetrated the partitioned walls of the exam rooms. The dedicated staff experienced delayed pay days when revenue came up short. The clinic where I worked, a short walk from the main center, had mismatched chairs in the waiting area, second hand medical equipment, and roaches in the cabinets. In spite of the physical shortcomings, EFHC cared about the patients, the community, and its staff.

EFHC not only survived its humble roots but thrived and expanded. The non-profit organization now has 14 health centers, and more Advanced Practice Nurses (nurse practitioners and midwives) than doctors and is recognized as providing the highest quality of care by the US Department of Health and Human Services. The Chicago Tribune named EFHC as one of the top workplaces in 2018.

I am honored to be part of EFHC’s history.

 

Retired Nurse Practitioner & Author Marianna Crane presents her memoir,
Stories from the Tenth-Floor Clinic
On February 20, Marianna Crane, retired Erie nurse and author, met with our nursing staff to discuss her memoir, “Stories from the Tenth-Floor Clinic,” which movingly recounts her experiences as a nurse caring for the underserved elderly at Erie in the 1980’s.
We had a full room, a great discussion about the nursing profession, and over $300 were raised for Erie’s patients through the sale of her book!
Please join us in continuing to support Crane’s work! Keep up with her on her blog and website, Nursing Stories.
Buy the Book!
Proceeds from the sale of Crane’s memoir go towards providing quality care for Erie’s patients.
Crane with Dawn Sanks, Director of Health Center Operations at Erie West Town
Crane with Dr. Lee Francis, President and CEO
A full room!
Erie Family Health Center | 312.666.3494 (city) | 847.666.3494 (suburbs) | www.eriefamilyhealth.org

Spotlight: Marianna Crane

This appeared in the September 2017 Erie Family Health Center Donor Newsletter

 

Anniversary Spotlight: Marianna Crane

 

Over thirty years ago Dr. Sally Lundeen, a nurse and Erie Family Health Center’s first Executive Director, spearheaded a project that would provide care for the underserved elderly right where they lived. The Senior Clinic* opened on the 10th floor of an apartment building on 838 N. Noble, then managed by the Chicago Housing Authority specifically for low-income elderly residents. Marianna Crane was one of the first nurses to join Dr. Lundeen in this endeavor. She had recently left the VA Hospital, disappointed that, due to a lack of funding, she wasn’t able to provide the specialty care she knew that the elderly there needed.

Crane was at the forefront of a shift in health care, one of the first gerontological nurse practitioners at a time when geriatrics was barely beginning to be considered a specialty. The idea that older people required a different approach to care wasn’t yet mainstream, and many doctors weren’t interested. But Crane had grown up with older family members whom she cherished – her own grandmother lived to be 104 years old – and she believed that a change in approach to elder care was long overdue. “During school, I had two classes in geriatrics,” recalled Crane. “Chronic Disease I and Chronic Disease II. It was the older people on the job that taught me what was really important about nursing.”

At Erie, Crane, along with her collaborating physician, Dr. Olga Haring, cared for patients in the clinic while staff members visited isolated lonely seniors, monitored people’s medication, and even arranged breakfasts and luncheons for those who couldn’t afford food. Crane quickly realized that meeting the physical needs of the elderly was only one aspect of care. She witnessed older people being emotionally or physically abused by their family members, and older people with depression or other mental health issues who needed someone to talk to. When she would make home visits, she was often unsure what she would find on the other side of the apartment door. She waded her way through hoarders’ stuffed living spaces, nursed sick alcoholics, and worked closely with an ambulance service to ensure critically ill patients were delivered to the right hospital. But she felt that this was the care she needed to provide. “It was such a unique model of nursing, and the job was so different from anything I had done before,” she said. “Our community nurse would give exercise classes including swimming lessons at Eckhart Park. We brought in a podiatrist, negotiated reduced fees with a local ophthalmologist. We’d host free breakfasts every single Friday. It was just so unique.”

Crane was with Erie for five years before moving on to provide home care at the VA Hospital in Durham, North Carolina. She is now retired and is an active volunteer at a local hospital, where she serves as co-chair of the Patient Advisory Council, recommending ways to keep patient care running smoothly and efficiently.

Crane is also a writer (check out her nursing blog at nursingstories.org) and is working on her first book, a memoir about her experience at Erie Senior Clinic. The book will be published by She Writes Press at the end of August 2018, and Crane has generously pledged that a portion of the proceeds from the book go towards patient operations at Erie Family Health Center.

 

*While the Erie Senior Clinic has closed its doors, Erie remains committed to serving elderly patients and connecting them with the resources and referrals they need for a healthy, comfortable life.

 

 

 

My Book Comes to Life

This past weekend I traveled to Chicago to attend the celebration of the 60th anniversary of the clinic where I worked 30 years ago. The clinic sets the stage for my memoir: Playing Sheriff: A Nurse Practitioner’s Story. The formal function on Friday had 500 in attendance but it was to the intimate and informal Alumni Luncheon on Saturday that I brought a prepared presentation: a short intro and a modified chapter to read during open mike.

I write, as writers do, in isolation. Over the years, my book gradually disconnected from the reality that spurred its inception. At the luncheon, when I stood in front of the room with microphone in hand, I realized this was not a time or place for a formal reading. The tightness in my throat surprised me. Here among the alumni were those who worked with me back 30 years ago at a clinic that defied the establishment by using nurse practitioners and midwives as primary providers and hiring doctors who supported the nurses by ignoring their ultra-egos and espousing the team approach.

I decided last minute to tell the story of the Pigeon Lady. Characters who peopled my book morphed into living, breathing individuals sitting at the tables before me, nodding in agreement about the series of events I described because they were there. At that moment, my book came to life.

 

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