Boone
County Free Medical Clinic
“Societal
needs also require that healthcare professionals develop an awareness of the
health disparities that exist in health care today. DNP programs…address the unique needs
associated with healthcare disparities” (Chism, 2013, p. 317).
Description
of service learning site
The
Boone County Free Medical Clinic is part of the free clinics of Iowa
initiative. The mission of the free clinics
of Iowa is to “facilitate the initiation, operation and collaboration of free
medical clinics in the state of Iowa” (Free Clinics of Iowa, 2014, p. 1). Free clinics of Iowa is a large network of
free medical providers in the state of Iowa.
It is a donor-supported, not-for-profit organization. The organization supports over 30 free
medical clinics in the state. The free
medical clinics are found both in rural and urban areas of the state of
Iowa. The clinics are staffed by
volunteer physicians, nurses, and other health professionals. They provide basic health care services at no
cost to patients. The clinic can be free
due to physicians, nurses, and other people volunteering their time; churches
or other community organizations donating the use of a facility; donations of
cash, supplies, pharmaceuticals, and equipment from generous businesses and
organizations; and a no-cost membership with the free clinics of Iowa, which
provides operational tools and equipment, technology, and education. The state of Iowa has a program that offers
indemnification to free clinics and its volunteers for malpractice insurance
(Free Clinics of Iowa, 2014, p. 1).
The
free clinic of Boone County is held in the basement of the First United
Methodist Church in downtown Boone, next to the city library. It is open the first and third Tuesdays of
every month from 6:00 to 8:00 p.m. Family
practice physicians from the two clinics in Boone rotate throughout staffing
the clinic. Not all of the family
practice physicians have agreed to volunteer at the free medical clinic, but
approximately 5-7 Boone County physicians offer their time. Also, there is always a volunteer from the
Free Methodist Church who serves as the greeter for patients and gives them
paperwork to fill out. There are usually
2-4 volunteer nurses that take vital signs and list the problems/concerns of
the patients. There is one nurse that
organizes the clinic and is in charge of helping fill medication refill
requests the doctor approves. There is
usually one health care professional that assists the physician each night, as
well. Most of the volunteers have been
recruited from Boone County Hospital, where they are employed full time as
nurses, respiratory therapists, receptionists, social workers, or radiology
technicians. There is usually a diverse
group of volunteers at each clinic.
The
Boone County does not ask any questions about finances or health care need upon
admission to the clinic. Anyone can come
to the clinic for any reason. A patient
may or may not have health insurance. Any
age of patient can be seen, but at this point in time, the clinic does not
offer vaccinations. Patients are treated
on a first come, first served basis. Due
to this, it is not uncommon for patients to start lining up outside the door of
the clinic at 4:00 p.m. when the clinic doesn’t officially start until 6:00 p.m. During the winter months, clinic facilitators
try to arrive early to open the doors so patients do not have to wait outside
in the cold. The physician arrives after
the regular clinic closes for the day—around 5:30 p.m. or 6:00 p.m.—to start
seeing patients. Most nurses arrive
between 4:00-5:00 p.m. in order to start checking-in patients and getting vital
signs so that patients are ready to see the physician when the doctor
arrives. Patients that arrive early
usually end up spending quite a bit of time waiting in a large waiting room.
There are limited toys
available if children are in attendance.
There is a bathroom available for patients. The last few weeks, there was a
representative available from the free clinics of Iowa administrative office to
help patients sign up for Affordable Care Act health insurance through the
marketplace on the internet. Volunteers
from the Free Methodist Church and various women’s groups around town have
signed up to provide a supper meal for all patients each Tuesday night, as
well. The meal usually consists of CrockPot
meals such as soups, loose meat sandwiches, cheesy potatoes, a drink, and a
dessert. If there is food left after all
of the patients eat, then volunteer staff can eat too so the food doesn’t go to
waste.
There is a lengthy
application to fill out in order to apply to be a volunteer at the free medical
clinic. There is a general application
that is around 8 pages long and then a free clinics of Iowa application around
4 pages long. The free clinics of Iowa
organization completes a background check on any licensed volunteers and then
the volunteer also has to pay $8.00 for a national background check. The paperwork takes a few weeks to complete,
and then it takes about a week to be approved after it is sent in to the administrative
office in Des Moines.
My
role as a volunteer nurse at the free medical clinic
When I volunteer as a
nurse at the free medical clinic, my job starts after the patient meets the
greeter, fills out preliminary paper work involving their name, address,
allergies, and basic health history. The
paperwork then goes to the volunteer in the secretary position who enters the
patient into the online database and pulls the patient’s medical chart from a
filing cabinet if the patient has been seen at the clinic before. If it is a new patient, then a medical file
is created for the patient. When the
patient is checked in, a nurse calls them back to a different room. As a nurse, I take a weight and vital
signs. I have the patient tell me a
height and confirm their allergies. I
review the past health history with the patient and any medications they are
currently taking. Then we start to
discuss the reason the patient has come to the clinic. I try to get as much detail as possible so
the physician is prepared to see the patient based on what I have written on
the chart.
Why
I chose the free medical clinic of Boone County and my future plans
I was drawn to work at
the free medical clinic in Boone County because I had heard a lot about it from
coworkers at Boone County Hospital and from my mother-in-law, who is a retired
nurse that volunteers there. I have
wanted to get involved for a while but never found the time to do so. I figured it was a good way to give back to
my community using my nursing skills. I
also like to be a good example for my students by volunteering to serve those
less fortunate than myself. I can also
make it known to my nursing students that the community where they attend
school has a free medical clinic that is in need of volunteers. Those that stick around the area after
graduation might then consider volunteering, as well. In the future, I see myself continuing to volunteer
as a nurse on a regular basis. My
passion for volunteering at the free clinic is growing as I become more
comfortable with the other volunteers and in my duties as a nursing
volunteer. In the future, I might try to
assist the doctor or learn more about what the medication refill nurse does and
all of the paperwork that goes along with that role. I may try to take on a facilitator role in
the future, but that would be after I complete my DNP.
Tuesday,
February 4, 2014- 4:00-8:00 p.m.
This
was my first day of volunteering at the free medical clinic. I was nervous about what I would be required
to do. When I showed up, there were
already a few patients waiting outside.
One of the other nurses who has volunteered at the clinic several times
before gave me a quick orientation to the paper work and the expectations for
the nurses. After that, we were off and
running.
I
was surprised at the number of patients who were there for medication refills
only. The free clinics of Iowa offers
common medications for free. These
medications are usually given in only a one-month supply and come from pharmacy
donations of returned pills from long-term care facilities and other
sources. Most of the patients I checked
in come every month to get their next month’s supply of medications. I took quite a few blood pressures that were
elevated. Most of these patients were on
antihypertensive medications but had run out so they hadn’t been taking them
for a few days. All other vital signs
were usually within normal ranges. I
also noticed a lot of obesity among the patients.
As
I reflect on my first day of volunteering, I feel enlightened that there is such
a need for a free clinic in my town. I
really had never stopped to notice the need before. We saw over 20 patients that first
night. I realized that the clinic
facilitators put in long hours of dedication to see the clinic be successful
and efficient for the physician, volunteers, and patients. I realized the patients really appreciated
the free hot meal. I realized how many
people can’t afford prescription medications.
I realized how little most people know about their health history or dates
of prior surgeries.
Last,
I felt privileged that I got to be a part of such an awesome organization. I also felt a little mad at myself that I
hadn’t volunteered sooner. The free
medical clinic in Boone County has been up and running for almost 3 years and
it took being required to do hours for this course for me to get motivated to
fill out the long application. I have
really enjoyed getting involved, and I have already recruited three other
nurses to fill out applications and help out, too.
Tuesday,
February 18, 2014- 4:00-8:00 p.m.
Today
I helped room patients at the free clinic again. We had around 17 people right away. I was surprised at how young most of the
people I roomed today were. Most of the
patients I checked in were in their late twenties or early thirties. I found out a little bit about some of them
and realized they had jobs as a cook in a bar, a bartender, a roofer, or were
in between jobs. I had one patient from
a southern state, who had somehow ended up in central Iowa and really didn’t
have a warm enough coat on for a winter in Iowa. Some of the patients had a history of drug
and alcohol use and had some chronic health complications because of a previous
bad lifestyle. Some patients have had
emergency surgeries or medical interventions in the past with no health
insurance and now have huge medical bills following them around. Most of them have jobs and are hardworking
but don’t make enough money to support themselves and/or others or to afford
health insurance. I was very happy to be
able to offer them help and compassion as they sought medical treatment for
minor concerns or to receive prescription refills. I also tried to tell them about additional
community resources such as discount clothing stores and other places that
serve free meals.
I realized today how I
can be an advocate for the underserved and vulnerable and help them to feel
cared about and notify them of additional community resources. I also learned to be very thankful for how my
life has gone and for my family and friends/support system. I learned that I can be judgmental sometimes
about people that have “chosen” a life of drugs and alcohol or that can’t hold
a job. Now that I know I can be
judgmental, I can work on stopping myself from having preconceived ideas about
people. I don’t know the full life story
of any of these patients, and I never will.
What I do know is that all human beings deserve basic medical care and
deserve my respect.
This was probably the
best day so far in that I truly realized my role for serving a vulnerable
population at the free medical clinic.
It was also probably the “worst” day in that I realized how hard life
can be for some people.
Tuesday
March 4, 2014- 4:00-8:00 p.m.
Today
it seemed that most of the patients that I roomed were attending the free
clinic for medication refills. In fact,
I had met most of them on February 4th when I roomed them my first
shift at the free medical clinic. I
realized that a lot of patients have to come the first Tuesday of every month
to get another 30-day supply of their medications for the next month. I plan to learn more about how the
prescription refill program works in future shifts at the free medical
clinic. I wonder if there is any way to
get the patients 90-day supplies of basic medications. Today we had fewer patients and I was able to
network with my coworkers more.
Tuesday,
March 18, 2014- 5:00-8:00 p.m.
Today
I got to the free medical clinic late due to driving back from a trip to Minneapolis. Most of the patients had already been
roomed. I covered other volunteers so they
could eat. I talked with some of the
patients. I helped clean up equipment
and supplies.
I
have started to feel very comfortable volunteering at the free medical clinic
in Boone County. I look forward to
volunteering there each first and third Tuesday. I get to network with other registered nurses
in my area. I have met quite a few new
people and have gotten to know others better outside of the work setting of
Boone County Hospital. I have learned a
lot more about the needs of the population of Boone County. There are several people who cannot afford
healthcare or prescriptions, so the free medical clinic is filling a major
need. It really makes me wonder what all
of the patients did before 2011 when the free medical clinic opened. I hope in the future more counties in Iowa
will be able to initiate and sustain a free medical clinic.
References
Chism, L. A. (2013). The doctor of nursing practice: A guidebook for role development and
professional
issues (2nd ed.). Sudbury, MA: Jones and Bartlett.
Free Clinics of Iowa. (2014). Free clinics of Iowa: A volunteer healthcare network. Retrieved
