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.
NR725B-
Application to Clinical Practice B- start of new course
Tuesday,
May 6th, 2014- 4:00-7:00pm
The free medical clinic
progressed as usual today. I helped take
vital signs and determine why patients had come to the clinic. The patients were provided with a free meal. A difference in the clinic today was that a
representative from the Free Clinics of Iowa was in house tonight to help
patients sign up for Obamacare and Medicare.
Most patients don’t have access to computers and are unable to figure
out the complex initiation process for these insurance programs so it was very
helpful to have someone available to walk them through the process. I thought this was a wonderful service to
offer.
Most
of the patients today attended the clinic for med refills. I again noticed the need for affordable
medications in my community. I have also
begun to notice patient number dwindling as the nicer weather approaches. I wonder how the rest of the summer will go
and if we will have less patients than we do in the winter months?
Tuesday,
May 20th, 2014 – 4:00-7:00pm
I continued with the
same tasks of rooming patients by taking vital signs and interviewing the
patient about why they had come to see a physician. Today, most of our patients presented for
medication refills. It is surprising and
sad that there are so many people in every community that cannot afford their
medications. I remember when I worked as
an anticoagulation nurse that I had a patient that never took the Coumadin dose
that I advised. I became very frustrated
with him before realizing that he wasn’t trying to be noncompliant, but that he
was cutting his pills in half for financial reasons not thinking it would make
that much of a difference. I had a very
difficult time getting his INR level up to a therapeutic range. This happens often in all of our
communities. I am very proud that the
Free Medical Clinic in Boone offers patients medications for free or for a discounted
price. The free medical clinic also has
a partnership with local pharmacies to accept vouchers to help pay for
medications to be reimbursed at a later date.
It is wonderful to see community organizations working together for the
betterment of the local population.
Last, I realized once again that you cannot predict the type of person
that needs to visit a free medical clinic because patients consist of all ages,
genders, ethnicities, and socio-economic levels.
Tuesday,
June 3rd, 2014- 4:00-8:00pm
On June 3rd
I took on a new responsibility of arriving first to set up the clinic. My mother-in-law is the clinic scheduler and
usually does this job but she needed to be off this day and asked if I could
take over. We met at the clinic the week
before and she gave me a list of everything to get out and unlock so that the
clinic was ready to go by 5:00 pm by the time we open the doors for the
patients to enter. I hadn’t realized how
much time she put in before everyone arrives to set up the clinic or how much
time she spends calling volunteers to staff the clinic. There is a lot that happens behind the scenes
to allow Boone County to offer free medical clinic services to the
community. I arrived to the Methodist
church where the clinic is held before 4pm.
I had to unlock basement doors to get to our supplies, roll out file
cabinets of patient piles, set up tables and chairs, cover pool tables and
other areas that we don’t want used while the clinic is in progress, set up a
lap top and fax machine, set up plates and drinks for the free meal that
volunteers provide, prepare paperwork and charts for patients, and set up
nursing interview stations for vital signs and patient intake. There is a lot to set up to prepare for the
clinic.
At 5:00pm, we open the doors to let patients enter where they sign up in order and fill out paperwork. Patients can then eat the free hot meal that is provided by women’s organizations in the community. Nurses call the patients back in order to obtain vital signs and the reason for the visit. Then the patients wait for the physician to arrive between 5:30pm and 6:00pm or whenever the physician gets out of the clinic for the day. Most patients are very patient in waiting for a physician who is running late. This evening went smoothly and I waited for the last patient to leave as we cleaned up and put everything away for the evening until the next clinic. I now have an appreciation for all my mother-in-law does behind the scenes for every clinic to run smoothly.
At 5:00pm, we open the doors to let patients enter where they sign up in order and fill out paperwork. Patients can then eat the free hot meal that is provided by women’s organizations in the community. Nurses call the patients back in order to obtain vital signs and the reason for the visit. Then the patients wait for the physician to arrive between 5:30pm and 6:00pm or whenever the physician gets out of the clinic for the day. Most patients are very patient in waiting for a physician who is running late. This evening went smoothly and I waited for the last patient to leave as we cleaned up and put everything away for the evening until the next clinic. I now have an appreciation for all my mother-in-law does behind the scenes for every clinic to run smoothly.
Tuesday,
June 17th, 2014 – 4:00-7:00pm
Today
we only had around 15 patients total attend the free clinic. This confirms a trend of having fewer
patients in the summer months than in the winter months which could be
expected. Again, many patients were seen
for med refills. This continues to be a
trend of why most patients come to the free medical clinic. There are always a few with minor health
concerns but the majority of the patients need a medication. I really enjoy seeing the clinic work as a
well-oiled-machine. It is nice to see so
many volunteers- physicians, nurses, receptionists, women preparing a free
meal, the Methodist church donating the use of the building, etc. to make this
clinic a success. It is amazing what a
difference can be made in the health of a community with a vision and a group
of dedicated people.
As
I reflect on this semester’s service learning hours, my biggest challenge was
setting up the clinic by myself.
Everything went smoothly, but I was concerned I would forget to prepare
something important or volunteers would not show up. I was sure something would go wrong that was
beyond my control. In truth, I did have
volunteers not show up, but everyone that was there pitched in and helped
out. I realized once again that there is
really no problem that is too big that a good group of people cannot fix when
working together.
As
an individual, I find myself advocating for the free medical clinic in my
community. If people mention to me that
they have a type of donation, I remind them that the free medical clinic might
be able to use it. I also make sure that
people in the community know that there is a free medical clinic available in
Boone. I work PRN as the county hospital
and I will mention it to patients who might be struggling with finances at the
time. We have great discharge planners
at the hospital too that ensure patients know about the free medical
clinic. I also am continually recruiting
more nurses as volunteers. I make sure
to notify our new graduate nurses who plan to remain in the area that the free
medical clinic is always in need of volunteers.
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
