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 w
Tuesday,
September 16, 2014 – 4:00-8:00pm
Today
I again realized the importance of having a free medical clinic in my
community. I checked-in two patients who
were both seen in the community hospital ER within the past couple of
days. The ER treated them and then
referred them to the Boone County Free Medical Clinic for further evaluation
and follow-up care. One patient had been
given some very concerning lab results that required more testing and
follow-up. He was sent to the Free
Medical Clinic to obtain additional services to help pay for these tests. I can’t imagine how scared this patient must
be first, to find out he/she might have a very serious disease, and second, to
not know if you can even afford the treatment for the disease. The other patient had also been to the ER and
was being seen at the free medical clinic for follow up and to get access to
needed medications. Both of these two
patients were younger than me. I value
the importance of the Free Medical Clinic in our community. No matter what environment we practice in,
nurses will always be exposed to difficult situations where patients need our
assistance and support. I hope that I
offered these two patients a few comforting words today.
Tuesday,
October 7th, 2014 – 4:00-8:00pm
The free medical
clinic has had a low census for the past few months. In a way, this is a good thing if people in
the community no longer need our services.
The goal is to get people signed up for the Affordable Care Act or to
help patients find ways to pay for their medications and health care. Also, a clinic in nearby county opened a
special clinic for patients without insurance or limited insurance that is
available during normal clinic hours. I
assume some patients are choosing to go to that clinic at a more convenient
time than the first and third Tuesdays of the month. There are multiple reasons as to why the
clinic is down in census but there is a strong core group of people that will
keep the clinic going as long as there are still patients that need our
care. Physicians and other volunteers
are all still willing to do their part to help the clinic succeed.
Today
I was enlightened by the career hardships some patients encounter. One patient was injured at her job and needed
to be seen for a work excuse due to increased back pain. She was injured at work but her employer
would not recognize her need to be off work due to pain so she needed a doctor
to sign her excuse. Another patient was
leaving from the free medical clinic to go to work for the evening. I asked her how many hours she worked a week
and she said anywhere from 37-39 hours a week.
She just couldn’t work 40 hours or the employee would have to pay her benefits. She was not allowed to work more than 39
hours in a week. She was not full-time
and therefore she had no medical insurance.
These encounters made me feel very fortunate for my current job. I also realized how certain employers create
the need for patients to need free health care due to unethical work
practices. That being said, employers
are in a difficult situation trying to make ends meet as well. Finances are always a delicate balance for
all.
Tuesday,
November 4th, 2014 – 4:00-8:00pm
I
had the opportunity again today to act as the nursing manager of the Free Medical
Clinic. I arrived early and set up the
clinic with the help of another nurse. I
set up all the supplies including the computer for the volunteer who is
checking patients in, the supplies for the volunteer greeter at the door, and
the basic vital signs supplies for the volunteer nurses. The usual clinical manger had already set up
the volunteers and everyone showed up.
The clinic had more patients than the past several clinics have had. It was nice to have patients and be busy
again. I don’t know if it is the fact
that we are getting into the winter months and more people needing health care
or why the clinic was up in census today.
The clinic had 14 patients today.
The majority of the patients were there needing medication refills
rather than with acute illnesses to see the physician. The physician was done before the volunteers
who were preparing the medications for the medication refill requests. The patients all received a free hot meal of
warm soup and crackers and lemon bars thanks to other community volunteers who
bring food to the Free Medical Clinic twice monthly. It is nice to be able to assist in the
setting up of the clinic in a leadership position as a way to give back to my
community.
As I reflect on this
semester’s service learning hours, my biggest challenge has been how
eye-opening this experience has been for me.
I am proud to volunteer at the Free Medical Clinic because it is one way
I can help out people who are deserving of health care but unable to obtain it
due to life circumstances and unfair practices.
Even when people have full-time jobs, it doesn’t mean that they get
assistance with health care. It seems
like we are setting people up to fail and I find this unethical. I am very glad that people in Boone with excellent
insight and empathy started the Free Medical Clinic of Boone County.
As an individual, I find myself
advocating for the free medical clinic in my community. I 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. I would
still like to find a way to involve my nursing students but have to worry about
laws and regulations. I plan to look
into this further upon completion of the DNP program.
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
ould be after I complete my DNP.
Your involvement in the free medical clinic is excellent, and your plans to involve your nursing students serves the community even more. Exposing the students to this type of community involvement is a good lesson. Thank you for sharing. See your blog grade in the grade book in the class...Barbara
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