I have had an opportunity to do clinical hours at a charitable public health clinic. The organization provides medical care for uninsured, low-income earners, unemployed and undocumented individuals. The organization is affiliated with a local church which is next to the clinic, thus a strategic location for patients to access church resources and items donated to the charitable foundation. The complex hosts a weekly dental clinic, seasonal flu and COVID vaccination clinics and a weekly chiropractor’s clinic. The clinic is a valuable resource in the community and depends on volunteers from local institutions and community to provide care under the supervision of a nurse practitioner, volunteer doctors and other administrative staff.
Electronic health records have replaced paper charting in most large health organizations. Digital health technologies include a variety of innovations but may also significantly disrupt traditional or contemporary healthcare processes, workflows, and structures ( Weberg & Davidson, 2020).This organization uses paper charting due to lack of funds for electronic health record. Limited information like vital signs and lab results are scanned into the computer system however not everyone at the clinic is trained to access this information. A significant amount of time is often spent looking for patients charts to file lab results and to prepare for patient visits. Rolling out an electronic health system at this location would need a detailed strategy to layout logistics leading to a successful transition.
Patients that are seen at the clinic usually arrive as early as 0500, as much as the clinic opens at 0800. Providers start seeing patients from 0830 based of first come first served prioritization. Patients sign up and are instructed to wait outside to be called in. The facility has limited space, therefore can only take in a limited number of patients. An expansion of the medical clinic would be beneficial in allowing more patients to come into the building especially during extreme weather conditions. Limited space in patient rooms can be improved by moving the exam tables from the center of the room. The exam tables affect patient privacy as the patients often have one company, thus limiting the room capacity especially in an emergency.
The organization could benefit from better work structure that would result in a better workflow. The heavy dependence on volunteers translates to lack of mandatory training before practice and ongoing in-service training. I observed unprofessional behavior by a seasoned nurse, who said she was “too old for this.” That was her rationale for being mean to others working at the clinic. Her behavior was not addressed because she has volunteered there for many years. Switching roles and increasing responsibility involves adjusting to new assignments, expectations, and relationships with ourselves and those around us ( Dreher & Glasgow, 2017). This was my first encounter, but to my dismay, the others at the clinic responded that “she is always like that when under pressure.” Without commitment to a code of conduct, it is hard to address professionalism especially when volunteers play an important role in achieving the goals of the organization.
Mentors at the clinic range from retired doctors, nurses and students who volunteer or perform their clinical rotations at the clinic. The multidisciplinary team at the clinic is an advantage as people are often ready to help new people at the clinic. Students at the clinic range from public health, biomedical engineering, nursing, physician assistant majors. Although mentorship is unstructured at the organization, professionals are usually willing to learn from the college students who sometimes have more knowledge of efficient ways to function at the clinic. Overall, this is a good representation of an institution that allows healthcare professionals and other specialties to give back to a much needing community.
Dreher, H.M. & Glasgow M.E. (2017). DNP Role Development for Doctoral Advanced Nursing Practice (2nd ed.). Springer. https://www.springerpub.com/dnp-role-development-for-doctoral advanced-nursing-practice-9780826171733.html
Weberg, D. R., & Davidson, S. (2020). Leadership for evidence-based innovation in nursing and health professions (2nd ed.). Burlington, MA: Jones & Bartlett Learning