It Takes a Community (Nurse)

nursing student talking to dental patient

Published September 3, 2016

Becoming a culturally-competent, globally-minded health care professional can begin anywhere – for 10 nursing undergraduates and 30 dental students from UB, a school in Cookeville, Tennessee, served as the backdrop for an eyeopening, hands-on lesson about the realities of health care access in their own country.

Right here in the U.S. many people live in areas with little or no access to basic medical care. The Remote Area Medical (RAM) program offers an opportunity for those in isolated and underserved areas to receive health care in a mobile clinic setting. And, it offers students an opportunity to make a real-world impact.

“One of the reasons I decided to go to nursing school was to give something tangible to society,” explains Regan Howlett, BS ‘16. “I want to regularly do service work, and getting involved with RAM, with an organization that does meaningful work, was a great way to start.”

Cookeville, Tennessee, is a rural, impoverished area of 30,000 residents located 80 miles outside of Nashville. The mobile clinic offered general medical, dental, vision and preventive services and education to those in desperate need of care.

The students began each day at 5:30 a.m. as they, along with other volunteers, gathered vital signs and health histories for over 800 patients, some who waited in line for days to be seen at the mobile clinic. Educating patients on how oral health affects systemic health and the benefits of tobacco cessation was an important role for the students, along with assisting during dental procedures, passing surgical instruments, suctioning and often providing reassurance to apprehensive patients. Lack of access and inability to pay were the main reasons people travelled from miles around seeking health care.

“I was surprised by how many people knew they needed their teeth pulled but hadn't been able to get to a dentist to have it done,” says Jillian Barry, BS ’16. “They said that the local dentists had to have [them] come in for multiple appointments, paying each time of course, before they would simply extract teeth. And, after extractions, implants and dentures are not cheap, often times not covered by their insurance. So if you got your whole mouth pulled, that was it – no more teeth. It's a sad state of affairs, but an all too common one.”

Linda Paine Hughes, DNP, RN, NPP-BC, FNP-C, ANP, PNP; Susan Nierenberg, PhD, RN; and Molli Warunek, DNP, FNP-C, RN, all faculty at UB School of Nursing, accompanied the students. Nierenberg was proud to see students step into a new role and embrace it: “The RAM trip offers our students an opportunity to provide vital treatment and education to people who suffer as a result of inequitable access to care.” In addition to offering this experience to seniors in the future, consideration may be given to DNP students as well.

“I whole-heartedly recommend this experience to other nursing students,” Barry says, “because you get to dig deeper into the picture of community health – the people we treat in hospitals often suffer from multiple, interwoven problems. Even knowing the problems are connected, we are forced to ignore other issues in the face of their ‘chief complaint.’ Hospitals are meant for those who are too sick to be taken care of in the community. But once we send them back out, what support do they have?

“Primary care providers often do not have the time to spend educating, and the public often doesn't know what to ask. It's a lose-lose. That is why nurses in community health settings are so important. We are the stop-gap – the educators, advocates and sentries guarding the health and lives of those we care for. We have the knowledge and power to fight for care of the whole person and we can empower people to take their health into their own hands. That's what these clinics are about.”

-Sarah Goldthrite, Donna A. Tyrpak