Current, future providers emphasize mental, physical health connections

“Where does it hurt?” doctors and nurses ask countless times a day; and yet the answer may not match what’s on the patient’s chart.

“You can’t separate mental health from [physical] health,” said Tricia Gatlin, who holds a doctorate in nursing education and is the dean of the Wegmans School of Nursing at St. John Fisher University. “The body is not divided like that; although for a long time we thought it was. I think now it’s coming back together.”

Acknowledgement of the inextricable link between emotional and physical well-being is a major focus of training for future health care providers. At the same time, current providers realize that how they feel about themselves affects their work.

Alweis
Alweis

“Taking care of yourself is an important aspect of taking care of your patients,” said Dr. Richard Alweis, associate chief medical officer for education at Rochester Regional Health. “Denying your own feelings, denying your own situation may seem like a good short term thing … Actually, it’s a terrible strategy and hurts people.”

Integrating mental and physical health has been part of nursing curricula for many years and has been the foundation of the educational philosophy at the University of Rochester Medical Center since the late 1970s.

As with other aspects of life, the COVID-19 pandemic made educators think about how they teach and support providers’ emotional needs.

Gatlin
Gatlin

“COVID has made us all stop and take that step back and say, have we really been doing a good job of this,” Gatlin said. “What can we do? How can we do more? Should we do more? Let’s think about where we’re introducing some of this, let’s be more intentional … It’s just been more of making sure that we’re listening to our students and teaching our students to really listen to the patient.”

The pandemic arrived when the American Nursing Association had declared 2020 the Year of the Nurse. The celebration turned to a reckoning of the roles that nurses play and the importance of self-care.

“It really was this launch for us to start looking at when we think about the healthy nurse … we have to teach them to be holistic with themselves and holistic with their own care,” Gatlin said. “What we’re doing more of right now is making sure that we’re teaching that so (students) can be more resilient as they’re moving into the workforce.”

Gatlin said the St. John Fisher faculty are working nurses, so they understand and can model the balance between their work and professional lives and the need for self-care so they can be at their best with patients.

At Rochester Regional, medical students, residents and fellows are taught the importance of being “present.”

“If you’re sitting in the room patient while they’re talking to you and you’re paying more attention to the electronic health record and you’re typing and you’re not making eye contact … the patient isn’t getting the sense that you’re paying attention to them and their concerns,” Alweis said. “They’re not going to open up because they feel you don’t care. If you’re not present in the moment when the patient is opening their hearts, they’ll clam up, they won’t even go on tell you what’s really going on. So it all starts with presence.”

Something as basic as a provider reflecting on what brings him or her joy can affect their feeling of being present and build connection with the patient.

“It’s much less prescriptive and more like a mentorship, if you will,” he said. “It’s like from personal experience. These are the things that helped me maintain my joy and help me get through tough days. Let’s talk about what helps you maintain the joy in what you do and what will help you get through the tough days.”

As for how a provider’s mental health affects the patient’s overall well-being, Alweis said studies show that patients who are cared for by burned-out providers have worse outcomes than those that are taken care of by providers who are not burned out. “Taking care of yourself is an important aspect of taking care of your patients that will improve their outcomes.”

Medical educators said students are demanding attention to their mental health, which, in some cases, has led to intergenerational strife.

“The students are saying, ‘This is important, we’re paying a lot of money for our education, therefore it’s going to have to be important to you,’” Alweis said.

Cardella
Cardella

The University of Rochester Medical Center has built its curriculum around the biopsychosocial model pioneered in 1977 by George Engel, who held appointments in the UR departments of psychiatry and medicine. Engel paid attention to a person’s disease as well the social, emotional, cultural and environmental factors affecting the person’s health.

“The real importance is approaching the patient in their own experience of illness rather than just assuming disease is the only entity to focus on,” said Dr. Laura Cardella, who completed her medical degree at UR School of Medicine & Dentistry. After residency at Brown University, she returned to Rochester and now oversees psychiatric education at URMC.

Students are immersed in that style of learning throughout their four years. They are supported in their development though a program to bolster resiliency, which is led by Tressa Newton, director of Student Enrichment, Career Counseling and Wellness Programs.

“We’re trying to increase the dialogue and making sure we’re accessible,” said Newton. “Our students want to be connected. They want to know us.”

Newton
Newton

She said many first-year students visit frequently, possibly drawn by the chance to play with the therapy dog and enjoy a snack.

“That speaks to Rochester,” Newton said. “We really want you here. You’re ours. We want to take care of you, we want to help you. And I think that’s part of that relates all the way back to the bio psychosocial model. We’re here for all aspects of whatever is going on in your life; let’s help you get to your goal.”

Self-care is prominent in the curriculum of the Education and Human Services Department at Monroe Community College.

“We talk about self-care practices,” said Elizabeth Mandly, assistant professor in the department and coordinator of the addiction counseling program. “It’s hard work helping people and so you have to do something to sustain and replenish yourself … What I say to them most often is that you are the instrument of help. So you have to be the best instrument you can be.”

Mandly
Mandly

Mandly has been teaching for eight years but has been in the human services field for much longer. She said focus on self-care and counselor wellness has increased over the years. Some of it stems from ways to sustain the workforce.

She said that if students coming into the MCC program don’t grasp the importance of tending to their own emotional needs, they leave with the realization.

The benefit is twofold.

“There’s understanding how to stay in the field that you’re passionate about, so there’s career sustainability,” Mandly said. “I think that understanding more about yourself can make you a more effective counselor. It gives you the tools that you can use with your clients who need to think about their own wellness as they pursue their mental health or their recovery.”

Patti Singer is a freelance writer in Rochester. Contact her at [email protected]

Rochester Regional to open College of Health Careers at former Irondequoit Mall

Rochester Regional Health is dealing with a nursing shortage head-on. The health services organization has welcomed the first class of students to its College of Health Careers, located in the once-abandoned Macy’s building in the former Irondequoit Mall.

Eric Bieber M.D.
Eric Bieber M.D.

“Once again, we have created an innovative community asset that demonstrates our deep commitment to health care access, economic development and environmental sustainability,” said RRH President and CEO Eric Bieber M.D. in a statement this week.

The College of Health Careers, which includes Rochester Regional’s Isabella Graham Hart School of Practical Nursing, offers students a navigable path to training and education across the nursing spectrum from Licensed Practical Nurse (LPN) to Registered Nurse (RN). Officials said the expansion represents not only Rochester Regional’s commitment to the advancement of nursing education but also its leadership in sustainability through urban renewal.

“The growth and evolution of our education programs combined with our ongoing efforts to revitalize vacant buildings will help create jobs and generate new businesses, and enable us to continue to provide excellent health care to the families who count on us every day,” Bieber said.

While most coursework has moved online during the pandemic, the college’s brick-and-mortar home is nearly ready to open. The state-of-the-art campus is creating a leading-class institution of higher learning for nurses and health care professionals of the future, officials said.

“Access to educational opportunities is a gateway to good jobs and a brighter future,” said Deborah Stamps, Rochester Regional executive vice president, inaugural College of Health president and chief nursing education and diversity officer. “The college will help increase the diversity of the healthcare workforce by providing economic mobility for those living in poverty or facing daily economic challenges. I am excited about the prospect of training hundreds of skilled nurses right here in Rochester who are dedicated to this community and the men, women, and children who live here.”

Data from the U.S. Bureau of Labor Statistics predicts that by 2029 the need for nurse practitioners will grow more than 50 percent. Other nursing jobs are expected to grow by 7 to 9 percent. The R.N. workforce is expected to grow from 3 million in 2019 to 3.3 million in 2029, a 7 percent increase. The Bureau also projects 175,900 openings for registered nurses each year through 2029 when nurse retirements and workforce exits are factored into the number of nurses needed in the U.S., a report from the American Association of Colleges of Nursing shows.

The College of Health Careers will encompass the existing Isabella Graham Hart School of Practical Nursing, a one-year Licensed Practical Nursing Certificate Program. Roughly 300 graduates each year will be qualified to sit for the LPN licensure exam in New York state.

It also will offer an Associate in Applied Science degree with a major in nursing. This is the College of Health’s first degree program. The two-year AAS degree is the minimum education required to take the examination for R.N. licensure by the state. The college also will provide support and opportunities for students’ continued professional development to Bachelor of Science in Nursing, Masters in Nursing and doctorate degrees in collaboration with area colleges and universities.

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Family First FCU, Greece Chamber to hold can drive for nursing scholarships

Family First Federal Credit Union is teaming with the Greece Chamber Charitable Foundation to raise funds to support nursing education scholarships through the foundation’s Daniel E. Richardson Memorial Fund.

On Saturday, Feb. 13, the organizations will hold a Super Bowl LV Can Drive, at which community members can drop off cans and bottles. The deposit refunds will be used to support nursing students in the Rochester community.

“We are so thankful for all that our health care workers do for us, especially during these challenging times. As a credit union started by teachers and rooted in education, we can’t think of a more appropriate way to give back to our community than by supporting our local nursing students,” said Family First CEO Tom Dambra.

The Greece Chamber Charitable Foundation board of directors recently awarded scholarships from the fund in support of three students of the Isabella Graham Hart School of Practical Nursing of Rochester Regional Health: Christine Seeger, Terrajah Nelson, and Shaniqua Williams.

“The Greece Chamber Charitable Foundation was established to support programs that prepare individuals for success in education and business. Through the Foundation’s Daniel E. Richardson Memorial Fund we are pleased to provide to nursing students from the Greater Greece and Greater Rochester region in the Isabella Graham Hart School of Practical Nursing and Rochester Regional Health System,” said Foundation President Michael Mordenga. “These scholarships are consistent with the Foundation’s objectives and will help these students pursue their careers in nursing while filling critical needs in our health care system and community. Our appreciation to Family First Federal Credit Union for their important support.”

In March 2018, the Greece Chamber’s Charitable Foundation established the Daniel E.
Richardson Memorial Fund in honor of Daniel Richardson, the foundation’s first board chairman and an active member of the foundation board of directors until his death in January 2018. Overseen by a foundation board that includes Dan’s widow, Carol Richardson, the fund supports grants and initiatives that help young people succeed in school, higher education and the workforce.

“I appreciate the generosity of Family First Federal Credit Union in joining the Greece Chamber Charitable Foundation, the Greece Regional Chamber of Commerce, Rochester Regional Health and many corporate and individual members of our community in helping to keep Dan’s memory alive and to support nursing and nursing education, a passion that he and I both shared,” Richardson said. “I know that Dan would be proud and grateful to be affiliated with all of you, as am I.”

Bottles and cans can be dropped off Saturday between 10 a.m. and noon at Family First Credit Union’s Penfield branch on Browncroft Boulevard.

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Follow Velvet Spicer on Twitter: @Velvet_Spicer

Nursing program receives $1.2 million federal grant

University of Rochester Medicine’s Nurse Practitioner Residency program will benefit from a $1.2 million federal grant that is expected to expand the program from two residents per year to four.

The U.S. Department of Health and Human Services Health Resources and Services Administration grant will provide $400,000 per year for three years to expand the program and add a rural medicine component.

The Highland Family Medicine Nurse Practitioner Residency program was developed in collaboration with UR School of Nursing. It is the first program of its kind statewide.

The Highland Family Medicine Nurse Practitioner Residency program was developed in collaboration with UR School of Nursing. It is the first program of its kind statewide. (photo provided)
The Highland Family Medicine Nurse Practitioner Residency program was developed in collaboration with UR School of Nursing. It is the first program of its kind statewide. (photo provided)

“We are very excited about this opportunity to expand our program and help provide more health care in rural communities,” said program Director Kristin Smith.

The program was created in 2016 and is accredited by the National Nurse Practitioner Residency and Fellowship Consortium. The HFM clinic is among the oldest physician residency programs in the country and is internationally recognized for leadership and innovation in the integration of behavioral health into primary care practice.

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Sands Family Foundation gives $3 million to double nursing program at FLCC

The Sands Family Foundation is giving $3 million to Finger Lakes Community College, providing the largest gift in that institution’s history and enabling the college to double its nursing program.

The gift is expected to cover almost half the cost of an expanded nursing wing on the FLCC main campus in Canandaigua, and allow the college to eventually double its enrollment to 80 new students in the registered nursing associate degree program each fall. FLCC will also launch a licensed practical nursing certificate that can be completed in a year. That program could offer as many as 56 LPN openings.

“Nurses provide the foundation for the excellent health care we enjoy in the Finger Lakes region,” said FLCC President Robert Nye. “We are grateful to the Sands Family Foundation for its significant investment in the people who will maintain that high level of care for years to come.”

The college and the foundation announced the gift Thursday morning.

“Medical institutions play a major role in the social and economic vitality of communities. The Sands family is proud to support FLCC’s efforts in elevating their nursing program to attract more nurses who will support our excellent hospitals in our surrounding communities,” said Richard Sands, co-chairman of the Sands Family Foundation.

 Thompson Health will partner with the community college to provide instruction for the nursing students, who are in high demand.

According to the NY State Labor Department, the need for registered nurses in the Finger Lakes region will rise to 15,660 by 2026, an increase of 18.2 percent  in a decade.

“We are looking forward to being able to say yes to many more of our applicants, starting in 2021. This means more students finding good jobs when they finish here,” Nye said.

Construction of the new Sands Center for Allied Health at FLCC is expected to begin in 2021 with part of the center opening that fall. The remainder will be completed throughout the 2021-22 school year. The wing will include a lab, patient bays, classrooms, meeting rooms and faculty offices. A health and wellness center for students will also be included.

The Ontario Board of Supervisors was scheduled to amend its capital plans Thursday  night to include the $6.8 million college wing. Additional funding will come from the FLCC Student Corp. ($250,000,) the FLCC Association ($200,000,) and the state ($3.4 million.)

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Diversity a key goal of healthcare education programs in Rochester

Local healthcare education programs make inroads on diversity.

When it comes to diversity in higher education programs for healthcare, two local institutions have made the grade nationally.

Insight into Diversity magazine gives awards each year to the higher education institutions across the country with the best track records for diversity in their professional healthcare programs. While the University of Rochester’s School of Nursing has won this award for some years running, this year the UR School of Medicine and Dentistry won for the first time, and the College at Brockport’s School of Nursing won for the first time, too.

These three programs were among the 43 nationally that won Healthcare Professions Higher Education Excellence in Diversity (HEED for short) awards from the magazine.

(Insights into Diversity also offers a general diversity award for higher education institutions, and Rochester Institute of Technology was one of 96 winners of that award.)

The awards reflect an institutional commitment to diversity that has been building for years or has recently been amplified. In some cases, the programs feature diversity initiatives similar to those at other schools, including some in the Rochester area, but it appears that a cumulative effort put them over the top.

Adrienne Morgan
Adrienne Morgan

UR “has been committed to increasing our diversity pool and our outreach for decades,” said Adrienne Morgan, assistant dean for medical education, diversity and inclusion at the UR School of Medicine and Dentistry.

For example, Morgan described a grant program UR participates in that starts recruiting minority and low-income students to science and health majors starting in middle school, with four-week summer intensives.

“That’s where you’re really starting to build your foundation, academically,” Morgan said. “It’s a great entry point for students to begin, hone their skills (and) understand what’s needed to be a researcher, physician, physician assistant (or) nurse practitioner.” While students as young as middle school know about doctors and nurses, they may not be familiar with some of the other professions within healthcare, she said.

It’s important to reach students that young, noted Margaret Kaminsky, dean of STEM and health at Monroe Community College, which also participates in the Science and Technology Entry Program that Morgan described.

“Choices made in middle school are going to determine how far a student can get in math and science through high school,” Kaminsky said. If a student doesn’t take accelerated math at the middle school level, that may prevent them for taking higher math, chemistry and physics later on, all prerequisites to healthcare degree programs.

Morgan recalled one STEP student at UR who shared that the program helped him realize how much he’d have to up his game academically to reach his newly formed goals. He went on to get a science degree in college and a job with NASA. He’s now pursuing a doctorate in a science field outside of medicine.

“Everybody who does the program isn’t necessarily going to enter the medical field,” Morgan said. “But everything they learn can be used in other professions as well.”

UR follows up with a research internship program for high school students that includes shadowing emergency room professionals, group journaling exercises, work in anatomy labs and other opportunities.

“We try to make them understand the steps they’ll need” to purse a degree in healthcare, Morgan said. “Many students who do the (summer) program end up being our students.”

Three key programs at the College at Brockport that helped the nursing program win diversity kudos:

  • Conducting an annual poverty simulation for students, an exercise in which participants are given a limited amount of income and resources and must use them to obtain basic needs in a prescribed amount of time.
  • Reverse role-playing with deaf actors. Nursing students play the patients who cannot use spoken language to communicate, and deaf actors and sign language interpreters play the caregiving roles. (Similar exercises are conducted at other local schools.)
  • Two-week clinical intensives in Costa Rica and Peru during school vacations, allowing students opportunities to study abroad and experience a different culture that their schedules would normally prevent.
Kathy Peterson
Kathy Peterson

All of these programs help sheltered students learn about different perspectives. Of the clinics abroad, Kathy Peterson, chairwoman of the nursing department at Brockport, said, “It really has changed more of their outlook on life, and what we have. It’s been life changing for many of them, and for our faculty.”

Students participating in the role-playing exercise really begin to empathize with the Rochester area’s deaf population, she said, and the poverty simulation teaches them how much hard work it takes to live in poverty.

Brockport, UR and MCC all described a somewhat diverse population of students, with an increasing number of male students entering nursing programs over the last couple of decades. Morgan said UR’s medical school and even nursing school generations ago used to attract mostly well-to-do students

“People are coming from all walks of life now to medicine,” Morgan said. “It’s not like it’s the family business anymore.”

Peterson said Brockport has always attracted more of a middle-class student body, but when she started teaching there 35 years ago, the freshman nursing class typically would have been comprised of 60 white female students.  Today’s class of pre-licensure nursing students at Brockport is about 14.6 percent minority and 16.2 percent male.

MCC’s Kaminsky didn’t have similar figures at her fingertips, but she noted that for some years when she taught basic chemistry, a prerequisite for healthcare majors, about half the students were minorities.

Keeping a diverse student body in school long enough to graduate can be a challenge because of income differences or other barriers.

“We have found — and this is national — that we do lose a higher proportion of our diverse students than our white students,” Peterson said. “We are actively looking at that and trying to support those diverse students with more engagement and more assistance.”

MCC participates in another grant program that provides funding for special programs for diverse healthcare students such as mentoring. It even offers small grants that can help them with expenses that could be roadblocks to their success. Kaminsky said she has approved grants for the $800 textbook that radiology technology students need and even for as little as $10 for printing so a student could print out course materials.

The growing number of healthcare students who are not white and female might find their gender or ethnicity presents an issue for patients.

Philip Phommala, a nursing student at MCC who is Laotian-American, said he hasn’t experienced racial discrimination, but he has been asked to switch out with a female nursing student when working with some patients. It’s usually the patient’s family members, rather than the patient themselves, that makes the request, he said.

“I try not to take it too hard. I do expect to have that happen from time to time,” Phommala said.

A men’s league for male nursing students at MCC provides a place for him to talk over issues like that.

Kaminsky, who has only been the dean over healthcare programs at MCC since August, said she has observed instructors tell students these issues are likely to come up in the context of sensitive issues, such as changing a catheter, and students should be prepared for it, and include a second nurse in the room.

And Peterson has heard reports — albeit rare — including a male cancer patient who didn’t want to be cared for by a male nursing student because he assumed male nurses would be homosexual. Yet she also heard a report from the maternity unit where both mother and father wore confederate flag clothing yet didn’t raise an issue with a black student nurse or black nursing instructor who attended them.

UR includes discussions about patient push-back in its classes, Morgan said, as such events can take a toll on students and professionals in the field, causing what she called “moral distress” over time. They practice coming up with responses to such patient requests, she said.

“Depending on who you are, it can happen on a daily basis,” Morgan said.  Whether hospitals should comply, and in what circumstances, with patient’s objections to being treated by healthcare professionals of different demographics is part of an ongoing national discussion, she said.

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Golisano gift of $5.8 million will create institute at Fisher for developmental disabilities nursing

St. John Fisher College and the Golisano Foundation announced on Tuesday a $5.8 million gift to the college from philanthropist B. Thomas Golisano to create an institute dedicated to training nurses in the care of people with developmental disabilities.

The Golisano Institute for Developmental Disability Nursing will be the first of its kind in this country, officials said. It will offer curriculum for undergraduate and graduate students, as well as a summer institute and conferences so working nurses can receive continuing education about health needs of this population. Additionally, the institute will partner with the Waterford Institute of Technology in Ireland, which provides  nursing degrees specifically in the area of developmental disabilities.

“We are honored to partner with the Golisano Foundation in advancing Tom’s vision for both the Rochester community and for individuals with developmental disabilities,” said President Gerard J. Rooney.  “This vital work and education will have an impact far beyond Rochester, and we are proud to lead the Golisano Institute.”

Continuing a series of transformational gifts aimed at improving the care and success of individuals with developmental disabilities, $5 million of this gift came from Golisano himself, and $800,000 from the Golisano Family Foundation, which is devoted to uplifting people with these intellectual disabilities.

“The Golisano foundation and Mr. Golisano himself have always been in the forefront of improving care and practices for people with intellectual disabilities,” noted Dianne Cooney Miner, dean of the Wegmans School of Nursing at Fisher. Cooney Miner will direct the institute.

Golisano has also made major donations to the Special Olympics organization, whose research shows that people with developmental disabilities often have unmet health care needs, limited access to health care, or are treated by health care professionals lacking training in how to care for them.

Cooney Miner said when medical professionals lack the training for dealing with a special population, they often fail to administer routine screenings or don’t fully treat or diagnose health conditions.

“When people are not comfortable, they choose not to do it,” she said. Some of the best nursing has come out of working with the unique needs of special populations, Cooney Miner said, citing the groundbreaking work the Hartford Institute at New York University has done with the elderly and Columbia University has done with veterans and their families, producing standards of care for the industry.

Fisher could do the same for care of the developmentally disabled population.

“Nursing could be a very powerful ally and advocate,” Cooney Miner said.

“Nurses play a critical role as primary care providers in health centers, and medical and dental practices,” said Golisano. “By preparing the next generation of nurses and thought leaders and by creating a network of health care professionals who care for people with developmental disabilities, St. John Fisher has demonstrated a commitment to making a significant impact on improving access to both quality and inclusive health care for people who are underserved.”

Ann Costello, director of the Golisano Foundation, said adequate health care is fundamental to the quality of life. She noted Golisano’s gifts have been made in that direction for developmentally disabled individuals for some time, including the creation in 2012 of the Special Olympics International’s Healthy Communities initiative, which aims to create greater access to health care globally for developmentally disabled people.

“Healthy Communities is about building best practices of care. It’s about all health professionals and systems understanding that this is an underserved population and quite vulnerable,” Costello said.

When Fisher proposed creating the institute with the help of the foundation, “It wasn’t a stretch at all for us to think they would be successful,” Costello said. “It starts with a champion.  St. John Fisher  and Wegmans (School of Nursing) stepped up and offered to be that champion.”

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