About two years ago, Joanna Carrega, RN, traded her job as a hospital labor and delivery nurse at Gwinnett Medical Center for one at The Kids' Clinic, an affiliate of the hospital that treats medically underserved children in the community. She went from having a couple of patients each shift to seeing 20 to 50 children a day.
Lisa Cauthen
Nurse Joanna Carrega holds an infant as Dolores Hughes takes the baby's temperature at The Kids' Clinic in Lawrenceville. The Gwinnett Medical Center affiliate treats underserved children
"This is a hopping place, and we never sit down" Carrega said. "You get an entirely different perspective when you're doing community health nursing."
In 1993, Gwinnett Health System opened The Kids' Clinic with one parttime physician. Now there are seven fulltime doctors and six nurses seeing 100 to 150 patients a day, for a total of about 29,000 visits a year.
The majority of patients are uninsured or covered by Medicaid or PeachCare. About 70 percent don't speak English, so the staff relies on several bilingual medical assistants and a hospital language phone line for interpretation. "With the language barrier, and families unfamiliar with our health care system, it's a huge challenge to meet the needs of each child in a 15-minute appointment," Carrega said.
The clinic gets its share of respiratory distress and other emergencies, chronic conditions and injuries, but concentrates mostly on preventive medicine. In January, the clinic won the Walt Orenstein Champions of Immunizations Award for its immunization program. Since 2003, The Kids' Clinic has entered 6,517 clients into the GRITS (Georgia Registry of Immunization Transactions and Services) program, with 59,244 immunizations.
"I'm definitely using all my skills as a nurse," Carrega said. "I'm supervising nonlicensed personnel, doing telephone triage and assessing what patients need to be seen first."
Her practice is "family-centered," hands-on and complicated. She makes phone calls, sets up appointments, writes down directions and spends plenty of time giving education and advice to parents.
"We want healthy babies and the parents do, too. It's rewarding to be able to care for the whole family," she said.
It takes passion to work in one of Gwinnett Health System's three community clinics, said Lisa Cauthen, CMM, CMPE, director of community health and wellness for Gwinnett Health System. "You have to have a heart for working with the underserved. Our medical staffs have to be part social workers and excellent educators ... you can't tell a Spanish-speaking mom to alternate Tylenol and Advil for a child's ear infection.
"You have to write each time what medication needs to be given and the exact dose - it all takes a lot more time and patience."
In the late 1980s, the hospital began seeing a growing and more diverse number of women in labor and delivery who had had no prenatal care.
"We took a proactive approach and started an OB/ GYN clinic to meet the needs we were seeing in the community. We knew if we could provide better care and more education, these women would have better outcomes," Cauthen said.
Established as a hospital department in 1996, the doctors and midwives from the OB/GYN clinic deliver about 1,300 to 1,500 babies a year, and the number of mothers delivering without prenatal care has decreased. The OB/GYN clinic led to the start of a sick-care pediatric clinic (The Kids' Clinic), which evolved into adding well-care services.
In 1995, the hospital partnered with Gwinnett County to open the Miles H. Mason Jr. Community Clinic to provide indigent care for adults.
"That clinic sees about 4,000 patient visits a year and focuses on helping people manage chronic illnesses like diabetes or hypertension," Cauthen said. "Our goal is to keep people out of the emergency room, where care is costly and doctors and nurses don't have time to develop relationships with their patients or to educate them."
At the OB/GYN clinic, for example, the staff can treat expectant moms with gestational diabetes (a condition prevalent among Hispanic women) so that those pregnancies don't become high-risk and the babies don't end up in the intensive care unit.
"When moms attend classes and learn to manage their diabetes with diet and exercise, everyone benefits," Cauthen said.
The Gwinnett Health System funds the clinics through its community outreach budget, as well as through donations and grants from the United Way, the hospital foundation and other sources. The biggest struggle is handling a growing number of patients. "Armed with medical skills, a cultural resource book and map, interpreters and a willingness to help people who are between a rock and a hard place - our staff is taking nursing to a new level and making awesome improvements in people's lives," Cauthen said. "The satisfaction level is high, because they all know that what they're doing is a good thing. They're providing care and making a difference."