29 Jun 2017

From Patient to Provider

From Patient to Provider

Author: Wings  /  Categories: Campus, Wings  / 

Sandra Sanchez and Estefania Jimenez have dreamt of becoming nurses ever since they were very young. Both women have a lot to offer their future profession. They are smart, driven and dedicated to their community. And they are both Hispanic bilingual and bicultural, something that is desperately needed in the professional nursing pool in places like Yakima County where nearly half of the population is Hispanic or Latino.

Estefenia JimenezWith less than a year left to study, Sanchez and Jimenez are close to fulfilling their dream. The two entered Heritage University as freshmen on the Act Six Scholarship. It was a bit of a leap of faith for them. At the time, Heritage offered only a two year Associate of Nursing degree, which led to a career as a licensed practical nurse. However, the wheels of change were in motion. Heritage was moving forward with plans to build a bachelor’s degree program that would lead to certification as a registered nurse. That work started when Nursing Program Chair Dr. Christina Nyirati joined the university. By the time Sanchez had completed the associate degree program, the four-year program was just about to launch. She and Jimenez were part of the first cohort of future nurses to enter the bachelor’s degree program.

Nyirati has a long history and a deep passion for ensuring underserved populations have access to health care. She is equally as passionate about ensuring the nurses that she trains are well prepared to fill the needs of the communities where they will be working. When she arrived at Heritage in 2013 to create the BSN program, she met with Carlos Olivares, CEO of the Yakima Valley Farm Workers Clinic, which is the largest network of community-based health care centers in the Pacific Northwest. She wanted to know how to best prepare Heritage nursing students to contribute to the work of Farm Workers Clinic, which has provided health care for migrant and seasonal workers since the 1970s.

Olivares laid out the challenge: “The patient population in the Valley is heavily Hispanic. We suffer a shortage of welleducated providers who can communicate with them effectively and help ensure medical compliance.”

Having bilingual and bicultural nurses eliminates the need for translators inside the exam room, and not only does that save costs, but it also changes the dynamic of the communication. “History and experience have shown us that patients have a better understanding of the nature of their visit, they comply better with medication taking and they understand side effects when there are clearer conversations with someone who speaks their language and comes from their culture,” he said.

That being said, he’s also quick to note that having welltrained nurses takes priority over having nurses who are bilingual and bicultural but who are not working at the “top of their license.”

Carlos Olivares“We have a limited supply of providers in the Valley. Primary care doctors are almost impossible to find. However, well-trained nurses can do a tremendous amount of that work. When I met Dr. Nyirati and the clinical staff she brought to Heritage, I saw they were highly qualified, and I knew they would graduate the best-trained nurses in the system.”

Another benefit to the introduction of a BSN program by Heritage, added Olivares, was the additional educational opportunity it would provide to young people in the Valley.

“I want kids to have this opportunity. I want to be sure they are tutored and brought up, and I know Heritage has always been in that position. That makes our partnership critical.”

The BSN program was designed with Olivares’s key tenets in place. It’s a tough curriculum with high expectations, but students receive a lot of support.

“Not all of our students come to us college-ready, but they are all very talented,” said Nyirati. “We take a very special interest in them and provide mentoring and intervention if needed. We also have excellent faculty here in humanities and the sciences and a nurturing environment, so by the time they are admitted to our program, they do very well.” “Dr. Nyirati listens and makes things happen,” agreed Sanchez. “She’ll even study with us, if we need it. The faculty teaches us to speak up, to be advocates for ourselves—and that has empowered us to be comfortable as advocates for patients and their families.” Jimenez believes another philosophy of the program–to be mindful and aware of the patient in every moment—has made her a better nurse. “We don’t just see the presenting problem; we are taught to see the patient as a person. We don’t focus so much on mastering skills that we forget why we became nurses in the first place.”

Patients Become Providers

Students apply nursing skills through a series of clinical rotations in medical surgical units, mental health facilities, hospice care, family medicine, OB-GYN and even Seattle Children’s Hospital. One of the sites is Farm Workers Clinic in Yakima, where Sanchez and Jimenez were patients during their childhood.

Sanchez was a baby when she  first started going to the clinic, and she laughs that her medical records are still there, after all this time.

Visiting Patients“It was amazing to be back,” she said. “I had a good experience there as a patient and as a student. In fact, I’m in the process of becoming a patient there again. I'm on the wait list to have the clinic be my primary care provider.”

After Jimenez and her family moved to the U.S. when she was 10, they received medical care at several Farm Workers Clinics, including the Yakima location. “I approached one of the doctors and told her she had been my doctor when I was little!” remembered Jimenez. “As a kid, I would look at the medical assistants and nurses and think about how I wanted to do that someday.”

The students shadowed nurses, watching them handle phone triage and traveling on home visits to postpartum mothers and their babies. It was during one of those visits that Jimenez saw firsthand what Olivares described—how cultural differences had the potential to create misunderstandings between providers and patients, even through something as simple as how long it took a mom to pick up her crying infant.

“Once you get into the field, it’s easy to think certain things are common sense or known to everyone, but that’s not always the case,” Jimenez said.

Like Sanchez and Jimenez, most Heritage nursing students come from the Valley, so they share the culture and language of their patients. Speaking the native language of the people they care for and understanding the nuances in those conversations helps bridge communication gaps.

“Throughout our system, bilingual providers exceed 40% [of our staff]; however, not all are bicultural,” explained Olivares. “In the Valley, only about 30% of our nurses are bilingual and that has been a big challenge. For a non-bilingual nurse to function effectively, they need a translator.”

Sanchez and Jimenez earned perfect scores in Spanish proficiency on the ALTA Language Test, making them the first Heritage students to provide translation at the clinic. As additional students join the BSN program, the number of highly educated, Spanish-speaking nurses is expected to grow, making good on the promise Nyirati made to Olivares during their first meeting.

As Sanchez and Jimenez begin their final year in the BSN program, neither woman is quite sure what type of nursing job they want to pursue. Both enjoyed making home visits and community-based care; Jimenez was also struck by the great need in mental health care and the stigma that remains for those who struggle with it, so she’s drawn to that field. Sanchez and Jimenez are certain, however, of one thing: after they cross the stage with their diplomas in hand, they plan to stay right here in the Valley where they can leverage their leadership drive with their sharply honed nursing skills to bring transformation to the community they call home. plan to stay right here in the Valley where they can leverage their leadership drive with their sharply honed nursing skills to bring transformation to the community they call home.


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