The goal of attending clinical is to gain practical experience to supplement and put into actual use the information in the text. Along the way, the goals are professional development, sharpening assessment and critical thinking skills, further utilizing and integrating new technology into practice, and gaining experience in collaborating with colleagues and staff. This semester I was assigned to the geriatric clinic at Woodhull, and overall it was a valuable experience. Throughout the semester, I was able to gain new insight into professional practice and get a feel for outpatient and ambulatory nursing.

When attending clinical sites in previous courses, the day was already in full flux, all care had been assigned and delegated, and I just became another cog in the wheel. However, this semester, I feel more a part of the team. The geriatric clinic does not open until 9. When I arrive, so are the rest of the staff. We go through the daily walkthrough, checking the cart, checking med counts, attending the huddle, and reviewing the paperwork for the upcoming day. It has added an entire new layer onto my nursing experience. My interactions with the rest of the staff are not confined to tasks and vital signs and meds, but rather we can also share personal information about our lives. This goes a long way towards building teamwork and making the staff a more cohesive unit, where the rest of the staff are not just their respective titles and functions, but people, which again is different from other clinical experiences I’ve had in this program. Also, the clinic has a social worker and a lawyer, helping to get more ready access to services and resources, as opposed to on a unit where referrals would have to be made for these services. However, while the clinic may provide quicker and easier access to social services, referrals for specialists are not as forthcoming. Referrals can easily be arranged, but the wait time for some services may be months. Often, we ask clients if they have an outside provider to refer them to for a shorter wait or even advise them to go to the ER for specialty treatment.

Each clinical site is to some extent a reflection of the neighborhood it is located in. This allows you to gain insight into some of the specific health and community issues of the population served. In addition, the geriatric clinic is an outpatient facility. Unlike a typical med surg or psych unit where I would only interact with the more acute cases, in an outpatient setting I can get a wider feel for the general health problems of the neighborhood. Woodhull Hospital serves a population that is mostly Hispanic. While Hispanic itself can be seen as an umbrella term covering several smaller subgroups, nonetheless there are a number of similarities. This allows assessment questions and patient teaching to be more focused to the population. It also means that when a new client enters, you have a better idea of how to go about assessing and phrasing questions.

This semester has given me plenty of experience in dealing with a specific population- elderly Hispanics with diabetes and/ or hypertension. It has therefore also provided me with an opportunity to become more culturally competent in dealing with these clients and others I will encounter in the future. I’ve been able to pinpoint some specific practices and foods that I can target in teaching plans. Based on information given in interviews with clients, after a while you can also begin to develop some area or culturally specific questions to ask new or returning clients that would not be asked otherwise. By the same token, I’ve also had to identify a major limitation in myself- the ability to communicate with non English clients. Doing clinicals at Coney Island, I cared for several Russian speaking clients, but was always able to find a classmate to act as a translator. While I never learned any medical or nursing terminology, I have enough experience with Chinese to at least break the ice and give the client a general idea of what I am trying to say and do. And while I’m nowhere near fluent, most are surprised and appreciative that I speak any Chinese at all. But this semester, it has been frustrating at times to be forced to take a back seat in patient interviews and teaching sessions because I have no Spanish ability. Perhaps that would be something to look into, both as a personal and professional growth opportunity. If we are to try and be empathetic to our patients, it is essential that we can listen and understand their complaints, but also placate their fears if they do not understand the barrage of technical information being thrown at them about potentially devastating illnesses.

The clinics at Woodhull use a PCMH system. Before a patient comes for a visit, a red flag will appear if any labs or diagnostics are missing or incomplete and allows us at the clinic to contact the patient. This helps streamline care. The goal was for the clinic to be entirely paperless in 2015. Here it is 2017 and the printer and copier are still two of the busiest workers in the clinic. It goes to show that for all the benefits of technology and for all the leadership meetings and project and process planning, implementation is a different matter. At any rate, truth be told, while the new spreadsheets do contain some new categories of information, I feel the old method was superior. The columns were more organized, and information from multiple patients could fit on one sheet, as opposed to the new system where only two patients have their labs and prior appointments on a page. With a little tinkering, the old spreadsheets could easily be modified to include a few more columns for data, and could also be set up for a specific doctor on a specific day, making the paperwork much more organized and reduced. I even mentioned this to the RN of the clinic and the supervisor when she came in to stress that going forward the new sheets were used, as staff were continuing to print them out using the old format. Still, just follow the institutional guidelines and policy, and let the rest fall into place. As professionals, we should strive to find areas of improvement, but need to remain compliant with the policies of the hospital.

The clinic screens each patient for diabetes, hypertension, and depression. Standardized questions using a Likert scale are given to clients for the depression screening. As an outpatient clinic, assessments are thus limited to vitals and fingersticks, with a more in depth history taken for new clients. Some clients may come in with complaints of new or worsening symptoms, but these patients will be referred to the providers, who in turn refer them to specialists, or are brought to the emergency department if abnormal results are obtained on repeat attempts. But despite any limitations in assessments or interventions can be offset by the formation of more permanent relationships with the clients. All patients are scheduled to return for follow up appointments every three months, and some more frequently. Over time, staff can get to know this particular client, his or her traits, any other issues or concerns regarding care, and use the more intimate knowledge to tailor more specific teaching plans and recommendations. Compare that to a med surg unit, where you may see a patient for a few days before discharge, but then are unlikely to see the client again.