August 2007 Native Women's Health and MCH Conference

The following is a summary of information collected from the 5 groups of
nurses who discussed access, behavioral health, quality of care,
referred/regionalized care and patient safety. Not all groups got
through the information, but the conversations and networking were worth
their time. Thank you IHS nurses!

There were 38 nurses who participated in this session.

Total: 35 Rn's and 3 LPN's

They are from:

**[Group 1]{.underline}**

\*Crown Point, Mescalero, Mayo Clinic, Sissetion

\*7 RN's, 1 LPN's

\*Ages: 47, 54,60,42,53,36,43,55

\*Years of experience: 29, 10,23,20,27,6,30

**Key Principles:**

1.  Access of care: Walk-in, triage, ER; same doctor/patient

2.  BH-available, psych. And social worker

3.  Quality of care: "everyone's facility could improve."

4.  Referred and regionalized care: Referral system-contract health-
    referrals out that could be local (better for the patient); need
    liaison.

5.  Patient safety: complaint box, complaint sheet available;
    consortium; public meeting; concerned for every facility due to
    nursing shortage which is always the root cause.

High Turn over, staffing shortage

IT support not willing to change

No continuity of Care

Space issues, herding patients in and out

Refer patients out

Safety Issues- Similar names, issues with nsg shortage and patient
safety

Women's health System capacities:

Problems getting accurate data

Train RN's to provide PN/CBE

Limitations:

Autonomy- RN's not rising to the occasion

Administration acknowledge performance

Problem: No professional growth from the top on down

**Practical changes:** Professional growth, recruitment, team building

**[Group 2]{.underline}**

They are from:

\*Dulce, NM

\*ABQ Head start

\*Hopi Health Care Center

\*ER Indian Health Services

\*Tribal Health RH Clinics

\*PMIC

\*Hastings Indian Hospital

\*Winslow Arizona

8 RN's

Ages: 53, 31, 53, 42,31,53,59, 58

Years of experience: 8,14,20,5,8,32,36,17

**Key Principles:**

1\. Access and concerns: Increase land base of reservation, finding
cuts, walk-in clinics, waiting times, staffing. Women's health care
system capacities:

Low risk birthing center; 1/2 referred out; no deliveries;
transportation, 90 minutes; phone consulting

2\. Behavioral health: same day; issue- patient's jailed for evaluation
of observed behavioral health problems

3\. Quality of health care: good providers, short visits, complaints of
high provider turnover. Staff shortage, competency issues, no funds nor
time for training; travel\\mobile unit for health screenings

4\. Referred/ regionalized care: less contract health due to limited
funding, transportation issues, refusal of care by outside entities

5\. Patient safety: Space problems, issues with patient confidentiality,
old buildings and equipment

6\. Elements of care: Tele-medicine; first prenatal nursing clinic; OB
enrollment classes/OB intake; centering model of care

Limitations: Limited space and staff; old facilities

**Practical changes**: none listed (ran out of time)

**[Group 3]{.underline}**

Ketchikan Indian Community Tribal Health Clinic

Santa Fe Indian Hospital

Rosebud Indian Health Services

Chinle, AZ- OB/In-Patient

NTHC

Northeastern Tribal Health Center Ambulatory Clinic

6 RN's; 1 LPN

Ages: 35,27,52,46, 46, 37, 55

Year's experience: 5, 4, 3,24,6.5, 37, 16

**Key Principles:**

1\. Access: Walk-in, triage, ER, Continuity of care

2\. BH- available, both mental health and social work

3\. Quality: "everyone's facility could improve. Quality of care: need
for more nurses

4\. Referred and regionalized care: Referral system, contract health
(could improve access instead of referring out)

5\. Patient safety: communication- patient access to voice concerns
(complaint forms/box)

Concerns regarding nursing shortage and patient safety; fall
precautions/

Women's health care system:

No OB; OB/GYN, midwife

**Practice Changes**: Improvements: On moral, monthly nursing meetings,
improved tracking system, review each incident by risk management;

Practical changes: team building, moral building, reward system,
building trust, more preventative education

**[Group 4]{.underline}**

Billings Area Office

White river AZ

Catawba Service Unit

8 Rn's

Ages: 36, 57,26,42,62,60,34,53

Years of experience: 36, 10, 3, 15, 30, 38, 8, 6

**Key Principles:**

> 1\. Access: NP- Interm. Docs; transport out- no feedback, no prenatal
> care- transportation issues --would like to see walk-in for well
> babies. OB primarily referred out, limited to staffing availability;
> Women's health care capacities: Elements of care: High risk patients
> care, ambulatory care clinics, Limitations: Transport out if under 37
> weeks
>
> 2.BH- Social worker available, referral services outside facility, 24
> hour services for regional services; no interest in collaboration
>
> Quality of care: Dedicated providers, great quality of health
> resources; Quality of care based on staffing/patient rations-will
> improve quality of care

3.  Referred/regionalized care-outstanding care; good care but long
    referral rate (i.e. ortho/mammo services)

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2.  Patient safety- everyone's responsibility; med errors, near misses;
    need staff meetings to discuss gaps

> **Practical changes:**
>
> Increase education and provide time- i.e. educate at weight checks and
> bili-checks
>
> Monthly inter-reservation meetings- Providers share needs, etc
>
> Beef up PHN's
>
> Provide child care and transportation
>
> \*\*Indian Health Service- please provide list serve to share
> information such as on policies/equipment
>
> Standardize job descriptions
>
> Simulators available for training purposes
>
> **[Group 5]{.underline}**
>
> Tucson AZ
>
> South Central Foundation
>
> PIMC
>
> GIMC
>
> HHCC AZ
>
> Tohatchi Health Center
>
> 6 Rn's 1 LPN
>
> Ages: 39, 42, 30, 23,
>
> Years experience: 12, 30, 30, 6, 19 30
>
> **Key Principles:**
>
> 1\. Access: referrals to PHN, high risk OB, satellite clinics, same
> day access. Women's health care system:
>
> See many different tribes, diverse populations, facility may be
> limited by tribes
>
> 2\. BH- referral services during clinic, social services, "need
> improved access to BH"
>
> 3\. Quality of care; elements of care: limited by capacity and level
> of care available per facility
>
> Limits of practice: dependant of safety- related to staffing
>
> Staffing- nurses are well rounded/ flexible nurses
>
> 4\. High risk referred to larger facilities
>
> 5\. Patient Safety- follows JCAHO standards
>
> **Practical changes**: "sweet success" diabetes program
>
> Better recruiting and retention
>
> Appropriate use of nurses/can to management
>
> More care management/ patient education

Foster" team concept"

Crown Point, Mescalero, Mayo Clinic, Sissetion

Dulce, NM,ABQ Head start, Hopi Health Care Center, ER Indian Health
Services, Tribal Health RH Clinics, PMIC, Hastings Indian Hospital,
Winslow Arizona

Ketchikan Indian Community Tribal Health Clinic

Santa Fe Indian Hospital

Rosebud Indian Health Services

Chinle, AZ- OB/In-Patient

NTHC

Northeastern Tribal Health Center Ambulatory Clinic

Billings Area Office

White river AZ

Catawba Service Unit

> Tucson AZ
>
> South Central Foundation
>
> PIMC
>
> GIMC
>
> HHCC AZ
>
> Tohatchi Health Center