Season 2, Episode 2: WNC Nurse Family Partnership Spotlight

What is Nurse Family Partnership? How can it help YOUR patients? How can you access this resource? Did you say HOME VISITS? Angie Parker, RN and Vickie Lewis, RN answer all these questions and more in the episode. Enjoy!

Links: https://www.nursefamilypartnership.org/locations/north-carolina/ 

Office Number: 828-477-4178

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https://redcap.mahec.net/redcap/surveys/?s=XTM8T3RPNK 

Transcript

Nurse Family Partnership Edited Episode

Intro [00:00]: Hi everyone. Welcome back to Just us before Birth and Beyond. We're so glad to have you here today. Today I'll be talking to Angie and Vicky from Nurse Family Partnership. We're going to take some what family partnership is, it means to North Carolina, how providers and birth in the region can access it, and we're so excited to have you all here today. I, think we'll start just some introductions so, Angie, do you want to go first.

Angie Parker [00:33]: Sure, my name Angie Parker and I am a nurse [Inaudible 00:36] with Nurse Family Partnership and I'm also a board certified lactation consultant. I have worked with maternal health specifically in Western North Carolina for 22 years now. Starting in the hospital setting with the mother baby unit and doing lactation services. I helped start that at the hospital and then I transitioned to Nurse Family Partnership almost two years ago. I love what I do, I feel like I can really make a difference in the lives of the families of Western North Carolina and I really like being able to see the results in the work that I do and that's why I like NFP specifically.

Katlyn 01:11]: Awesome, thank you so much Vicky how you next?

Vicky Lewis [01:14]: Hi Katlyn,. I'm Vicky Lewis. I am an administrator, nursing supervisor for Southwestern Child Development Nurse Family Partnership. I have been here six years and I've been a nurse for almost 40 plus years. Most of my background was in the PACU and the emergency room. So, I basically knew how to treat and treat patients and never really ever understood what really became of them. I did transition at one point to third floor at the hospital where I worked labor and delivery and then became the director and Angie and I worked together up there. I went from that to Nurse Family Partnership and it's one of the best moves I've ever made because for the first time in my long career I'm able to see results. We see what happens with these girls that we work with and that has been the most positive thing I've had lately. I'll say that in my nursing career because you get to see what all of your efforts, what comes of them, and that's what makes Nurse Family partnerships so special.

Katlyn[02:19]: Wonderful. Again, thank you all so much for being here what a health of nursing experience to have here on the podcast I am so excited about this episode. So, I think we'll just go ahead and dive right in, and my first question to you is, in a nutshell, what is Nurse Family Partnership? What is this program, and how did it come to exist here in western North Carolina?

Vicky Lewis [02:43]: Nurse Family Partnership is actually a national program. It was started by gentleman named Dr. David Olson. He felt like some of our more, I want lower income, not low income or anything, but lower income mothers could benefit from having a little extra boost when they were pregnant and especially in their first pregnancy. He did a lot of trials. Most of them were in urban areas such as New York, and his last trial was in Memphis. He started the program using lay people just anybody that wanted to do this and do the home visiting and he found that didn't work really well. So, he tried to, he said, well, let's try something else. So, he started using RNs in the program and got the results. He to see that is seeing these mothers become great mothers, become self-sufficient and become the champion for their children and their lives.

Vicky Lewis [03:41]: How did it get in North Carolina? Well, it went all over the United States, and we do have it at right now in North Carolina. There wasn't that much in western North Carolina. There was one at Buncombe County and then there was one on the Cherokee Indian Reservation that served the Native American population. So, Southwestern Child Development decided to step out of the box a little bit because most of the sites are affiliated with a health department. They stepped out of the box, put in an application because you do have to apply for site and got it, and they had help from region A and several other community services to get the application to get approved, and that's how we got this site here in western North Carolina. We started covering four counties and we have now been blessed with the ability to cover all southern counties in Western North Carolina, and we need it because our moms and our older moms are first time mothers deserve a little help. I know I was scared to get when I had my first child and would've given anything for somebody to help be there and educate and support me, and that's what we do, and I think it's wonderful. It's free, it's voluntary. We take referrals from any source. We are companions to other programs, not competition. Our funding now that's another subject.

Katlyn[05:14]: Always when it comes down to the money, especially in healthcare, there's always a little extra that comes play. A little extra. Well extra.

Vicky Lewis [05:24]: You know, think about it Kate, and with all this travel right now five Bs prepared, registered nurses look at the degrees that Angie has, just for an example with all of that, it's not cheap. We get funding from North Carolina, but not enough to run the entire program. It comes through the Department of Health and Human Services, and we get a grant every year from them. It's wonderful. We appreciate their support, but again, we're not affiliated with the health department, so our entire funding doesn't come from them. So, this old, registered nurse here has to get out and beat the bushes to find scholarships, and I take that back. The word I want to say there is grants and I write them, and I apply for them and keep my fingers crossed that we get them, and that is how we find our program because it's not cheap, but the returns are double what money you invest in it.

Katlyn[06:21]: Vicky, thank you so much for that background. I want to hone on something that you said specifically, which is a home visiting part? I want this audience to understand that this program, the backbone of the program is that these nurses who are part of Nurse Family Partnership get assigned to a patient who is pregnant and go to their house to provide supplemental care to what they're getting in their prenatal office visit, which I think is so important. I have often been told that I'm an old soul and I tell the people a lot that I feel like a 75-year-old in a 32 year old body and something I missed something that I never had, which is healthcare that do exist in the home. I think it's the whole benefit for the patients and you guys both talked about seeing the results of your care and seeing the impact that your care is making on these patients, and I truly think that a lot of that impact comes back to being able to meet these patients literally where they're, where they live, and I can enjoy you all for bringing the program to Western North Carolina, and for keeping going and doing all grass root groundwork by getting it funded. So, thank Vicky again for that background content. So, again I mention I mentioned that your nurses are going out to the home and that is how this care is conducted. Can we get down dirty and you get little nitty gritty with what the actual services are, what are these nurses doing with their patients through this program?

Angie Parker [08:07]: So, there's a lot of stuff that we might do, and it varies per clients. So, we do in general, we prefer to meet with them in their home, but ultimately we can meet with them anywhere that they feel comfortable. Sometimes that might be at the park, sometimes we might meet with them at their doctor's appointments. It can vary greatly but we do really, really try to focus on getting into the home setting. We learn a lot about clients by being in the home setting and really can see some of their needs, and what's going on in that household. So, typically some of the things that we can do with these clients, we do provide some basic nursing care. When they're pregnant, we check their blood pressures, their weights. We check them for any, you know, pregnancy danger signs and things like that.

We do weight checks on baby and we do feeding assessments on baby and make sure everything's going well with that. We do developmental screening, mental health screening, all of those kind of things are very standard for the program, and a big thing that we do is education, especially through pregnancy, there's a lot to get ready for, a lot of them say, I have no idea what I'm doing. They don't know how to get ready for it. We can provide some of that education. A lot of that education and we also try to get them set up with some of the community resources that we have in Western North Carolina. Like free childbirth classes, free breastfeeding classes, newborn care classes, get them connected with some of the support groups like mommy groups and things like that for after babies born, really a home visit can just, it can encompass so much, but the general idea is education support, you know, the basic assessments and just seeing what they need from us.

So, we tend to ask them, you know, what kind of stuff do you want to talk about? Where do you want to go with this? What are your goals and your hopes and your dreams? And it's not just like basic nursing assessment type of things. We are looking at their whole life as a whole, it's not just about getting them through the delivery, but it's about reaching goals that they have set for themselves. Helping them even think that they can have goals. Some of these girls just think that they don't really open up their mind to the fact that there's so much out there for them. So, we try to encourage them to set goals, let's reach those goals. What do you want out of your life? Where do you want to be in two years, three years, five years, whatever, and we help them get there.

That can be a lot of different things, not just nursing. We often joke that we are nurses with a side of social worker because it, and it does feel like that, and I love it that way. I wouldn't trade it for anything. I worked at the hospital for a very long time, and you just don't get the relationships that you get with NFP, and that's another aspect of what we do with these girls is we form a bond with them and we're someone that they feel like they can actually open up to. Someone who is non-judgmental, I've been told that by a lot of my girls. They say, I just feel like I can talk to you about anything I need because you don't judge me, and that's not my job. My job is not to judge them or tell them what they are supposed to do, but just give them basic education; best cares practices and help them as they make those choices. Whether they do fall in line with best care practices or not, I educate them and help them from where they're coming from, and just kind of get in there with them and figure it all out.

Katlyn[11:46]: I mean, I'm just hearing patient centered care in my brain over and over, I mean, everything you're saying is solely centered around this woman, this birthing person, this patient and what they need. Just like you said, that non-judgmental care, not walking in saying here are all the things you have to do, but walking in and saying, what can I do for you? What is it that you need? And I think that is so important.

Angie Parker [12:16]: And oftentimes it may not even be basic nursing care. We also can offer transportation. I have a lot of girls who don't have a license, don't have transportation and a typical visit with them sometimes might be picking them and their child up and taking them to the child's appointment or recently I picked up one of my girls and her daughter and I had to take her to go get lab work drawn. I took her to WIC to get some stuff done with some of the girls. I've even stopped by the grocery store for them on the way home so that they can get a few groceries while I hang out with the baby in the car because that's a need for them. If we're already out and you need groceries and you don't have transportation to go do that, go ahead and go on in there and I'll watch the baby, and stuff like, that's just kind of fun.

Katlyn[13:05]: Which is transportation is always, I feel like a barrier to care in Western North specifically.

Angie Parker [13:14]: Like that one of the biggest.

Katlyn[13:16]: One of the biggest barriers to caring North Carolina. So even just that, just that piece could be life changing to pregnant postpartum patient. It just speaks to the tangible, grassroots way that this program is making a difference here.

Angie Parker [13:32]: Now, we also sometimes just kind of focus on what we know the patient needs when we're basing. Like where are we going to do our visit? I've had girls that I knew were struggling with mental health postpartum and just needed to get out of the house, but they weren't doing that on their own, and so I would continue to ask them, I'd say the weather's really nice, do you want to meet and go for a walk? And when they finally feel like they can do that and agree to do it, all of a sudden they'll, they'll realize like, this is what my mental health needed. I needed to get out of the house, I needed to go for a walk. I needed to get some fresh air, and that can make a big difference for them.

Katlyn[14:07]: Yes. And I hear you mentioned doing education and sort of blood pressures and weight checks. Can you tell me a little bit, this audience for our podcast is primary providers and birth workers in the region, nurses, ultrasound techs, doulas. Can you talk to me a little bit about how your care coincides and parallels with the prenatal care they're getting from the office? Especially you go to the house, your doing a home visit with your patient, you have a high pressure. How does that translate? How is that communicated to the prenatal care provider?

Angie Parker [14:47]: So, we recently did sit down with a couple of the midwife providers and part two of us were a part of like a lunch and learn where they were discussing high blood pressures and things such as that, and that is one thing that I focused on with them was how can we help you in this area and what do you want from us? And one of the things that's difficult for these girls, if it is noticed that they're having issues, it's hard for them to have, like you said, transportation to get to appointments or even find the time or the doctor's offices. They're very, very covered up in appointments and it's hard for them to find even space in their schedule for the day for some of these checks that these girls need when they need to become more frequent.

And so, I specifically asked them if you have someone who you need just a blood pressure check on, are you comfortable with us going to the home to do that? And then checking her for all the danger signs and signs and symptoms and just getting back with you, and they were super excited about that and gave us like handouts and information on what they specifically would like for us to do if we do that for them, and that was, you know, with that care provider specifically, something that they were really excited about, and also that comes into play for postpartum too because sometimes these girls are noted to have blood pressure issues that are continuing on after delivery and they have to either do blood pressure checks at home following certain rules or come into the office if they don't have a blood pressure machine to do that with, they have to come back to the office like three days later and then a week later and then two weeks later. So, that's another way we can help. We can go to the home and do those blood pressure checks and report back to the office for them.

Katlyn[16:39]: Fantastic. So, it sounds like you all are very open to that two-way communication and absolutely. Yeah. And being able to really integrate, yourself and the program into the physical care of the as well. You know, that social aspect of things

Vicky Lewis [17:00]: Can on my nurses, just a moment, just a moment, I promise. Course you been, we have had incidences and I couldn't be more proud of these girls where they will actually catch a change in the blood pressure and the client would say, I'm not feeling really good. So, they'll call their physician, and they'll say, have them come in and board them once they put them in the hospital because these girls were really getting sick with their high blood pressures. So, please don't think that my nurses don't communicate, oh my gosh. They communicate with the physicians and healthcare providers all the time and I'm very proud of their willing to get their point across, and I just, I just bragging, there is a lot of communication.

Katlyn[17:43]: Hey, I'm a nurse. I especially love it when we get to hear people brag on nurses.

Angie Parker [17:49]: One thing that we want to make sure that all of the other providers, perinatally throughout Western North Carolina know is that we are not, we don't take their place. We are not trying to take clients from them in any way, shape or form or anything like that. We want to be able to work collaboratively with people and be a resource for them and an advocate for a patient. So, that is very important for other providers to understand, is that we can be helpful for you in the care of your patient, especially if you communicate with us what you need from us, and then we'll communicate with you if we find something that our patient needs.

Katlyn[18:29]: So, I'm also hearing both the prenatal and postpartum points of pregnancy in these conversations. So how long does a patient get their assigned nurse?

Vicky Lewis [18:45]: We try and take them; we have to take them because we have to what they call the model elements. We have fidelity to those elements from the national service office. So, we take clients below 28 weeks in their first pregnancy. Now, if they've had a miscarriage or their infant passed away after living only 30 days, we can take them. We take them at that point below 28 weeks in their pregnancy and we can follow them till their child is two years of age. As I said, it's totally free and voluntary. So, if they choose not to remain in the program, that's their right. But we don't have a large, as they would say, dropout rate. Most of them complete the program and ask if they can stay longer.

Katlyn[19:31]: That is amazing.

Vicky Lewis [19:33]: You're over two years Katlyn.

Katlyn[19:35]:

That's exactly that's not the same now you're going on 3 years of that. That's such an amazing resource, especially her first time moms. I mean you all, I'm a little envious. I want to hang out with pregnant postpartum.

Angie Parker [19:51]: You should be envious. Its amazing.

Katlyn[19:58]: Do you keep those regulations in mind, and you've already shared some amazing examples, but I wanted to give y'all an opportunity to share a success story or, or maybe share a standout experience that you think would really help drive home the importance and the benefits of a program like this in Western North Carolina. So, do you all have a success story to share with us today?

Angie Parker [20:24]: We do. We have actually a lot to talk about with that.

Katlyn[20:27]: Great.

Parker [20:28]: We were actually like discussing this with the nurses yesterday at our staff meeting, and we did pick out a specific success story, but all of the nurses also just wanted us to, to discuss the fact that success to each client can be something different. And even like success for us as nurses, the things that we're excited about, we want to touch on that. But when it comes to our clients Vicky was talking about like the program model and things like that, and one of the things that they really focus on one of the principles of NFP two of them that I want to mention, the first one is that the client is the expert on her life, not us, it's the client, and the idea is that we are supposed to allow the client to follow her heart's desire.

Angie Parker [21:18]: So, it's not us telling her what she should do or need to needs to do. She's following her heart's desire and where she wants to go, and we're there to support that. So, with that in mind, some of them, you know, success may be just finishing high school. We do get quite a few girls who are still in high school when they become pregnant. And it's harder to get them through that than you would think sometimes, and also for some girls, even just enrolling in college and finishing that program is success, and for some it's simple as finding housing, which is difficult in Western North Carolina. So, finding stable housing for them and their child or a stable job those are big things that for them are areas of success, and another big one for our clients is just making sure that their children are meeting developmental milestones.

That is a biggie that my girls talk about all the time, that their biggest concern is developmental health and growth for their babies. So, when we do those developmental screens and the baby does well on those, they get super excited. So, and then for our nurses, the things that we focus on, some of it is something that's focused on, throughout the program nationally, some of these are even some of like healthy people, 20, 30 things even that come up here. But we're working on things like prevention of short interval pregnancies, which is just preventing pregnancies within 18 to 24 months of a previous pregnancy, and that's just for maternal and fetal health and morbidity there. But some of our girls sometimes we're successful there, sometimes we're not. So, as nurses that's successful and it's fun, you all.

Yeah, for us, that's a success. When we can get them graduated from the program without another pregnancy, that's a big deal. Another thing that we look at as, and we're actually currently doing some stuff within our program and a health project related to that furthering the education and for the nurses for birth control education and how to teach parents about the risks of short interval pregnancy. So, that's something that's near and dear to us, and then also things that we have seen in our program that we consider a success is a marked decrease in like children entering the foster care system, DSS reports and DSS involvement. We've seen a decrease in preterm births and we've also seen a huge increase in our breastfeeding rates over the last couple of years. So those are things that we're super excited about and that we consider success within the program.

But I do have, and of course, like you said, with hippie, we're not going to mention names, but we do have a nice success story that one of our nurses gave us, and this just covers a lot of different successes in my opinion. She was 18 years old and still in senior in high school when she became pregnant, she graduated high school after graduating, was able to start college and while she was still pregnant, she graduated high school pregnant and still got into college and started while she was still pregnant, continued through the community college and received her associate's degree after delivering, and then she has recently, just this January started at WCU, she's getting her bachelor's degree. She's worked full-time this whole time and a full-time student and a new mom. Her and the baby's dad have been able to find stable housing.

They rent a home together. She did utilize things such as WIC and whatnot, but she has worked herself to a point where she has been able to come off of that and provide for her family without having to use that assistance. The baby's now 22 months, so he's got a few more months until he graduates. He's happy, healthy beautiful little baby boy and meeting all of his developmental milestones. She successfully breastfed him till just recently. So, over a year and a half while she was going to school full-time, while she was working full-time, all of those things, and one of her goals is to not have another child right now. So, we considered it a success for her that she did get a long acting birth control to help her be able to prevent that until she's more comfortable for that. So, she will say that without the help of her nurses, it would've been much harder, and she doesn't know if she's been able to really been as successful as she has. So, we're really proud of her.

Katlyn[26:00]: Definitely, this is what I call a drop moment, I mean that in itself is perfect reflection of work and that this program is making, and I just have to tell for those who are listening, I'm here recording this live and I can see Angie and I can see Vicky and their smiles and the pride that they have It is so obvious that they love their work, that they love this program and that they are like I said so proud of what's going on. I wish that you all could see their beautiful faces.

Angie Parker [26:41]: So, Caitlin, there's something else I wish you could see.

Katlyn[26:42]: What's that?

Vicky Lewis [26:44]: When they have visits here in the office, which of course I love them because I don't go into the homes except with them, I'll go by an office where they're doing a visit and they'll be on the floor. I went by the other day, Angie was in the floor with the mom when the baby, they're showing them how to play with the baby and they're playing with the baby, and the moms are so relaxed and so happy to be doing this, and to me that's a big success because some of these moms come out of situations where their mothers never played with them, never read to them because they didn't know how, and these mothers are learning how and I think that's a great big success.

Katlyn[27:24]: Yes ma'am. I agree wholeheartedly. Amazing. So, rolling into how do Connect and the healthcare workers listening connect? I know you mentioned some of the requirements for the program. It has to be a first time mom; they have to get enrolled before eight weeks. Is there a referral form that y'all use? Do we call and have our patients enrolled? Tell us a little bit logistically, operationally how can we get our patients enrolled in this program? And if you don't mind, I know you mentioned that you have recently extended coverage with another office a little further west where you're now, can you give us the specific counties that you will cover as well?

Vicky Lewis [28:15]: Okay, let's see. I can call them, now, it's Haywood Jackson, Macon Swing, Cherokee Clay in Graham County. The last three are our newest edition. If you want to refer a person, I'm going to give you my office phone number. All would have to do, they can refer or they can refer a family member or more to the point at one point can refer someone she knows and all they need to do. Now, a lot of offices do have referral forms, but those that don't call me at [828] 477-4178. I will take the referral I the phone, fill out the form, and then I will assign a nurse and we go from there. I will take any call, if you just want information if you want to make a referral. Most of provider Practices do have referral forms as do the health departments. And we can get one of those to any practice that would like.

Angie Parker [29:20]: We can get them a form that they could fax to us if they would like that.

Vicky Lewis [29:24]:

Okay. Yeah, we can fax or scan any kind of information. Mostly we make the rounds of the health departments. If Angie's out staying in Macon County, I can give her the information, she'll take it to anyone over there that needs to have it. But again, anyone that wants to really get started or have some referrals, if they'll call that number [828] 477-4178, we'll get them whatever they need.

Katlyn[29:51]: So, you all hear that loud it is as simple as one phone call and we will have that number, Vicky and Angie's contact information as well as links to website resources they've given us down in the notes. So, if you are driving do not panic you will be able to reference this information in our show notes, so I think I will jump into the last and final question that I have for you all today, which is do Hope partnership looks like in the next five years. It's really appear and obvious that you all grateful for your work that you are all grateful for you work, that you are proud of what you do and that you are truly again making a changeable grassroots difference. So, what are your hopes, dreams? We can get hie in the sky with this if you all want. What do you think the next five years could look like for this program in Western North Carolina?

Angie Parker [30:49]: I hope to see a waiting list, sounds bad because that means some people might not be able to access it. But I would just love to see so many people trying to get in the program that we need to hire more nurses. You know, there's not really anywhere else we can expand necessarily. We've gone as far as we can, but just needing to expand just our staff because we have so many people who want it. I think it's one of those things that not everyone knows about, a lot of people haven't heard about, and I want it to be just that when someone in Western North Carolina says, you know, I'm a nurse, family partnership client or I work for a program called Nurse Family Partnership, I want everybody to know what that is.

Angie Parker [31:33]: When I started with Nurse Family Partnership, a lot of people would say, what is that? And still to this day, I have to explain what the program is and what I do, and I would love to see in five years that everybody just knows who we are and they're referring people left and right and we're hiring more nurses and it's just thriving. I would love it because it's such an amazing program, and I say that coming from, I've done maternal health for many years in Western North Carolina, but I worked at the hospital for, I still work at the hospital some. So, before I came here it was like 20 years and I thought I would retire from working as a mother, baby nurse, lactation consultant at the hospital I thought that was all I would do. I loved it, but this program kept kind of tugging on me a little bit in my heartstrings and just everything, and when I made that transition, I am just, I love it. It's amazing. I didn't even know how amazing it was till I got here. So, I would love to just see us being able to bring in more nurses and maybe even bringing in more services that we can offer to our clients, so, that's my dream.

Vicky Lewis [32:40]: Well, Kate, mine's sort of like hers. I want to see us grow. I want to see us taking more and more clients than having the nurses we need to serve them. I would like to see, and I know this sounds a little funny, I would like to, as of now they need to qualify for Medicaid or something like that to be in the program. I'd like to see even that loosen up in the time I've been here. There used to be really, really, really strict guidelines for the schedule that's loosened up, It's now whatever the client deserves. So, I want to see us be able to serve more people because I just think it's a necessity being a firsthand mother is so hard. So, I want to get the nurses to do that. I want to become a program that everybody looks at and says, that's a compliment to us. They work with us, not against us, and I want to see us grow and grow and serve all the people that need us.

Katlyn[33:40]: Well, I hope hopefully this podcast episode will help increase your numbers, help increase that awareness. That is of course our goal, and I want to thank you both, Angie and Vicky for giving us your time, giving us your story and sharing this wonderful program with us, and we I think we've come to an end. I think this is all, I sit here and talk for hours you all.

Vicky Lewis [34:07]: We could talk forever.

Katlyn[34:12]: Alright, well, thank you all again so much and I hope everybody enjoyed this episode.

Vicky Lewis [34:16]: Thank you Katlynfor having us.

Outro [34:19]: I hope you really enjoyed listening to my conversation on the Nurse Family Partnership program and I hope that it is one that you will participate in and get your patients hooked up with. Again, we will have all of the resources and phone numbers and information that Angie and Vicky discussed linked in the show notes below. Also, if you like what you hear, please subscribe. Like, give us a five star review. We would really appreciate it and it would help us get the word out to other listeners to take a listen to our podcast. Also, we do have a survey linked in our show notes we would love feedback and there's even a spot in this survey to give us ideas for future episodes. So, we would really appreciate if you would take the time, it will take less than five minutes to complete the survey if we would love, we would love your feedback. We would love to hear what you think of the podcast. So, until next time, thanks you all.