You can always tell the difference between EMU nursing graduates and other nurses without asking them, says Kate Clark, associate professor of nursing at EMU. 

“It’s what we hear all the time from hospitals and other employers, that there’s something special about EMU nurses in their approach to patients and their professionalism,” she said. “One major element is our family nursing class, which helps shape both their self-confidence and their cultural humility.”

That class, the semester-long Nursing & Family in Community course (NURS 426), partners undergraduate nursing students in pairs with refugee and immigrant families in Harrisonburg and Rockingham County. Students in the course, who are juniors and seniors midway through their clinicals, visit the families at their homes weekly to promote health education, help them navigate the U.S.’s complicated health system, and teach them basic essential skills to help them adjust to life in a new country.

These skills might include: navigating a phone tree to schedule a medical appointment, setting up taxi rides to appointments, using the bus system, enrolling in an employer-sponsored health insurance plan, and understanding the difference between primary care and the emergency room. Students have been known to ride Harrisonburg city buses with families, walk with them to a local food pantry, help read their mail, attend medical appointments with them, and connect them to community resources such as clothing closets and bicycles through the program (led by alum Ben Wyse ’99). 

Students might tell families they can expect to see people in costumes walking around the neighborhood and knocking on their door for Halloween. They also might help families from warmer climates prepare for cold weather with appropriate winter clothing. 

Students communicate with their assigned families using either their own foreign language skills or a provided interpreter. This semester, there are eight different languages spoken by families in the course’s Family Partnership Project.

Through the course, EMU nursing students build long-term therapeutic relationships with families, learn to provide care for a family unit, and experience the barriers that marginalized groups in the community face when trying to access health care.

“Because they get to experience those things from the family’s perspective, it gives them a good understanding of how the health system is not always designed for certain types of patients and the challenges they experience,” Clark said. “Whether or not they pursue home visiting long-term, it makes them better, more compassionate nurses across the board.”

She said the course sets EMU’s nursing program apart from others. “I’ve rarely heard of another school that has a standalone family nursing class that involves home visiting,” she said, “especially not one that focuses on refugee and immigrant families.”

A ‘win win’

Many of the families participating in the Family Partnership Project have a tenuous grasp of English, are lower income, and need additional information to be able to navigate this new country. EMU’s nursing program partners with , a local office of Church World Service that serves and advocates for refugees, asylum seekers, unaccompanied children, and immigrants in the Shenandoah Valley. The agency identifies local families in need who can benefit from the project’s tailored support, resource referral, and health teaching. The students’ help is invaluable, especially at a time when policies enacted by the current presidential administration have led to funding and staffing constraints for the organization. 

“We’re grateful for EMU’s nursing program,” said Susannah Lepley, Virginia director of Church World Service. “I like programs that are a win win for both the university and the families and this is definitely one of those. The students get a lot out of it, the families get a lot out of it, and I think it’s a strong selling point for EMU.”

In the past, students have worked with families who have been in the U.S. for only one to two months. This semester, due to fewer refugees entering the country, nursing students are working with families who have been in the U.S. for a year or more. This has allowed them to focus on longer-term concerns such as nutrition, stress management, and mental health.

“You can’t overstate the friendship aspect,” Lepley said. “People often leave a pretty intense network of support back home and they come here and they don’t have that anymore. They have to recreate it from scratch and I think the nursing students are a big part of that.”

The epitome of EMU nursing

Clark, who has taught the family nursing class for the past 13 years, graduated from EMU with a BSN in 2007. She took the course as a student under longtime professor and mentor Ann Graber Hershberger ’76. During her semester in the course, Clark was paired with a Spanish-speaking single mom in Timberville. 

Up until that course, Clark had questioned whether she actually wanted to become a nurse. She felt like there was never enough time during her clinicals at the hospital and that she was just checking boxes. 

“I knew I wanted to do something with a bigger impact, and when I took that class, I felt like I could finally let out the breath I had been holding since I started the nursing program,” she said. “I don’t know if I would’ve stayed in nursing had it not been for my experiences in that class.”

Another alumna from that year, Rebekah Good Charles ’07, said the class prepared her well for the work she now does as a community health nurse serving families around Lancaster, Pennsylvania. During her semester in the course, she visited with an immigrant family from Mexico and helped them sort through medical bills, contact financial aid, and fill out paperwork. 

“It was interesting to see the health care system from that side,” Charles said. “You can do all these things for your patients when they’re at the hospital, but when they get home, they’re left with all these loose ends to tie up. It was eye-opening to see that and help someone work through that, and it made me realize just how complicated the health system can be.”

Lydia Tissue Harnish ’17, MSN ’23, uses the same skills she acquired from the family nursing class in her job as a maternity educator for the Lancaster Nurse-Family Partnership. During her senior year at EMU, she was paired with a refugee family in Bridgewater expecting a second child. Harnish spent the semester preparing the family for what the birthing experience in the U.S. would be like.

“It’s really the epitome of EMU nursing,” she said. “We’re in the patients’ home setting, assessing the whole person, their environment, and their family as a whole.”

‘Begin to thrive’

When senior nursing major Joshua Stucky and another EMU nursing student met with a Syrian refugee family for the first time in January, only a month after they had arrived in the U.S., he felt overwhelmed at the prospect of helping with their cultural transition.

“They didn’t know how to use their phones or get their kids to school and didn’t have a way to get around,” he said. “And so I walked out of that first meeting thinking, How are we ever going to help this family? … You eventually have to set an expectation that you’re not going to solve all their problems.”

Over the course of the semester together, the pair of students was able to solve some of them. Through a connection he had with Bikes for Neighbors, they were able to provide the family with bicycles. They were also able to ensure the children received the vaccines they needed and that the family had access to a neighbor’s car.

During one of their final home visits with the family, while talking to the parents, he remembers seeing the two younger children bound into the home with their backpacks. “They had been going to school and, even though we didn’t play a huge role in that, it was just the most rewarding thing to watch them begin to thrive,” Stucky said.

Learn more about EMU’s nursing program at .

 As Virginia’s vaccine rollout spreads into the Shenandoah Valley, ��ݮ���� students are participating at both ends of the needle: both giving and getting the shot.

And in some cases, they’ve giving the shot to fellow students and EMU employees. According to an informal count kept by EMU Health Services, 110 students and 135 employees have received the full course of vaccines as of April 14. These numbers are based on copies of vaccination cards provided to Health Services (through covidhotline@emu.edu).

Senior nursing students in Professor Kate Clark’s community health course and associated clinical rotation this semester have been giving vaccines and aiding with processing at clinics up and down the Shenandoah Valley: in Lexington, at Augusta Health in Fishersville, the Rockingham County Fairgrounds, and Sentara RMH, the city jail and city community center in Harrisonburg. A recent afternoon saw a small group among the volunteer nurses, physicians, and other health professionals staffing a clinic in the convocation center at James Madison University.

While other rotations like shadowing in the emergency department and the ICU unit may be more exciting, Natalie Stoltzfus has enjoyed the hands-on work and the chance to contribute in an historic public health effort. 

“These have been my favorite clinicals,” says Stoltzfus, who will work at Penn State Hospital Hershey after graduation. “Once you get the routine down, it’s pretty simple. Six hours goes by fast.”

According to Clark, EMU’s smaller program and long relationship with the local district of the Virginia Department of Health has contributed to unique opportunities to work small and large clinics and to interact with many different populations, including healthcare professionals, incarcerated individuals and senior citizens. [Read about spring 2020 clinical experiences and how the Class of 2020 nursing graduates finished their semester.]

Nursing students provide Q & A at campus info sessions

The knowledge students have gained as vaccinators and in the public health context has also benefited their fellow students and campus community. In mid-March, EMU Director of Health Services Irene Kniss contacted the nursing department about hosting a Q & A session.

“We knew students had lots of questions and a need for information related to the vaccines,” Kniss said. “We encourage everyone to educate themselves and our nursing students and professors could be an important and trusted resource in that process.”

On Wednesday, April 7, students in the community health nursing class, with Clark and nursing instructor Lisa Burkholder, hosted a virtual information session about COVID vaccines. Questions from the attendees ranged from possible health impacts of the vaccines, the testing process and efficacy of each type of vaccine, and the biotechnology that has been developed.

In recent weeks, Kniss, along with other area health officials, has been in near-daily communication with VDH representatives for updates about the status of vaccines arriving in the Valley. An application to host an on-campus clinic had been made in January.

EMU students now eligible for the vaccine

On April 9, students were emailed about opportunities to sign up at several local clinics hosted by the Virginia Department of Health within the Central Shenandoah Health District. The campus’s COVID Response Team has provided transportation if needed.

“Getting the covid vaccine is an act of care for the entire community,” Kniss said, adding that the more fully vaccinated the population is, the more vulnerable populations will be protected and  “the sooner we can move towards sharing spaces and seeing faces again.” 

Students (and faculty and staff as well) sharing a copy of their vaccination card will no longer need to fill out the daily symptom tracker, one of several measures instituted this year to help track individual and community health.

While some universities are requiring proof of vaccination in the fall, EMU officials are still collecting information and exploring options. 

The COVID-19 pandemic has wreaked havoc on educational institutions across the country – with students, instructors, and families seemingly in limbo as they try to navigate public health precautions and an increased migration to virtual learning. At ��ݮ���� (EMU), faculty have had to adapt their curricula to a semester that will begin and end online and accommodate in-person instruction in the middle. And fields that rely on practicum study have added challenges to face.

Some professors are finding this an exciting challenge.

“In many ways, this is an incredible time to be teaching students about public health and how medical and nursing research should influence practice,” said Professor Kate Clark. She’d normally be setting up clinical experiences with families and in other community health settings. Instead, a partnership with Harrisonburg City Public Schools will have student nurses assist with COVID-19 screening. The students will also perform a variety of nursing tasks at the Harrisonburg-Rockingham Free Clinic and at the Purdue poultry plant’s wellness center in Bridgewater.

These opportunities are the result of many years of relationship- and trust-building between the EMU nursing department and local agencies. Clark said she often hears from area healthcare providers “how ‘different’ our nursing students are – how professional, caring, broad-minded, culturally competent, et cetera. This is why they allow us to help in their work – because they trust our students to do this difficult work well and with great care and compassion.”

[Read more how spring 2020 nursing students gained unique experiences during the COVID-19 here and here.]

Future teachers also have a practicum-heavy course load. This semester, they’ll be learning through the same trial-by-fire as established educators, as they’re paired with local middle and high school teachers leading virtual classes for Harrisonburg City and Rockingham County Public Schools . 

“With local public schools providing primarily virtual instruction, our EMU students will have important opportunities to learn and apply new strategies in the context of online education,” said Professor Paul Yoder. “As a professor, I will similarly have opportunities to engage new technology and instructional platforms like VoiceThread as part of classes I am teaching.”

VoiceThread is a software platform that allows users to interact with video clips and voice and text comments for a multi-media forum experience. It’s one of the many new technologies emerging as prominent teaching tools in the era of COVID-19, and one that was introduced in a summer course for EMU faculty titled “For Our Students: Fall 2020.” Professor Daniel Showalter helped design the course along with professors Mark Sawin, Tara Kishbaugh, Barbara Wheatley, and Steve Cessna.

“The primary motivation for the course was to equip faculty to provide positive learning experiences during the challenges and unpredictability of the pandemic,” said Showalter.

The course included a four-week module in course development, safe classroom configurations, resources for effective online teaching, and examples of creative solutions EMU faculty are employing this semester – like this introduction video Sawin made for his History 101 and 102 classes – which students can attend in person, via Zoom, or just complete the coursework asynchronously.

Kishbaugh led the module on course development. She said one of the biggest challenges this semester is the “cognitive load” of having to re-do, or at least reevaluate, every element of a class to make sure it fits in the new normal of COVID-19.

“It feels like nothing is on auto-pilot. This is true in other areas of our lives as well which leaves all of us with less energy,” said Kishbaugh. 

She drew inspiration for this semester from a training she took years ago on institutional transformation work to improve the retention of students in STEM. The training, which came as part of a National Science Foundation grant, focused on “increasing our teaching efficacy and learning to be more responsive in our classrooms,” Kishbaugh explained. “The principles we focused on in this training were the ones that we highlighted this summer. Empathy and checking our assumptions are key to the rest of the pedagogical tools being effective.”

Showalter said this summer’s course participants came with a number of concerns and anxieties. How would they build relationships with their students in an online setting? What if they encounter technical difficulties? Will important conversations on racial justice, microaggressions, and disabilities be lost in the chaos of COVID-19? Showalter and his team tried to address each of these questions with digital resources, knowledgeable guest speakers, and small-group troubleshooting. 

At the end of the day, everything we do, teaching college classes included, is “winging it” this fall – but in EMU’s classrooms, it’s done with particular care. 

“The main idea here is that this semester will probably be stressful and there will be plenty of mistakes, but amidst it all, the goal is to center ourselves on the students’ needs and those relationships,” Showalter said. 

What will a post-pandemic world look like? How is COVID-19 affecting each of us differently, and what are our responsibilities to one another in the face of those disparities? What do we know about the biology of the virus? And are there things that are changing for the better because of this crisis?

A free seven-week online course offered at ��ݮ���� this summer will delve into those questions and more. Community members are welcome. Students can opt for a pass/fail grade and will have online access to readings, videos, and other materials before each class. 

The course meets each Tuesday evening, beginning June 30, from 6:30-8:30 p.m. for seven weeks, with a different pair or trio of faculty and staff from different academic fields leading each class.

The lectures and Q and A will be recorded and available for viewing later.

The course is co-led by language and literature professor Kevin Seidel and chemistry professor Laurie Yoder.

“What pulled me in at first was the possibility of teaching with faculty from all three schools – sciences, social sciences, and humanities – talking together and learning from one another about the virus,” Seidel said. When the pandemic hit, he started fervently gathering information and perspective: from scientists, from fictive literature, and from poetry, trying to make sense of “this strange new world.” 

Week 1 | June 30, Tuesday, 6:30–8:30 p.m.

Treating COVID-19

What do we know about the biology of COVID-19? What’s next in vaccine development? What public health measures are working to slow the spread of COVID-19?

Kristopher Schmidt, Associate Professor of Biology

Kate Clark, Assistant Professor of Nursing

Week 2 | July 7, Tuesday, 6:30–8:30 p.m.

Pandemic History and Data

What can we learn from past pandemics about life after this one? What can we learn from visual presentations of data about the pandemic? 

Mary Sprunger, Professor of History

Daniel Showalter, Associate Professor of Mathematics

Week 3 | July 14, Tuesday, 6:30–8:30 p.m.

Politics and Collective Trauma

Why has the U.S. response to COVID-19 been so contentious and uneven? What is collective trauma and what might it have to do with that response?

Mark Metzler Sawin, Professor of History

Ryan Thompson, Assistant Professor of Psychology

Trina Trotter Nussbaum, Associate Director, Center for Interfaith Engagement

Week 4 | July 21, Tuesday, 6:30–8:30 p.m.

Zoonotic Viruses, Wet Markets, and the Economics of COVID-19

Where do coronaviruses come from? What are the links between environmental degradation and pandemics? What does COVID-19 have to teach us about how our economy is connected to the natural world? What are the economic impacts from a pandemic?

Jim Yoder, Professor of Biology

Jim Leaman, Associate Professor of Business and Leadership

Week 5 | July 28, Tuesday, 6:30–8:30 p.m.

Our Life with Animals, Our Life with God

Why are so many people taking refuge in nature during the pandemic? Why is that refuge harder to come by for some people? What do the scriptures say about how our life with God is related to our life with animals? 

Steven Johnson, Professor of Visual and Communication Arts 

Andrea Saner, Associate Professor of Old Testament

Week 6 | August 4, Tuesday, 6:30–8:30 p.m.

Systemic Racism in the U.S. before and after COVID-19

Why has COVID-19 hit African-Americans harder than other groups? Why does rural Navajo Nation have the highest infection rates in the country?

Jenni Holsinger, Associate Professor of Sociology 

Matt Tibbles, Teaching Fellow, Applied Social Sciences

Jim Yoder, Professor of Biology

Week 7 | August 11, Tuesday, 6:30–8:30 p.m.

Resilience, Repair, and Transformation after COVID-19

How do we carry forward what we’ve learned about COVID-19, trauma, and restorative justice? 

Johonna Turner, Assistant Professor of Restorative Justice and Peacebuilding

Katie Mansfield, Lead Trainer, Strategies for Trauma Awareness and Resilience (STAR)

We have amazing dedicated faculty and a dynamic leader who brought us all together to put together a game plan that works. And students who trusted us and were ready to go with what we proposed. Everyone pitched in. EMU nursing shines in moments like this.

-Professor Kate Clark

Nursing majors at ��ݮ���� can expect the spring semester of their senior year to be challenging, exhausting and hectic – with required clinical hours, difficult coursework, and demanding oral finals being just part of the equation. Seniors also take Kaplan tests and three 8-hour days of review as prep for the NCLEX-RN board exam.

The 2020 spring semester provided all of this and more in a dizzying acceleration caused by a historic global pandemic that would eventually end face-to-face classes and restrict access to clinical sites and  for these 17 students preparing to enter the healthcare profession – and the frontlines of COVID-19 – in just a few short months. 

Melody Cash, EMU’s nursing department chair with more than 30 years experience in the nursing profession, simply shook her head when asked if she had ever experienced anything like the COVID-19 pandemic:

I’ve never experienced anything like this before. This is truly an extraordinary time. We’re already in a nursing shortage and this is exacerbating it. We are doing everything we can to get these students to graduate on time and enter the workforce. 

Everything was changing so fast. We went from face-to-face classes and some normalcy to constant evaluation of students in clinical placements. Eventually we temporarily suspended online classes for seniors and focused entirely on meeting requirements for our Level 3 students who were closest to graduation. 

For clinical rotations, the 17 seniors are divided into three groups. Some were at a regional jail with plans to continue at a local pediatric practice and the Harrisonburg Free Clinic, while the third group was just about to start at Sentara RMH. 

The faculty were meeting hour to hour, staying 12 hours ahead of the students as we were making decisions.

I’ve been so impressed with the professionalism of the students. We often see this in our seniors, but this time was a little earlier than normal. They start to click into that professional nurse role. 

At the same time as nursing students expressed steadfast resolve and professionalism, the sheer scope of the crisis was overwhelming.

Student: ‘Nursing is educating’

Senior Aaron Gusler said nothing in his education had prepared him to enter a healthcare crisis at this level. “I don’t even think that health professionals with years of experience are really ready for what’s to come, simply because this is so unprecedented,” he said.

We are seniors, which put us in the tough position of trying to meet the required number of clinical hours while maintaining safety. To try and meet these goals, a small group of students had clinical rescheduled to three consecutive 12-hour days, an attempt to pack in as many hours as possible before the COVID-19 situation got too risky for us. We went through these as scheduled, and had another 36 hours to complete either online or in the hospital…Doing 3 12’s in a row was a great experience for me, as this is the typical workweek for a new nurse.

Senior Joy Driver, also in that group, said the past several weeks have demanded flexibility and patience.

Initially when I thought I was not going to be able to participate in any adult health clinicals, I became fearful because I felt as though I needed to check my assessment and prioritization skills through this experience. These realistic days allowed me to achieve that goal … The other day a patient in the hospital asked me if I was fearful coming to work because of the COVID pandemic. I said not at all. Those people need care just as much as the next. And we take precautions to protect ourselves so we can continue to care for these individuals. 

I am reminded of stories from the Bible at this time when people feared going near those who were sick and “unclean.” Not only do hospitalized people with COVID need medical attention but also emotional and spiritual support. At this time, they are not allowed visitors, so my intention in sitting down and hearing the patient’s concerns and story has grown. I think the pandemic has also solidified my understanding that an ample part of nursing is educating. In this time of the unknown, some people become frustrated with others who are not abiding by social distancing and other regulations/suggestions. These people should not be reprimanded, but educated. 

 I am so incredibly thankful for my clinical instructor Staci Stoneberger who set aside her agenda to see that our clinical hours were complete, the nurses of 4 East at SRMH, and the rest of the nursing faculty for making adjustments to see us succeed. 

Hotline help

Professor Kate Clark shares Level 3 nursing student teaching responsibilities with colleague Professor Lisa Burkholder. As community clinical sites closed, Clark worked on finding other options for her students. She called the regional Virginia Department of Health, an agency with which EMU has had a 30-year relationship. Several EMU alumni work there.

I have a lot of students in the schools for community clinical hours, and when the schools closed down, that was not an option. So I called Debbie Bundy-Carpenter, the central district manager of Virginia Department of Health, and said, “Is there something we can do that would actually be helpful for your nurses?” And so she offered this [staffing the VDH regional hotline]. They have to have four staff in here at all times to answer phones. And so if we can fill up two of these chairs, then that’s two nurses who can be doing their other work, including contact investigations for positive cases. So this isn’t like a normal thing we would be doing. It’s a really amazing public health opportunity and it’s the way that students can actually do something helpful, not just for the nurses here but for the general public … And so we’re really happy to be taking advantage of that opportunity and glad that they trust us with it. 

Senior Emily Travis logged several hours at the VDH hotline, calling it “an amazing, once-in-a-lifetime opportunity” to help “people who are looking to do the right thing and look out for others as well.”

I was definitely eager to get some hours as my other clinical last week didn’t work out. I feel so lucky … Kate asked me if I wanted to take this full time this week and do every day, eight hours. And I said, absolutely …  I’ve learned so much. I’ll probably never have an opportunity we could do with something like this again during a health crisis …I also sense a lot of people wanting to do the right thing and look out for others as well. It is definitely an interesting time to be a nursing student.

Clinical waiver means more simulation training for faculty

Through the first and second week of March, Clark, Burkholder, Cash and other faculty members met several times a week as information changed. Their major concern, that students get in required clinical hours to graduate, was alleviated by the March 19 announcement from the Virginia Board of Nursing. The director waived certain regulations “with the goal of removing certain regulatory barriers to assist with education, testing, practice and workforce issues.”

The waiver also included an increase in the number of simulation hours to replace the normal clinical hours. While helpful, this required that EMU purchase access to the simulation program for Levels 1 and 2 students, who do not normally have it, and increase training for faculty, not all of whom were previously involved in simulation.

“Some of our faculty are trained to teach with simulators,” Cash said. “But this move means everyone, even our adjunct nursing faculty, who are full-time practicing professionals. They are all doing this additional training and giving of their own time and energy.”

‘We want to celebrate you’

On Friday, March 27, Clark and Burkholder held an evening meeting to update students as they resumed online coursework and prepared for final group presentations and the rigours of scenario-based oral exams. They also discussed changes to the NCLEX-RN exam,which has been modified in length and time to accommodate fewer test-takers at each time slot.

And they talked about the pinning ceremony that would no longer happen and the commencement celebration that was on hold.

“We talked to the accelerated program nurses and they brought it up that they want to share their pinning ceremony with you in August,” Burkholder told the students. “I know some of you won’t be around and you may not want to come back to Harrisonburg for that. But you have worked really hard and we want the opportunity to celebrate you.”

Whenever that celebration is held, it will be an opportunity to celebrate not only the persistence and dedication of the Class of 2020 but also how the EMU nursing faculty pulled together and supported them.

“We hear this all the time, that we’re a small, close-knit program,” Clark said, “and because of that, we’ve been able to be agile through this whole experience. We have amazing dedicated faculty and a dynamic leader who brought us all together to put together a game plan that works. And students who trusted us and were ready to go with what we proposed. Everyone pitched in. EMU nursing shines in moments like this.”

VDH’s regional COVID-19 call center, located in the basement of the Mason Street office in Harrisonburg, is manned by four nurses between the hours of 8 a.m.-4 p.m. For the last week, students have joined the staff during each four-hour shift.

“I’ve learned so much,” said senior Ally Coffey, who will graduate in May with 16 classmates. “Each call I take, I learn something new because I have to find and process the information, and then I know it for the next time.”

Fielding questions from citizens living in the four-county Central Shenandoah Health District and as far south as Roanoke, the students provided information, calmed fears, and pointed out resources. Each hour they logged freed public health nurses for other work. Additionally, the time counted as clinical hours and put them in direct communication with residents in need. 

“It’s been an amazing public health nursing opportunity,” said Kate Clark, assistant professor of nursing. 

The service (access it by calling 877-ASK-VDH3) is a way to “get out accurate, fact-based information to the public, to help people remain calm and give them guidance when they don’t know what to do or can’t find specific information,” Clark said.

Questions “run the gamut,” she added. “So we do have people calling who say, ‘I’m exhibiting these symptoms. What should I do?’ We have people who say, ‘My friend’s or coworker’s wife might be positive. What should I do?’ We’d have employers asking about what they should do for their employees and letting them work from home. We have people asking about their pets and if it’s safe for their pets to be around them.”

For Coffey and classmate Emily Travis, each phone call is a way to practice their communication skills, conveying both empathy and competence to allay fears.

“Helping the public filter out fact and fiction is really important,” said Travis, “ because they’re hearing a lot on the news and hearing a lot of fear and you sort of have to sit down and on the phone and say this is what’s going on and this is how we can stay safe. I know there’s a lot of fear out there and there’s a lot going on, but if we take these measures then we can be okay.”

Despite ending their clinical rotations earlier than normal, all of EMU’s nursing majors in their final semester will be ready to take their boards and enter the workforce. Some will have a little extra public health nursing experience. 

“This isn’t like a normal thing we would be doing,” Clark said. “It’s a way that students can actually do something that is helpful, not just to the nurses here but to the general public. And so we’re really happy to be taking advantage of that opportunity and glad that they trust us to join them in the work.”

Along with her spring semester community health nursing class groupmates Abby Byler, Esther Ghale and Emma Millar, Sauder partnered with the Harrisonburg-Rockingham Free Clinic in part to promote its services and conduct a survey of the local Latino population.

Other groups in the course, which is required for nursing students and offered each semester, collaborated with Bridge of Hope, the Harrisonburg Community Health Center, Harrisonburg High School and an Augusta Health Community Outreach program.

“Community and public health nursing is a unique kind of nursing, with its own challenges and rewards,” said Professor Kate Clark. “The best way to learn is by doing, and these practicums provide valuable real-world experience and opportunities to engage with patient populations where they are.”

In addition to conducting door-to-door interviews, the Free Clinic group planned, promoted and held a community health event open to the public, where they offered information about the importance of having a primary care provider and eligibility for Medicaid expansion in Virginia. Basic health screenings were also offered.

“Through this project, I have learned that there is a lot of value in simply asking people what they need,” Sauder said. “How many times has someone knocked on your door and asked you if you had access to a primary doctor? We are planting small seeds that will empower families and individuals and hopefully lead them to better health.”

For Ghale, learning about health needs in the community and the impact of not having health insurance or access to primary care was eye-opening. “As a future nurse, I have the power and role ability to help with this need in my community,” she said. “I am excited to see what that means for me and how I can help my community.”

Millar was “struck” by the group’s reception. “We have been thanked profoundly by many for promoting healthcare for all and access to it within the Harrisonburg community,” she said. “I feel like I am truly making an impact on the community, even as a nursing student. I never thought I would have the chance to experience something like this in my undergraduate studies.”

Gathering information by going out in the community was a formative experience, Byler said. “We have been taught through nursing school to go into a community and ask for what they see is the problem. This is a great example of partnering with a community instead of going in with ideas that might not work for that particular community.”

Additional student groups in the community health nursing class supported other local agencies:

• With Bridge of Hope, which supports single mothers facing homelessness, Lauren Brintzenhofe, Anna Gibbs, Audrey Martin, and Katlyn Shelton created health-focused education “bags” for teaching families about health promotion and prevention topics.
• Marina Baker, Tarsha Baker, Danielle Davidson, and Amber Dodson partnered with the Harrisonburg Community Health Center’s new obstetrics program to create patient education materials about family planning options and routine prenatal/postpartum home care.
• In collaboration with WARM, a Waynesboro-based program sponsored by the Augusta Health Community Outreach department, Asenie Daniel, Haley Kuehle, and Kaitlyn Klager developed a foot-care protocol for volunteer providers and foot-care education for the homeless.
• After volunteering in Harrisonburg High School classrooms to learn about various needs of students receiving special education services, Kassidy Arsenault, Maria Cardoso Martinez, Joleah Hamilton, and Rachel Morris planned and implemented several basic health-related sessions for the high school students.

For their community health nursing course’s semester-long “community project” with a local agency, the students defined and described a patient population, conducted a needs assessment in their project area, formulated an intervention plan, and, once the plan was implemented, evaluated the intervention.

The five groups in the course this fall focused on a variety of public health issues in as many settings – and “directly touched the lives of over 300 individuals in our community ranging in age from five to 80-plus years old,” said Professor Kate Clark:

• At Gemeinschaft home, a group provided smoking cessation and heart health education to men recently released from prison, conducting a group education program that included interactive teaching sessions;
• With teenagers at the local Boys and Girls Club, a group created and played a healthy choices game and completed several cooking projects to make healthy snacks from commonly available, cheap foods;
• At Park Place, a residential home for adults with mental illness, a group provided teaching sessions about healthy eating, plus worked to make small health improvements in the residents’ favorite foods;
• At the Virginia Mennonite Retirement Community (VMRC), a group surveyed residents to identify gaps in the communication and marketing practices of VMRC’s Farm at Willow Run, which provides VMRC dining services with fresh produce; and
• At Eastern Mennonite School (EMS), a group conducted vision screenings, plus organized a health fair on various topics.

For their project at EMS, senior nursing majors Louisa Quaynor, Connor Faint and Laurie Serrell screened kindergarten, third, seventh and tenth graders, and identified students in need of vision care.

Working across grade levels developed the group’s communication skills, Serrell said, as “kindergartners definitely require a different approach than tenth graders.”

The group also organized a health fair about influenza prevention and the health hazards of electronic cigarette usage among teens, in particular JUULing. JUUL is a brand name of an inconspicuous but powerful e-cigarette that is shaped like a USB flash drive and contains “extremely high levels of nicotine,” . Available in “kid-friendly” flavors, JUUL use by students in schools has been “widely reported.”

The national statistics about JUUL use surprised the group: Approximately one in ten youth aged 15-17 have used a JUUL, .

As a result of the health fair, Quaynor said, high school students at EMS “now know the real effects of JUULing and will hopefully avoid it.”

Sentara RMH Medical Center and its affiliated offices of healthcare providers, plus a plethora of private offices offering medical, rehabilitation and wellness services, employ the vast majority of our alumni. This community-themed Crossroads did not contain sufficient space to do in-depth coverage on the vast array of our alumni in local healthcare, so we chose to focus on their work at the heart of some unique healthcare services for often-marginalized people – the kinds of services that might not be readily found in other communities.

HEALTHCARE FOR THE HOMELESS

As its name suggests, all the necessaries for Harrisonburg’s Healthcare for the Homeless Suitcase Clinic fit in a suitcase toted from place to place by the clinic’s volunteer nurse practitioner on weekly rounds of the city’s homeless shelters. At each one, the nurse practitioners offer free, on-site medical care to some of the neediest patients in a city population that ranks among the neediest in the state.

(The most recent figures from the U.S. Census Bureau put Harrisonburg’s poverty rate at 31.8%, nearly three times the statewide rate. Nearly one in five people below 64 years old in a several-county area that includes Harrisonburg lack health insurance, also according to the census bureau.)

This suitcase clinic traces its history back several years to when the director of a local homeless shelter called a meeting of health workers to talk about how to handle what they expected to be a bad flu season. Tammy Kiser ’88, assistant professor of nursing, took a few students from her community health class to that meeting. Soon thereafter, a group of those students began visiting the shelter to provide foot care to some of the men staying at the shelter, and the idea snowballed. Soon, Kiser and like-minded people at James Madison University and other local agencies began talking about how they could give more comprehensive care to the city’s homeless.

When the Healthcare for the Homeless Suitcase Clinic officially began in the summer of 2011, Kiser and others guessed they’d be seeing 50 to 80 patients per year. Instead, they saw 130. The following year, that total jumped to 245 individuals, and current year-to-date figures are on pace to remain at that level. Everything is free for the patients; the clinic’s shoestring budget has been funded by a combination of grants, church donations, private support and fundraisers. It has one paid staff member, a case manager who oversees the work of several volunteers.

“This is genuine. It’s grassroots,” says Kiser. “[The clinic] is a good fit with the whole philosophy of the EMU nursing department. It’s providing quality care to people whatever their situation is.”

But a suitcase can only fit so much, and some patients have needs beyond the clinic’s modest capabilities. When such an instance arises, staff refer them to several other providers – and hand them a bus ticket to get there – that also do their best to care for the many people in Harrisonburg who would otherwise slip through the cracks. These other agencies include the Harrisonburg Rockingham Free Clinic, the Harrisonburg Community Health Center and the local Virginia Department of Health office, all of which also have strong ties to EMU. Overviews of the work of alumni at each of these organizations follow.

“We emphasize that it’s an honor as a nurse to be able to care for people who are in vulnerable situations,” says Kate Clark ’07, an instructor in the nursing department. “That mentality makes our graduates more inclined to work with vulnerable or low-income people on a level that I don’t know a lot of other programs do.”

HARRISONBURG COMMUNITY HEALTH CENTER

The Harrisonburg Community Health Center (HCHC) saw its first patient in 2008, opening as a federally qualified health center with a federal grant. A lack of providers in the area, particularly pediatricians, who accepted Medicaid was one of the major factors in its grant award. David Cockley, an adjunct professor in the nursing and MBA programs (as well as a professor in James Madison University’s health sciences program), was among the group that applied for the founding grants and remains on HCHC’s board today.

HCHC, which employed just one physician at the beginning, has seen its patient base expand rapidly. In 2011, it saw about 5,600 patients, in 2012 saw about 6,900 patients and in 2013, more than 7,400. A total of seven pediatric and adult providers – a mix of doctors, nurse practitioners and physician assistants – now work at the health center. Because a significant number of the center’s patients are non-English speakers, one full-time and two part-time Spanish interpreters work for the HCHC, and most of the center’s nursing staff are bilingual in English and Spanish. The center also employs a part-time Arabic interpreter.

Although it receives federal grants to provide healthcare to “underserved communities and vulnerable populations,” the community health center has a broader mission.

“As a federally qualified community health center, HCHC is committed to serving as a medical home for all members of our diverse community,” says HCHC director of nursing Christine Reimer Wagler ’08. “Providing comprehensive, excellent quality care, with the patient at the center of our practice, is the heart of our mission.”

The center offers sliding scale fees to patients without insurance or ability to pay for their care, and it also accepts – and welcomes – all major insurances.

In 2011, HCHC partnered with EMU to launch a Community Health Worker program. Clark, the EMU nursing instructor, was then working part-time at HCHC and helped found the program (she is also David Cockley’s daughter). Jointly administered by EMU and HCHC, the program employed four women to educate and support high-needs patients by visiting them at home. That year, HCHC also became the parent organization for the Healthcare for the Homeless Suitcase Clinic described earlier. (The homeless clinic has since spun off as its own outfit, and the grant that funded the Community Health Worker program has expired.)

The next year, HCHC opened a satellite office at the Virginia Mennonite Retirement Community that, like the main office on the east side of town, is open to the entire community.

Wagler notes that EMU’s emphasis on peace and justice also have direct tie-ins to healthcare.

“Healthcare is a justice issue,” she says. “There is no bigger issue, in my mind, than ensuring that every single person has meaningful access to quality care if they want it.

“Working in healthcare is not for the weary,” she continues. “Navigating the brokenness within the various systems can be exhausting at times. Yet amidst all of this, there is change, which creates movement. It’s an exciting time.”

Wagler finds hope in there being so many others here in Harrisonburg doing their own bit to untangle one of our society’s most difficult problems.

THE FREE CLINIC

Nearly 1,000 patients per year come through the doors of the Harrisonburg-Rockingham Free Clinic in downtown Harrisonburg. To qualify for services there, a person has to have an income at or below 200 percent of the federal poverty limit, be an authorized resident of Harrisonburg or Rockingham County, and have no health insurance.

The clinic focuses on treatment and management of chronic health problems; nearly two-thirds of its patients have been diagnosed with three or more chronic diseases, says executive director Keith Gnagey ’76.

With just two full-time staff – Gnagey and an office manager – and 12 part-time employees, the clinic relies almost entirely on several hundred volunteers, who see patients, run lab tests, work the pharmacy and fill pretty much every other role there. The fact that volunteers perform the most skilled and fundamental roles at the Free Clinic distinguishes it from many other nonprofits.

“It’s not just putting on stamps and folding mailings. It’s about getting healthcare out the door,” says Gnagey.

Among the doctors who volunteer at the clinic are Wes Ross ’74, who sees patients there once per week and also serves as its medical director (a position that entails things like chart reviews and signing off on lab reports) and Don Martin, class of ’79, a rheumatologist who sees patients at the clinic once a month.

“There’s no way in our lifetime that all the inequities in our society are going to be resolved, but those of us who have opportunity to work on that should,” says Martin. “We can’t, as individuals, solve some of our bigger problems, but we can certainly try to address some of these things that are in our own back yard.”

Internist Richard Stoltzfus ’59, who used to treat coal miners in Harlan County, Ky., before he officially retired, sees patients once a week, working alongside his wife Elaine Stoltzfus, who is a health educator. (Elaine spent 1961-62 studying at EMU’s seminary.)

Clinical services director Janice Good Gandy ’87 said the rewards of working at the clinic include knowing that “you’re really helping a very needy population, and you can really see it make a difference in their lives.”

In her current role, Gandy manages the schedules of the volunteer doctors and nurse practitioners; before taking the part-time job at the clinic, she volunteered there and also taught at EMU.

The biggest challenge at the Free Clinic from a healthcare standpoint, Gandy says, is the fact that patients face so many economic and social barriers to maintaining healthy lifestyles.

“We just have to do so much education. Sometimes it’s like we do all we can, and we just hit the wall,” says Gandy, who often draws on lessons about holistic well-being, and viewing specific health problems in relation to other life circumstances, that she first learned at EMU.

Funding presents the clinic with another significant challenge. As the large majority of its budget comes in donations from people, businesses, churches and other organizations in the community, revenues took a significant hit after the 2008 recession. A “rainy-day fund” got the organization through a number of lean years, but the clinic also began to institute a modest fee structure for most patients (making the name “Free Clinic” something of a misnomer) as a way to ensure that it will remain open.

It is a confusing time to be in healthcare. Many people, Gnagey says, are under the impression that healthcare reform will eliminate the need for a place like the Free Clinic (“far from true,” he says, particularly given Virginia’s decision, as of press time, not to expand Medicaid eligibility). It’s not clear what, exactly, the future holds for the Free Clinic. Uncertainty about healthcare abounds; this small organization, scraping along to provide needy patients with expensive services at little to no cost, is being swept along for the ride.

“I love working for a small, local organization serving an important local need,” Gnagey adds. “It’s a privilege.” The former chair of EMU’s nursing program and provost, Beryl Brubaker, class of ’64, was a founding board member of the free clinic, serving 1991-98.

VIRGINIA DEPARTMENT OF HEALTH

Job responsibilities for Laura Quass-Ferdinand ’06, a public health nurse, include screening Medicaid patients for eligibility for in-home personal care or nursing home placement, working in the immunization and sexually transmitted infection clinics, and helping with the refugee health and baby care programs. Debbie Gullman ’73, also a public health nurse, primarily works in maternal and child health.

While the health department performs a wide variety of functions – it also enforces health code in restaurants and has an entire environmental health arm – public health nurses like Gullman and Quass-Ferdinand mainly provide preventive healthcare to populations that otherwise would have none. (Undocumented immigrants, many of whom lack insurance and who are ineligible for Medicaid, for example, comprise much of the obstetrical practice.)

“I like that I can be involved with people who are at the margins,” says Gullman, adding that public health nursing is “really nursing and social work [mixed] together.” The EMU nursing program’s strong focus on the social dynamics of health and wellness translate well to this kind of nursing, adds Quass-Ferdinand.

— Andrew Jenner ’04

This situation, repeated in towns and cities everywhere, may be addressed and eased locally through a community health worker pilot project being launched in June.

The nursing program at ��ݮ���� and the Harrisonburg Community Health Center (HCHC) have been awarded a $115,000 grant to train lay persons to be “front line workers” on the HCHC health services team. The funds from a private foundation were provided by Dr. Arthur (Tim) Garon, provost at the University of Virginia

Ann G. Hershberger, professor of nursing at EMU, set up the pilot training program in cooperation with HCHC officials.

According to Dr. Hershberger, EMU’s nursing department will manage the project, working in conjunction with HCHC in an eight-week training program for the four health care workers as well as a six-week field/clinic training program

Kate Cockley Clark, who has been hired as project coordinator, is a 2007 graduate of EMU with a BS in  nursing and graduated May 21 from the University of Virginia with a MSN degree in public health nursing. She is also joining EMU’s nursing department faculty part time this fall, teaching community health and introductory undergraduate clinicals.

“The primary aim of this project is to assist local individuals and families who need some extra attention to navigate the health care system,” Clark said. “We believe that EMU was approached to start this program because it fits with the university’s mission and service values.

“Experience with similar projects in other locales has shown this to be a cost-effective program,” she added.

Clark has led an eight-week training sessions at EMU using available curricula with the four community health workers. They will also complete a two-week field-clinic training session with HCHC. Clark will continue to supervise the workers and provide followup training when they begin working.

The community health care workers who are completing training are Paloma Saucedo, a native of Mexico who is fluent in English and Spanish; Salime Almanzar (Spanish) from the Dominican Republic; Reem Mohammed from Iraq (English and Arabic); and Tina Beachy (English/Kurdish).

Once the program is under way in June, the workers will proactively make calls and visits and respond to family calls. Their training enables them to follow protocols for about 25 different common health conditions aswell as work with families to develop health plans and goals to promote and improve health.

The initial project will run one year, and funding is being sought to extend the life of the program.

”This program will not only improve the health of participating families, but will also promote health in the broader community,” Clark said. “By teaching healthy practices and lifestyles, the community health workers will not only affect the lives of the families they are directly working with, but also the friends, relatives and neighbors of those families.

“The collaborative nature between HCHC and EMU adds strength to the program,” Clark added. Both EMU and HCHC are well established and trusted organizations in the Harrisonburg community. In working together, they can more effectively meet their mutual goal of improving and promoting health for the local community.”

For more information on the project, contact Kate Clark, 540-432-4710; email: kate.clark@emu.edu.