How did you get into nursing? Why did you choose to become an NP as opposed to other specialties?

Sometimes, you have to get away from something to appreciate what you have. I'd worked in the ER and critical care for 14 years and considered leaving nursing. To remedy my frustrations, I changed focus and worked on medical videos along with doing some photography, but everything led me back to nursing. I realized that the values and the theory of nursing were a part of me. I liked the patients, I liked working with my colleagues and I was skilled at my job. The opportunity came to get my MSN and NP. This offered new challenges, so I went for it. Who knows why I originally went into nursing? I was 19; my dad said I should become a nurse, so I did.

How did you hook up with the Care-A-Van and the Visiting Nurse Association?

In the early 1990s, school nurses in the Antelope Valley were concerned that many students had no access to health care to receive physical exams and vaccines. It was started in 1995 by the Visiting Nurse Association Foundation with support from the United Way in response to their concerns to provide physical exams and immunizations for low-income children and families. Today, the nonprofit Partners in Care Foundation oversees the Care-A-Van.

I've always enjoyed being out and about. That's one of the things I liked about home nursing. When the Care-A-Van started here in Lancaster, I knew nurses who worked with it, but the timing never seemed right for me to work with them. It wasn't until last year that I was able to come on board.

What is your favorite part of what you do?

I have a lot of favorite parts. Of course, as always, there are the patients. We treat low-income people with no health insurance and no access to health care. I gain from knowing them.

I also love the mobility and not being stuck in an office all day. We have an RN and a driver/translator/registration clerk. Our office support staff includes a receptionist/billing clerk and an outreach coordinator/grant writer. We all have multiple jobs and some patient problems call for pooling all our creativity to find solutions.

Least favorite?

Money, money, money. We never have enough. Like many other clinics, we've suffered from cuts in state health care funding and the loss of some of our grant money that we depended on. We often seem to be on the edge and that's difficult.

Are there any special incidents that you hold on to?

There is one young family I met when I first started on the van. This also shows the holistic component of what we do. Medical aspects can't be separated from the emotional or social problems of our patients.

Anyway, in this family, the mother had a debilitating health problem as a result of a difficult vaginal delivery and she had been dealing with this for more than a year. Her husband had rheumatoid arthritis. Neither of these conditions was being treated when we first saw them. We spent a lot of time trying to arrange for the specialized surgery that the mother needed and we also began to manage the father's arthritis.

The highlight of my year with them was that at Christmas, the employees of the Boeing Co. asked if we knew a family they could help. I told them of this family. The mother came in and saw me in January after their Christmas and said it was the best Christmas she had ever known. They'd had no money for presents. The kids were wearing shoes with holes to school. She had told them just to study hard and Santa would reward them with good grades. Instead, they received new clothes and shoes.

What is your greatest hurdle?

Finding resources for our patients. We utilize patient assistance programs through pharmaceutical companies to get free or low-cost medications. This is a wonderful service, but very time-consuming with the paperwork involved. We are always searching for and applying for grants. We are involved in community fund raising for our program. The paperwork is daunting. For every hour of patient care, it seems I have at least an hour of desk work. All this takes me away from patients and that's hard.

Anything else you'd like to add?

We gratefully accept donations. This is a worthy cause that helps the working poor. People can contact the Care-A-Van offices at (661) 942-2391 or e-mail me at ahorner@picf.org. My office address is Care-A-Van, 44733 Date Ave., Lancaster, Calif. 93534.