NurseWeek: Tender mercies

Tender mercies
Nurse-run community clinic benefits San Francisco’s homeless, students

By Cathryn Domrose
February 12, 2001
Photo: Artville

San Francisco's Glide Health Clinic, a collaborative effort by UCSF, Glide Memorial United Methodist Church and Catholic Healthcare West-West Bay Region, offers health care to the homeless and the opportunity for nursing students to gain clinical experience.


	You've read the article. Now tell us what you think. For more information Glide Memorial Church Gliding along Nurse-run community clinics have been around since the days of Margaret Sanger, who opened the first birth control clinic in 1916, and Lillian Wald, who, in 1893, ran the Henry Street Settlement to meet the needs of newly arrived immigrants and the poor of New York City’s Lower East Side. Traditionally, these clinics have treated inner-city and rural populations. But since the late 1970s, many nursing schools have started nurse-run clinics to allow their faculty a place to practice and their students a supportive clinical setting. The clinics often include counseling and patient education components that involve families and communities. Some use complementary medicine such as acupuncture and massage therapy. Although most, like Glide, still focus on people with limited options for health care, some nurse-run clinics are serving upper middle-class communities, said Jan Towers, Ph.D., NP, RN, director of health policy for the American Academy of Nurse Practitioners. "We’re finding that this is a really good model," she said. Studies have shown that nurse-run community clinics have reduced emergency room visits, hospital inpatient stays and the use of specialists, according to the Regional Nursing Centers Consortium, an organization comprised of nurse-run clinics in the Northeast. The 2-year-old Glide Health Clinic is on the fourth floor of Glide Memorial Church. Glide Memorial offers more than 50 services for the homeless that include free meals, housing aid, job training and a senior program. The clinic, in keeping with Glide Memorial’s rounded approach, includes mental health services, complementary care, faith-based recovery programs for drug and alcohol abusers, patient education and referrals. Four nurse practitioners, all faculty members at the University of California, San Francisco, see patients and supervise the mostly advanced practice nursing students. Volunteers – physicians, nurse practitioners, nurses, clerical workers and others – have donated thousands of hours to the clinic. ~ Cathryn Domrose

Each Monday, Elissa Utiss, RN, a nurse practitioner student at the University of California, San Francisco School of Nursing, goes to a cardiologist’s office where she works with mostly elderly people. Common ailments include hypertension, diabetes and cardiac problems. Everyone has insurance.

Wednesdays, she goes to Glide Health Clinic, nestled among the residence hotels, liquor stores and subsidized housing in San Francisco’s Tenderloin neighborhood. There, she works with people who live in the hotels or on the street. Common ailments include skin disease, upper respiratory infections, gastrointestinal complaints, schizophrenia, alcoholism, diabetes and hypertension. Many patients are mentally ill, addicted to drugs, or both. No one has insurance.

Utiss, who wants to specialize in cardiology, values both clinical assignments. But her experience at Glide, a nurse-run clinic established by UCSF, Glide Memorial United Methodist Church and Catholic Healthcare West-West Bay Region, gives her added insight into what being a nurse practitioner is all about.

"Here, it’s a more relaxed learning environment for me to treat the entire client," she said, taking a break from seeing patients one Wednesday morning to talk about her work at Glide. "I feel it’s rounding me out as a nurse practitioner to see diverse patients and be able to treat different conditions. I know it’s making me a better nurse practitioner."

A few years ago, the UCSF School of Nursing had a difficult time finding placement for students to gain clinical experience and adequate training, said Grace Galzagorry, MS, RN, managing director of Glide Memorial Church’s health services division.

Managed care had forced many hospitals to eliminate mentoring programs, Galzagorry said. Physicians and nurse practitioners had little time to supervise or teach. The school approached Glide with the idea of opening a clinic staffed by faculty members who could spend time with students. At about the same time, Catholic Healthcare West approached Glide, wanting to start a medical service for the homeless. Glide suggested a partnership and the Glide Health Clinic was born.

At 10:30 in the morning, the clinic’s tiny waiting room is packed. The clinic opens four mornings a week and receives more than 300 patient visits a month. Thursdays often are the busiest days, said Patricia Dennehy, MS, RN, clinical manager of Glide Memorial Church’s health services division, because on Thursday the food program serves fried chicken for lunch.

Some in the waiting room have nodded off. Others chat quietly. Most stare straight ahead with the glassy-eyed look of people with nowhere else to go.

Ricky M., a soft-spoken young man with a shiny bald head and a cane, waits for the results of a blood test. Routine blood tests are a good idea when you live on the street, he said, because you never know what diseases you might pick up. Usually, he has the tests done at San Francisco General Hospital, but today he came to Glide. He appreciates the time Glide caregivers spend with patients, he said.

"It seems like it’s easier to communicate with a nurse than with a doctor. You get some of these doctors, you can’t explain what’s really wrong because they don’t want to hear it."

Besides treating complaints – a cough, acne, an upset stomach – volunteers, students and nurse practitioners routinely ask questions, Dennehy said. How much are you drinking? What’s your drug of choice? How many sex partners have you had? Where have you been sleeping? What have you been eating?

They track down those who need treatment. An outreach worker and peer advocate who once lived on the streets herself brings in patients from parks, residence hotels or the General Assistance office, where patients pick up their checks. Dennehy once nabbed a woman in the hallway, after food program workers alerted her to the woman’s whereabouts. The woman had tested positive for a sexually transmitted disease, but left before receiving treatment.

"We sat her down, gave her the tablet and made sure she swallowed it," Dennehy said.

They think of creative, multifaceted approaches to treatment. An African-American mental health provider is using prayer to help her patients. An advanced practice nursing student who specializes in occupational health is developing a health and safety program for Glide’s food service workers.

Like Ricky M., many homeless people receive their health care at any hospital or clinic they happen to be around – or not at all. But gradually, more and more people are coming to Glide on a regular basis, Dennehy said. More than half are returning patients, she estimates.

Those who work at Glide say they have come to appreciate the plight of a population that desperately needs health care. Renee Etienne, NP, a clinic volunteer who lives in an upper-middle-class San Francisco neighborhood, said her work at the clinic drives home the inequality of health care in the United States.

"Here, you have the satisfaction of doing something for people," she said. "Instead of criticizing all the time, you’re trying to fix the imbalance."

After graduation, Utiss would like to work in a clinic where she can use her cardiology skills, she said. "But wherever I am, I’ll definitely continue to volunteer my services once a week because of working here at Glide."