In honor of National NP Week, Clinical Advisor is highlighting Melissa Kalensky, DNP, FNP-BC, PMHNP-BC, CNE, who is a dual board-certified family NP and psychiatric-mental health NP with clinical practice experience in pediatrics, family, internal, and emergency medicine. She splits her time practicing in the Shelter-Based Services Team at Rush University Medical Center and as an assistant professor in the Family Nurse Practitioner Program at Rush University in Chicago. Hear Dr Kalensky discuss her experiences treating and vaccinating patients experiencing homelessness during the COVID-19 pandemic, coordinating mental health care via telepsychiatry in shelters, entering academia, and repairing burnout in the videos and read her story below.
Key Messages From Dr Kalensky
|“One of the trends that we have seen during the pandemic is a dramatic uptick in the amount and the degree of domestic violence.”|
|“I found you can do quite a bit with a laptop, mobile Wi-Fi hotspot, and stethoscope.”|
|“We set up a method to triage mental health concerns so that we could connect patients to a psychiatric provider via telemedicine for evaluation to determine if they needed medication or referral to a therapist or social worker.”|
|“We have to think past avoiding burnout and instead of repairing burnout… I’ve been seeing a therapist for the last year and a half, and it has been very helpful in processing a lot of the stress related to work.”|
|“I would encourage everybody to find their own path. There are a lot of paths for people in health care outside of a clinic or hospital.”|
Q: What is your daily practice like on the Shelter-Based Services Team?
Dr Kalensky: I work on a team that is affiliated with Rush University Medical Center — the Shelter-Based Services Team — and provide care within homeless shelters throughout Chicago. Our practice can vary quite a bit day to day, particularly in light of the COVID-19 pandemic. We did start out as a team performing COVID-19 testing and contact tracing as the pandemic started. We’ve also provided COVID-19 vaccinations, both Moderna and Johnson & Johnson. As the NP on the team, I go site to site to perform services ranging from routine physicals all the way up to urgent care and triaging through transferring patients into the emergency room. I’m board-certified in family medicine and psychiatric mental health; as you can imagine, I do a fair amount of mental health care in shelters. It is really interesting because no 2 days are alike.
Q: How did your team implement a COVID vaccination strategy for people experiencing homelessness in Chicago?
Dr Kalensky: Our team was very fortunate to work in partnership with Heartland Alliance Health in Chicago. Our funding is through the Chicago Department of Public Health. We were able to create a team from Rush that includes my role as an NP, 3 nurses, and a social worker. We also have a lot of great volunteers including Rush nursing staff. We took nursing students with us into shelters, and then we had several community health workers. That whole team was vital in terms of physically going out into shelters and coordinating the logistics of administering COVID-19 vaccines particularly with the Moderna vaccine, which has to be kept at a certain temperature and can only be used for a certain amount of time.
I can even think of a time over the winter where we ran out of packs and coolers and we were pulling snow in Chicago and packing it into coolers to keep the vaccines at the appropriate temperature. It was really a challenge at times. We scheduled a lot of mass vaccination events. Now, our team has worked COVID-19 vaccination into our everyday practice. Every time I go out to shelters to provide primary care I bring COVID and flu vaccines so that we can try to keep everybody healthy through the winter.
It is really difficult during a pandemic to socially distance in shelters. One of the things that the city of Chicago did was move shelter space around. For instance, one of the sites I serve used to be at a high school on the south side of Chicago that was not being used. The city also paid to use one of the hotels downtown on Michigan Avenue that had closed because of the pandemic; it allowed each of those gentlemen to have their own space with a door that shut and so it helped with infection control.
One of the trends that we have seen during the pandemic is a dramatic uptick in the amount and degree of domestic violence. I witnessed this when I worked in the emergency department at the start of the pandemic as well as at the shelters I work at now. We also expect to see a marked increase in the number of people looking for shelter now that the eviction moratorium ended in Chicago.
Q: What supplies do you bring with you to homeless shelters?
Dr Kalensky: The challenge is determining how many things I can fit in a backpack and physically carry with me to homeless shelters for the day. I found you can do quite a bit with a laptop, mobile Wi-Fi hotspot, and stethoscope. Those are probably the 3 things I use the most often. I also pack a set of basic supplies with me including urine pregnancy tests, urine dip screenings, mobile A1C kits, and COVID, flu, and strep swabs. Our team is also starting to provide rapid HIV testing on-site. When I work with a medical assistant or nurse, they are able to help bring more supplies for changing wounds and dressings or can visit the patient the next day to administer a laboratory test that I don’t have on a given day. It is really a matter of coordinating the team to make sure patients get the services that they need.
Q: What other unique programs have you participated in to advance patient health?
Dr Kalensky: One of the programs that I’m probably the proudest of was working with an NP at the Safe Haven shelter on the west side of Chicago. To my knowledge, this was the only COVID respite shelter in the city. When people at another shelter tested positive for COVID, they were transferred to Safe Haven, where the staff took care of them during their 10- to 14-day quarantine period and then triaged patients back to a longer-term shelter after the quarantine. We found that people were having mental health challenges such as anxiety because of their COVID status and being quarantined in a shelter where they weren’t allowed to leave the premises.
We set up a method to triage mental health concerns so that we could connect patients to a psychiatric provider via telemedicine for evaluation to determine if they needed medication or referral to a therapist or social worker. We also saw patients with substance use disorders, some of whom were experiencing withdrawal symptoms while in quarantine, and were able to coordinate transfer to outpatient treatment facilities after discharge.
Moving forward, I hope that we can figure out a way to continue to incorporate telemedicine into shelter-based care. The level of access to psychiatric care it creates is phenomenal and the bonus is that it brings the no-show rate down to almost zero. We are fortunate to be able to experiment with unique programs such as this because of our grant-based structure.
Part of our job as health care providers is to get people signed up for Medicaid so that they can qualify for services, which is really difficult if you don’t have a place to live. Access to Medicaid means that even if they leave the shelter space, they can now participate in telemedicine from wherever they are standing.
Q: What was your path to academia?
Dr Kalensky: I didn’t take a very direct path to academia. I had thought, as a lot of nurses do, that I would be in clinical practice for a while and would teach at the end of my career. My path to becoming an NP started when I worked for a nonprofit organization providing disaster relief after Hurricane Katrina through the American Red Cross. I worked with a phenomenal set of nurses who were running a clinic out of a basketball stadium in Baton Rouge, Louisiana. I remember saying to myself, “that is what I want to do.” I ended up going back to nursing school and I picked an RN to MSN program at the University of Illinois at Chicago and received my family NP degree.
I worked for a couple of years in family medicine and then decided I wanted to go back for my doctorate at Vanderbilt University. One of my mentors, Karen Hande, PhD(c), DNP, APRN, CNE, ANP-BC, FAANP, ANEF, pulled me aside and suggested that I apply for the Nurse Faculty Loan Program, which allows you to pay for the majority of your doctorate with a teaching commitment for 4 years after graduation. I signed up for it initially to help get my doctorate paid for and fell in love with teaching. After my commitment was over, I stayed in academia because I really enjoy working with students.
Q: How do you avoid burnout?
Dr Kalensky: We have to think past avoiding burnout and instead of repairing burnout. There is probably nobody working in health care who is not burned out in at least one area. My therapist friend likens mental health to a jar full of marbles. We have to routinely do things to put marbles in the jar because health care workers can do a lot of taking marbles out of that jar while providing patient care. I think replenishing on a regular basis is probably the most important component. For me, that means getting a certain amount of quiet time, prioritizing sleep, and exercising. Getting out into nature. During the pandemic, I started walking outside probably at least an hour a day and just for the sunshine and the quiet time. I went kayaking yesterday morning up the Chicago River just by myself. It was absolutely beautiful. This restores my mental health.
Also, seek out the help of a therapist. That is something I needed during the pandemic. I’ve been seeing a therapist for the last year and a half, and it has been very helpful in processing a lot of the stress related to work.
Q: Do you have any career advice for NPs?
Dr Kalensky: There are a lot of paths for people in health care outside of a clinic or hospital. Mine is just one example of things that you can do outside of what is considered a traditional clinical space, and I encourage everybody to seek out their own path and what works for them. The sky’s the limit. If you dream it, you can build it. I never thought I would find a role that is half education and half clinical practice and it works really well for me in terms of balance. I just want people to be aware that those types of roles are out there and they have options if they feel burnt out in a clinical space and need to seek out other ways to serve patients and potentially other colleagues in terms of teaching.