Rebecca Shames (right) with alumni from our Complex Health and Social Needs Fellowship program, Kimberly McGuinness (left) and Tina Ahmadinejad (center), at the Putting Care at the Center 2018 conference.
 

By Amy Yuen

After graduating from college with a nursing degree, Rebecca Shames was working long hours as a bedside nurse at an intensive care unit, attending to patients with complex brain, spine, or neurological conditions. “I would look around the ICU and notice one preventable disease after another,” she recalled. “I so badly wanted to help prevent these patients from coming to ICU in the first place, and wondered if there were holes in the healthcare system that were causing people to be so sick.” She knew one way to get to the root issues was to switch from specialty care to a primary care setting, where she could work in preventative medicine and educate patients about their health. But when she returned to school to get her master’s degree in nursing, it was clear that improving patient outcomes was far more challenging than she thought.

Wanting to fully utilize her knowledge and skills as a nurse practitioner to improve patient care, Rebecca applied for the one-year Complex Health and Social Needs Fellowship, a partnership between the Camden Coalition and Crozer-Keystone Health System. She completed the fellowship this month. Recently, The Hotspot sat down with Rebecca to learn more about her experience as a fellow, the insights she’s gained, and her future plans.
 

How did you find out about the Complex Health and Social Needs Fellowship?

I found out about the fellowship through my previous manager’s sister, Kimberly McGuinness, who was a Complex Health and Social Needs fellow and is now the clinical lead of the Crozer Connections to Health Team. After talking with her, I realized that our frustrations and ideals related to healthcare aligned. Why were we putting bandaids on healthcare issues when the root of the problem was not solved? What about the social barriers and mental health barriers that were preventing these patients from getting better? Well, the fellowship was about to open my eyes to a world of complexity in the healthcare system, and how I can change my practices to moving in a direction of healthier, happier patients.
 

Kimberly is also a nurse practitioner, like yourself.

Yes, she was the last nurse practitioner (NP) who was a fellow a few years ago. It’s hard to find a fellowship like this, and it’s not a common route that NPs take. I was really happy to hear there were fellowships for nurse practitioners. We’re underutilized.
 

In what ways?

Nurse practitioners are utilized by some hospital systems as “filler” providers when hospitals are understaffed or can’t afford a Doctor of Medicine or Doctor of Osteopathic Medicine. The educational background of nurse practitioners is so unique because they have boots-on-the-ground experience, with a master’s degree focusing on the diagnosis and treatment portion of medicine that’s essential to becoming a provider. Nurse practitioners are also registered nurses who usually have a great bedside manner. This makes the role toward provider such a seamless one. Nurse practitioners should be utilized to practice at the highest level of their scope and educational background, and this includes being primary care providers.
 

Tell me about your work as a Complex Health and Social Needs Fellow.

As a fellow, the majority of my job was working at Crozer-Keystone on the Crozer Connections to Health Team, which works with patients who have frequent and preventable hospital admissions and/or emergency department visits. The team works in a multidisciplinary fashion — there’s a clinical case manager, a social worker, psychology students, and medical and pharmacy students, for example — and we collaborate to help improve the health and meet the goals of the patients we serve. We have anywhere from twenty to thirty patients at a time, all who have multiple chronic health conditions and social barriers that cause hospitalizations or emergency department visits. In addition to the teamwork I did, I was also a primary care provider at the Crozer Center for Family Health in Springfield, PA, where I saw patients a few days a week.
 

And once a week you worked at the Camden Coalition?

Yes, I worked with the Clinical Redesign Initiatives team once a week. I was consulted on a number of different projects where a clinical lens was needed. Mostly, I worked with the team on the 7-Day Pledge and Everyday Pledge, where the main goal is to get patients reconnected with their primary care provider within seven days of discharge from the hospital.
 

What’s the biggest thing you learned?

I’ve been amazed by the sheer resilience of human beings, and how my patients can endure so much but still have the ability to meet their goals. This has given me strength and motivation to move forward with the work that I do. Despite the setbacks that inevitably will happen, people are very appreciative and grateful for what we do. This has helped me develop more patience as a provider.
 

How else has your practice changed from this experience?

The fellowship has completely changed the course of my career. For a long time, I knew I wanted to work in a primary care setting, but beyond that, did not know how that would look. I know now that I want to do more, push the boundaries of our healthcare system, and stop checking boxes on each patient encounter. I’ll individualize care and focus on the goals of my patient, instead of preaching of what I think their goals should be. I’ll keep the conversation open system-wide, statewide, and nationwide about why this work is so important, and how treating patients with complex health and social needs has become a movement.
 

What do you hope to do after the fellowship ends?

First, I am going on my long overdue honeymoon. My husband and I got married back in April, and we are going to Southeast Asia for two and a half weeks to explore a new culture and eat amazing food. When I get back, I’ll start a new position as a provider at Oak Street Health, which is a primary care office in Philadelphia that focuses on Medicare patients with a value-based care model. Oak Street was first started in Chicago and recently opened a few offices in the Philadelphia area. Instead of focusing on quantity of patients in their offices, they focus on the value of care, including health outcomes and preventative measures.
 

Anything you want to say to other nurses thinking about applying to this fellowship?

Nurse practitioners are the present and future of healthcare. Their role is so important, and they bring a unique viewpoint to the table. It’s been interesting to be an NP in an MD world, and there should be more of us having this discussion as it relates to complex care. There’s a reason that multidisciplinary care works, and nurse practitioners are an important piece to that puzzle.
 

To learn more about the Complex Health and Social Needs Fellowship supported by the Camden Coalition and Crozer-Keystone Health System, contact the Fellowship Coordinator at [email protected] or visit https://www.camdenhealth.org/camden-coalition-careers/complex-health-social-needs-fellowship/.

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