In a room at the Salvation Army, nurse Janet Rosenfeld treats those who live on the streets.
Chronic obstructive pulmonary disease, a lung disorder, is common among them. Wound care is an issue, particularly with intravenous drug users. Untreated mental health issues can be found in many. Addiction brings a host of problems. Even familiar problems that affect the general population, such as diabetes, become life-threatening to them.
A homeless person’s condition will deteriorate until the day they can no longer function, and they arrive at the emergency ward at Ridge Meadows Hospital.
A new nurse practitioner position has been created to help them cope with their health issues before they become critical.
Janet Rosenfeld, a veteran nurse, jumped at the challenge.
“It’s an opportunity to be innovative, and work with a hard-to-reach population,” she said. “I saw it as a good fit for my experience over the years.
“I’ll be seeing patients, and providing primary care.”
Rosenfeld explained that the difference between a regular RN and a nurse practitioner is enhanced training.
A nurse practitioner must have a nursing degree and two years of experience. Then they can get the additional training to become a nurse practitioner.
The designation allows her to see patients and diagnose their health problems, even mental health concerns. Nurse practitioners have a limited ability to write prescriptions, such as for antibiotics, can order health investigations through labs and imaging, and can refer patients to specialists.
It is a new designation that is intended to address the shortage of family physicians in B.C. The first graduating class was in 2005.
A nurse with 30 years experience, Rosenfeld took the masters program at UBC and became a nurse practitioner. She has a large background in women’s health, from maternity wards to sex assault programs. She has also worked with hepatitis C patients, and was the nurse practitioner for a remote aboriginal community near Prince George, in Takla Landing.
There are a lot of health care positions a nurse practitioner can fill, but Rosenfeld was drawn to the job at the Caring Place in Maple Ridge.
“I wanted frontline work. I enjoy patient care,” she said. “I enjoy the interaction. I enjoy building relationships with patients and finding where I can help them.”
The finding in the health care system is that homeless patients are not getting health services because they don’t want to wait at a walk-in clinic. It takes them out of their comfort zone.
“We label them as hard to treat,” she said. “They use emergency like a physician’s office.”
Rosenfeld said it may be a while before her new position is working at its full potential. She can’t be pushy in getting patients to seek any level of care.
“Trust is a big issue with this population. They need to trust you before they’ll talk with you.
“It takes time to build that relationship.”
She is already building relationships in the medical community. Her position is supported by the local Division of Family Practice, and the doctors have included her in their meetings. Similarly, local mental health professionals are working with her.
Not a Maple Ridge resident, she has been impressed by the intimate knowledge the local crisis intervention team has about people on the streets.
“They really have a pulse on the homeless people in town,” she said. “And they have a lot of good programs at the Caring Place.
“The work that’s done here is really impressive, and they’re all volunteers.”
There may be a need to do outreach work – for her to literally walk the streets to meet with people who may need medical care. But presently, the office at the Salvation Army is where she will start.
Last year, the Caring Place housed almost 500 people in its shelter, and served more than 120,000 meals. So, there will be a lot of potential clients for her to see.
Immediately, she has found an issue that needs to fixed. She can see a patient and write them a prescription for medication, but it won’t do any good if the person can’t afford to have it filled.
“They don’t have the money, and that’s something we need to address,” she said.
Rosenfeld is hoping to work with pharmacies in the community to come up with a plan.
There are costs for this unique service, but she believes the health care system will benefit by fewer ambulance rides, a decrease in emergency room visits, and even decreased hospital stays – patients can be discharged knowing there will be an opportunity for follow-up care.
“I hope to eventually be very busy,” said Rosenfeld. “I love nursing, and I’m passionate about what I do.”