As a Sigma chapter, we seek to advance nursing scholarship and leadership by providing opportunities to current and future members of Phi Epsilon Chapter at The George Washington University School of Nursing in Washington, DC, USA. Our accelerated BSN program presents us with many opportunities to achieve this goal. One clinical opportunity arose amidst the current COVID-19 pandemic from Dr. Erin Athey, a faculty member who was practicing at a local hospital that was doing testing and vaccinations out in the community using their large mobile unit. Fortuitously, two of our undergraduate students had the unique opportunity to do their clinical rotation on the mobile unit. They both exhibited significant insight and leadership during this experience. We hope that hearing from them will be a catalyst for other nursing faculty to find creative and innovative ways to engage nursing students in nursing experiences that extend beyond the hospital walls!
The United Medical Center (UMC) mobile health program was born out of a need to serve the populations of Wards 7 and 8 in southeast Washington, DC, USA. This area is only three miles from the nation’s capital but has some of the worst health disparities in the country. This predominantly African American population experiences diseases such as diabetes, hypertension, cancer, and mental health disorders at a much higher rate than other areas of the district. Therefore, it was no surprise when the pandemic hit early in 2020 that those residents who reside here, colloquially known as “East of the (Anacostia) River,” were disproportionately affected by COVID-19. As an experienced nurse practitioner who has spent the last decade at UMC, I knew that there would be a great need to reach these residents. Taking the UMC mobile unit out into the community would alleviate issues of access and fragmentation in the healthcare system that had worsened due to the pandemic. Nurses, who have been consistently voted the most trusted healthcare professionals, could also play a key role in addressing some of the fear and mistrust of the healthcare system. Since I am also a part-time faculty member at the GW School of Nursing and teach community health to accelerated BSN students, I thought this was a perfect opportunity to demonstrate an innovative prevention program to nursing students in their final semester of nursing school. Student nurses not only could participate in clinical interventions, such as COVID-19 testing and vaccinations, but they could also appreciate the social determinants of health and their impact on this community. This was quite literally their introduction to community health nursing—during a global pandemic—so it was an extraordinary time for them to experience this and reflect on what they learned through this clinical opportunity.
William “Billy” Baron
Before my clinical rotation on the UMC mobile unit, I volunteered with UMC, where they had renovated one of their floors to be a COVID-19 vaccine distribution center. I administered dozens of vaccines daily and first heard of the mobile unit then. I was excited to get involved as soon as I heard there were openings for nursing students to help distribute the vaccine to underserved DC communities. Initially, I expected we would drive through areas without close public transportation availability and advertise that we had vaccines for anyone who wanted them.
It was so much more than that, though. I learned we were collaborating with a DC police department’s summer community event, “Beat the Streets.” These events involved many community-focused groups with a dedicated space in community roads to come together to advertise and educate about their individual group mission, while police cadets organized and officiated the tents, food, music, and community involvement.
My first day with the mobile unit was shocking, to say the least. I did not expect to walk into a charter bus complete with two full exam rooms, a waiting room, and a restroom! However, I was excited to see it open for business. I set up my exam room, organized my supplies, and headed to my designated tent outside of the van to talk to some of the community members about being vaccinated.
That is when I realized this was going to be much more difficult than I thought. Nearly everyone I spoke to had already received his or her vaccines earlier in the year or had completely denied it altogether. As a senior nursing student, I am proactive in my personal health and well-being. My individual habits sometimes influence my close friends and family, too. I found it difficult to understand why so many people in the community were as hesitant as they expressed themselves to be. I wanted to understand, so I shifted my “vaccine advertisement” pitch to more of a conversational, humanistic approach. I found it very rewarding once I established a real, trusting relationship and got to hear the raw information behind their why.
They did not trust the government, the communication, or the way the rollout was organized. I felt overwhelming paranoia from them, too. Some community members said they did not think the vaccine was actually a vaccine. They thought the batch that they had been offered had the vaccine vial labeled correctly, but the solution in the vial was a placebo.
I worked closely with another student, and we discussed many of these psychosocial events in the community and within the healthcare system. Our findings were incredibly parallel to unvaccinated healthcare workers. We decided to take the initiative and investigate this further—focusing our community education project on nursing vaccine hesitancy. Without the attentiveness and leadership skills we utilized in the community, I do not think we would have thought to bridge the hesitancy similarities into the nursing profession.
Healthcare is very complex and has many nuanced fields that overlap. My exposure with Dr. Athey, the UMC, and the mobile van allowed me to see how the community was affected and how they reacted to healthcare and policy changes. I loved that I had the opportunity to step up and cross paths with so many community members and healthcare workers regarding their experience. I plan to keep asking “why” in my nursing career to better understand and influence change for the future.
When I first learned that I was placed on the UMC mobile unit for my community clinical rotation, I was extremely excited about the opportunity. I knew I would have an experience unlike any other that I had in nursing school so far, and it certainly was.
Working on the UMC mobile unit was quite an adventure. Each week, we typically had one or two events. When we had events, we would meet at UMC and ride together in the van to our site for the day. I worked with the team throughout the month of June, mainly administering second doses of COVID-19 vaccines and doing community outreach to increase vaccination efforts. We went to apartment complexes, public housing, and other community events.
Throughout June, we saw a lot of vaccine hesitancy surrounding the COVID-19 vaccines and tried to figure out how to combat it. I found that understanding the root of a patient’s hesitancy was key to advancing the conversation. Engaging with the community slowed the spread of misinformation and helped community members make educated decisions about their health.
I had a very formative experience, and I think I was able to grasp what it means to be a community health nurse and provider. There are different challenges compared to inpatient care, but there are also so many rewarding moments. You really see patients in their entirety and have the opportunity to build a trusting relationship. This allowed us to uncover challenges the community faces. We saw real-time effects that social determinants of health have on patients and how their experiences have sparked mistrust in the medical system. Although difficult at times, I enjoyed engaging with patients out in the field and know that my time with the UMC mobile unit will serve as a constant reminder to examine and seek to understand the whole patient.
I know that my experience will undoubtedly affect my nursing career in a multitude of ways. I learned to keep an open mind, the importance of remaining flexible and adaptable, and that teamwork will allow days to pass more smoothly. I believe I am a stronger nurse because of this experience and that I will further develop critical thinking skills to allow me to get to the root of future patient hesitancies. I am extremely grateful for this experience, and I look forward to returning to the community setting one day.
The UMC mobile health program provided a formative learning experience for the ABSN nursing students who participated in this rotation. They were able to engage with the local DC community and improve upon their clinical skills. The GW School of Nursing plans to continue this partnership as a unique way for students to engage with community members and as a way to bridge the community to the university. Although we hope that the pandemic will end soon, this clinical experience will allow other opportunities to learn about and address social determinants of health, as well as other health issues that exist in the neighboring communities.
Erin Athey, DNP, FNP-BC, RN, FAANP, is a faculty member at the George Washington University School of Nursing and the Nurse Practitioner/Clinical Director of the UMC Mobile Program. She is a member of Sigma’s Phi Epsilon Chapter.
William “Billy” Baron, BSN, RN, is a recent graduate from the George Washington University School of Nursing and is a Medical/Surgical ICU Nurse at MedStar Washington Hospital Center. He intends to apply for Sigma membership as a nurse leader in the near future.
Alyssa Filippelli, BSN, RN, is a recent graduate from the George Washington University School of Nursing and is employed at the George Washington University Hospital Emergency Department. She is a member of Sigma’s Phi Epsilon Chapter.
Esther Emard, MSN, MSLIR, RN, CPHQ, is a faculty member at the George Washington University School of Nursing and president of Sigma’s Phi Epsilon Chapter.