It is 4 p.m., as Sara Hussein ’16 packs up her books after class in Peterson Hall, scrambles to her car and heads up Interstate 5 to her medical-surgical clinical shift at Legacy Salmon Creek Medical Center in Vancouver, Wash. Here she will spend the rest of the evening poring over the charts for the patients she’ll care for the next day. After a few hours of sleep at home, she’ll return to the hospital at 6:30 a.m. for a 12-hour shift.
The life of a nursing student is hectic. And like the other 341 students at the Linfield-Good Samaritan School of Nursing (LGSSN), Hussein wouldn’t have it any other way.
“Twelve-hour days are long, but I look at the clock and think, ‘Where did the time go?’” she says with a smile. “I’m absorbed, happy to be there, and my mind is always going, critically thinking and assessing. Time flies.”
It is precisely those critical thinking and assessment skills that set Hussein and other Linfield nurses apart in the workplace. Guided by a liberal arts core of study, Linfield nursing students are immersed in community-based health, both in on-campus classes and off-campus clinicals. They learn a holistic approach to nursing and health, says Beverly Epeneter ’68, professor and associate dean of nursing.
“Our nurses delve deeper,” she said. “It’s that truth seeking that comes from critical thinking. It’s not an accident. It’s built into the way our curriculum works.”
And Epeneter knows. As former interim dean and a member of the faculty since 1984, she has been intimately involved in the evolution of the Linfield curriculum. Linfield graduates stand out because they can think beyond the task, she said.
“Linfield students have the foundation of the liberal arts on which to build their profession,” Epeneter added. “They can anticipate, question appropriately, put things together in ways that work better than if their focus is just on doing the task. They can think more broadly and that’s an advantage.”
Linfield’s liberal arts core distinguishes it from the majority of nursing programs in the state, according to Mallie Kozy, dean of the LGSSN. Beyond learning the science of nursing, students take courses in art, history, humanities and religion that help them think in different ways as nurses. Integrated clinical experiences are critical to weaving together foundational concepts.
“The liberal arts foundation provides a better way of relating to patients and hearing their needs at any given moment, because that’s really what nursing is about,” Kozy said. “The response is emotional, social, physiological, psychological and spiritual. It’s all those things.”
Community-based health care – helping people stay healthy – is at the heart of the Linfield nursing curriculum. Escalating health care costs and increased chronic illnesses mean the traditional care model is changing, and the Linfield nursing program is responding. What was previously provided in the hospital or clinical setting is now often done in homes, with an emphasis on patient education and empowerment.
Every year, in addition to course requirements, Linfield nursing students put in approximately 1,000 hours of clinical learning at some 55-65 sites in Oregon and Washington. They work under the supervision of clinical instructors and alongside nurses in a combination of community settings and clinic-based care, making home visits, taking blood pressures and weights, assessing medication levels and more.
They learn how to help patients manage chronic diseases at home instead of in the hospital. They also learn how to collaborate closely with the providers by providing pertinent and critical assessment findings during their visits.
Kim Kintz, assistant professor of nursing, has provided experiences for her students in the community for a number of years. When possible, Kintz involves students in her role as a nurse practitioner working with vulnerable and underserved populations. Her work has included inmates at the Oregon State Penitentiary and refugees through the Multnomah County Health Department. She and Henny Breen, associate professor of nursing, have led January Term courses in impoverished areas of Cameroon and Peru. They also led a January Term trip to New Zealand to provide McMinnville and Portland students the opportunity to learn about cross-cultural collaboration and a different health care system.
“Students see what it’s like when there isn’t access to care and how you prioritize when the patients need everything,” Kintz said. “In Cameroon, the students did over 596 assessments of kids and adults.”
Another aspect of community interaction occurs in the RN-BSN program, which includes already-licensed RNs. Those students have a service learning component, and are tasked with identifying needs in their own communities and creating projects to address them. Emilie Minney ’16 and Trisha Mannix ’16 worked with the Westbrook Homeowners Association, an over-65 community in Beaverton, on disaster preparedness and education. They met with residents in their homes prior to a city-wide exercise in May and talked with them about ways to survive a natural disaster.
The community projects are rewarding for the nurses and beneficial for the organizations, say Professors Breen and Melissa Jones, who teach RN-BSN students. Not only do students develop confidence in their leadership abilities, but they also gain a deeper understanding of vulnerability – for example, what it means to live in poverty or to have a trauma history.
“Even though students learn and theorize about it in the classroom, when they’re actually face-to-face with it and see it, it changes their world view, and it changes who they are as nurses,” Breen said.
Linfield students, ranging in age from 20 to 60+, can earn a nursing degree in one of three ways. The traditional program requires that students migrate to Portland with two years of coursework on the McMinnville Campus or another accredited institution. The RN-BSN program, offered online, is designed for registered nurses with a diploma or an associate’s degree. A 15-month accelerated program is for students who have a prior degree.
Patrick McKinney ’16, a transfer student, is a married father of two young boys who earned a degree in community development and landed a job at Portland Metro before realizing he wanted a more active career. He started volunteering, found his niche in health care and enrolled at Linfield.
“Even when you are not at your clinical site, you’re working on a patient care plan,” said McKinney, who in addition to his studies, works as an emergency room technician and serves as sustainability director for the Portland Campus.
“You might be thinking about the patient, anticipating what the problems are and what you’re going to do about them, and who you can work with to accomplish those goals. As nursing students, we meet people in all different walks of life and different cultures, religions and ethnicities, so having a liberal arts foundation is useful.”
One way to improve community health is to walk a mile in someone else’s shoes. Literally.
During one clinical experience, Jake Creviston ’08, assistant professor of nursing, led his students along the busy streets of Multnomah Village in Southwest Portland that included a large population of elderly residents. The students soon realized there were no crosswalks for nearly a mile and attended a neighborhood meeting to propose changes.
“The most important thing about community health is to open the eyes of students to creative perspectives of health and treatments,” said Creviston, a psychiatric mental health nurse practitioner who teaches at Linfield and sees patients one day a week at an integrative care clinic. “Community health promotes prevention and keeping people out of the hospital – some of the biggest cost savings in health care.”
That big picture thinking pushed Creviston out of the hospital setting because it felt too late to help patients by the time they arrived there.
“I kept asking, ‘But why are they ending up here?’” he said. “If we can prevent someone’s depression, maybe we can prevent the insomnia and weight loss that goes along with it, and the physical issues that manifest and can spiral out of control. Suddenly, they’re diabetic and have kidney failure. It’s important to look at the whole picture.”
Like Creviston, many of the Linfield faculty are practicing nurses with advanced degrees, who offer a practical as well as theoretical perspective.
As a practicing bilingual nurse practitioner in Multnomah County, assistant professor Jackie Webb helps her students understand the challenges and struggles of families with limited resources by sharing her own experiences and providing volunteer opportunities. Students get hands-on knowledge doing screenings of children of migrant workers at Head Start – weight, blood pressure, eyes, hearing, anemia – while also learning about the role of the nurse practitioner. Webb developed a home visit clinical rotation so students can see how patients manage their chronic illnesses. Students learn first-hand how to assess for the many variables impacting an individual’s ability to heal.
“At the end of the day, I want our students to understand the unique positions they find themselves in when they choose to be nurses,” Webb said. “It is a privilege to be in somebody’s life when they are absolutely vulnerable. We can have a tremendous impact on the outcome.”
Luke Puerini ’16 understands being able to respond when someone is in a susceptible situation is crucial.
“In nursing, you’re dealing with people who have complicated problems and you’re dealing with them in their most helpless moments and sometimes on the worst day of their lives,” he said. “It’s important to adapt. In a split second, everything can change.”
A former wildland firefighter, Puerini enrolled in Linfield’s accelerated program after completing degrees in management and human resources. As an EMT on the fire crew, he worked extensively with Medivac helicopters and became interested in flight nursing.
“Firefighting is a hard job and I was wearing down,” said Puerini, who will complete his Linfield degree in 15 months. “It’s a brutal schedule. I worked 16 16-hour days in a row, and then got two days off. I was ready for something different.”
Hands-on experience, either acquired before coming to Linfield as in Puerini’s case, or while a student, is critical to nursing. When Elisabeth Martinez-Mendoza ’16 graduates in December, she will have experienced six clinical sites and a summer internship with a health organization in Ecuador. The hands-on learning is invaluable, as she provides patient care under supervision of a nurse. She recalls listening to a patient’s lungs and realizing for the first time that it didn’t sound quite right.
“Reading in a textbook is one thing, but when you hear it and see it, it’s totally different,” she said. “Things start to click.”
At the end of a 12-hour shift, it’s the hugs and thanks from patients that make all the hard work worthwhile.
“It’s really cool to have a patient thank you for all that you’ve done,” said Martinez-Mendosa. “I feel like I’m just the student, but to that patient I’m more than a student. I’m their nurse. I’m making an impact.”
By Laura Davis. First appeared in Linfield Magazine, Summer 2016.