Vanderbilt Nurse Faculty Practices Anchor Down, Step Up

Cornelius Vanderbilt statue with mask

As Vanderbilt University leadership considered whether it could bring students, faculty and staff back to campus safely in the fall, they knew that COVID-19 testing, contact tracing and symptom management were going to be necessary to protect the campus community. Fortunately for Vanderbilt, it has a world-renowned School of Nursing that stepped up to collaboratively design and implement plans for providing those essential services.

“From the start of the pandemic in March, the School of Nursing has been active in the university’s planning. Early on, Interim Chancellor and Provost Susan R. Wente appointed Dean Linda Norman to head up the university’s public health taskforce,” said Pam Jones, BSN’81, MSN’92, DNP’13, VUSN’s senior associate dean for clinical and community partnerships. “Dean Norman volunteered that the school has expertise, particularly in the area of community health planning and response. The university enthusiastically took her up on that.”

Jones is coordinating VUSN’s key role in the return of nearly 20,000 students, faculty and staff to campus. She directs VUSN’s Faculty Practice Division, which includes advanced practice registered nurses who provide patient care at more than 10 clinics and on-call services in cooperation with Vanderbilt University Medical Center. Many of the division’s faculty members have been providing COVID-19 testing and follow-up care through their clinics and practices.

“The health and safety of our Vanderbilt community are our highest priority,” wrote Incoming Chancellor Daniel Diermeier and Interim Chancellor and Provost Wente in their announcement of the university’s plans for in-person classes fall semester. The university emphasized that the plans were developed in close consultation with experts at Vanderbilt University Medical Center and the School of Nursing as well as national, state and local public health officials.

“As a core component of our preventive measures, we will have requirements for COVID-19 testing, as well as rigorous contact tracing and symptom management. We are partnering with experts at VUMC and our School of Nursing to deploy best practices in these areas,” the university stated.

Jones has been working with Andrea George, PhD, CHMM, PMP, director of Environmental Health and Safety for the university on the protocols for the return to campus.

In conjunction with Student Health and VUMC, School of Nursing faculty and members of the Nurse Faculty Practice Division will perform symptom screens for all arriving undergraduate students and subsequent testing.

“We’re setting up a testing center for high volume and special needs, be that students, staff or faculty,” Jones said. “We’ve mapped how the testing will occur. Our next step will be running our testing protocol through VUSN’s simulation lab. That will allow us to check for efficiency, determine how long the process takes, identify where hold-ups could occur and see places where we can improve. The simulation also will be observed by an infection control expert to ensure best practices are in place.”

She said that the university will use new FDA-approved testing swabs that can be self-administered by an individual and only require a sample from inside the nostril. Each collection will be observed by a health care professional to ensure maximum effectiveness. The university also plans to film someone being tested to show how easy the process is and share that video with parents, students and others who might be tested.

Contact tracing

The Faculty Practice Division has also been asked to collaborate with the university’s Student Health Center in assuring student health and safety. Advanced Practice Registered Nurses and RNs from VUSN and Faculty Practices will perform contact tracing for COVID-19 positive cases; act as an interface between the university, Student Health and VUMC; provide counseling for any students who are in quarantine and isolation; and provide periodic well checks for all students.

“As the most trusted profession in America, the discipline of nursing is uniquely prepared to lead contact tracing programs,” Jones said. “Our nursing faculty will obtain the names of those who were in contact with an infected individual. Then we’ll contact them, notify them of their exposure and give them guidance for their own testing and health. Once someone is quarantined, we’ll be in regular contact to check on them and provide assistance.”

The testing and contact tracing support will continue for as long as needed.

Norman, the Valere Potter Menefee Professor of Nursing as well as dean, believes that involvement by the School of Nursing will reassure students, parents, faculty and staff who might have apprehension about the return to campus.

“Many groups were involved in the decision to return to campus, and leadership took into account a variety of scenarios and best practices. They believe, as do I, that it is important for Vanderbilt students to have the invaluable experiences of in-person learning and interaction with faculty, staff and fellow students,” said Norman, DSN, FAAN. “This is a great opportunity to help the university and provide quality, holistic care to students at a time when they will be under physical and mental stress.”

Testing and assessment

Setting up testing centers, conducting testing and performing contact tracing is not new to the School of Nursing Faculty Practice Division. Faculty members have been providing that care and more since early March.

As soon as COVID-19 tests were available, faculty from the Vanderbilt Nurse Faculty Practices in coordination with VUMC provided testing in some of their practice sites and volunteered to staff sites elsewhere.

Nurse practitioners gowned and wearing face masks under clear shields Associate Professor Abby Parish, MSN’05, DNP, FNAP, and Instructor Shelza Rivas, BA’12, MSN’15, DNP’17, normally can be found at Vanderbilt Nurse-Midwifery and Primary Care at Melrose, one of more than 10 nurse-managed clinics operated by Vanderbilt University Medical Center and staffed with VUSN faculty. The two volunteered to perform COVID-19 testing at VUMC’s Clarksville clinic near Fort Campbell. They weren’t the only ones.

Instructors Randy Smith, MSN’12, DNP, and Amanda Noblett, MSN’11, usually work as providers at Vanderbilt Health at Gaylord, an employer-provided health clinic that serves Gaylord Opryland Resort & Convention Centers’ more than 2,500 employees and their families. Smith and Noblett volunteered to conduct tests at an assessment site set up by Vanderbilt University Medical Center in one of its parking garages. The rapid cycle site was set up to test VUMC staff and faculty primarily; it was created and managed by advanced practice nurses Kathleen Donais and VUSN alumna Shannon Ellrich, MSN’17, DNP’20. Noblett said that doing assessment was an amazing experience to help with early detection of COVID-19 and to have the opportunity to reassure people worried about the virus.

Safe at home with technology

When people were encouraged to stay safe at home, many Vanderbilt University Medical Center providers turned to telehealth for routine health visits. Vanderbilt Health OnCall, an on-call service operated by School of Nursing faculty nurse practitioners, was one of the early adopters. “We were able to launch telehealth services within a matter of hours,” said Jennifer Mitchell, MSN’05, APRN, clinical director of Vanderbilt Health OnCall. “I’m so proud of what our group has been able to accomplish.”

Patient talks to nurse practitioner via computer from home using telehealth Normally, the service’s nurse practitioners are on call to assess patients over the phone and to pay them home visits; the services are open to non-Vanderbilt patients as well (it’s very popular with visitors to Music City). VUMC made establishing secure videoconferencing an early focus and it paid off. With the videoconferencing option, concerned individuals can speak directly to a nurse practitioner without any exposure risk. This service proved especially essential in the early weeks of the pandemic when much was unknown about the virus’s transmission and progression. Since March 5, Vanderbilt Health OnCall providers completed nearly 200 telehealth visits, primarily for COVID-19 positive patients.

The nurse midwives and advanced practice nurses from Vanderbilt Nurse Midwives and Primary Care for Women at Melrose and the West End Women’s Health Center also quickly revised their care model. One group of providers conducted telehealth appointments and another group provided on-site care, said Lori Cabbage, MSN, CNM. In the first six weeks of the stay-at-home orders, 325 postpartum visits and 202 primary care visits were conducted by telehealth.

The Clinic at Mercury Courts, which is operated through a partnership between VUSN, VUMC and Urban Housing Solutions, also moved to a combination of telehealth and home visitation—but it also faced a different issue. A few days into Nashville’s initial COVID-19 response, the clinic’s physical building experienced a water break that resulted in flooding and the need for the clinic to move to a different location. Within a week, it was in temporary quarters and soon the clinical team was back at work providing care to vulnerable clients in an impoverished area. The identification of a COVID-19 positive individual in the Mercury Courts community triggered a coordinated response from the Nashville-Metro Health Department with support from VUMC and the clinic staff.

More than 120 homebound and/or medically vulnerable individuals were screened; the clinic then provided treatment and support for those who needed isolation. Several of the individuals who needed to be in isolation did not have access to food, so the School of Nursing, clinic and others provided food boxes. Items in the boxes, along with pictorial instructions for recipients with limited English proficiency, were recommended by interns in VUMC’s Dietetic Internship Program for maximum nutrition and low preparation. The quick action by the health department and various Vanderbilt teams is credited with preventing a cluster outbreak.

Hotline heroes

As associate nursing officer for VUMC Advanced Practice and director of the Office of Advanced Practice, alumna and faculty member April Kapu, MSN’05, DNP’13, was part of VUMC’s command center team and charged with deploying the APRN workforce enterprise-wide. Within 24 hours of the decision to create a COVID-19 telephone hotline, Kapu and her team had it up and running.

Callers to the hotline speak first with VUMC schedulers, working from home, who provide answers to frequently asked questions and arrange for clinicians to return the calls. The hotline started with three nurse practitioners and expanded as call volume increased; currently, about 200 nurse practitioners, physician residents and fellows respond to patients’ calls.

Questions range from people who want to know if they should be tested to those who have tested positive and want to know when they can go back to work. If testing is advised, the hotline clinicians recommend where patients can go for assessment. If patients test positive, another team follows up by telemedicine visits every other day to make sure they aren’t worsening.

The clinician hotline supervisors are both School of Nursing faculty and practice providers. Alexandra Speros, MSN’99, CNM, is a certified nurse midwife and family practitioner providing women’s care at West End Women’s Health Center and Vanderbilt Nurse-Midwives at Melrose, and Alyssa Miller, MSN, is a nurse practitioner who provides primary care to the Metro Nashville Public Schools’ Employee & Family Health Care Centers.

“It’s been great to see the teamwork between many people who have never met, working to get information out to all of our patients quickly and easily to keep them as safe as possible,” Speros said. “It took a little bit of figuring out how to manage the calls at first because we had such a huge influx of calls very quickly. We didn’t know at first how many calls to anticipate, but we got appropriate staffing quickly and knocked those out as quickly as possible.”

As of press time, the hotline had fielded more than 26,000 calls.

Reporting by Jill Clendening, Nancy Humphrey and Nancy Wise

Images, from top:

Even the statue of Cornelius Vanderbilt outside of Kirkland Hall wears a mask.

Associate Professor Abby Parish and Instructor Shelza Rivas in their PPE while doing COVID-19 testing.

Patient Jill Clendening meets with nurse practitioner Katy Hansen in a telehealth visit.

Members of the Nashville-Metro Health Department with support from VUMC and the Clinic at Mercury Courts staff head to the Mercury Courts area to provide screening.