Open Forum

Hi All,

I manage a team of 20 Chronic Care Nurse Navigators. I am limited on the number of nurses who are bilingual. I have had providers specifically request that all Spanish speaking patients be assigned to a Spanish speaking nurse navigator. Our model includes that the nurse navigator is embedded in the clinic so she/he is able to attend office visits and have nurse visits with their panel of patients. I obviously do not have the bandwidth to accommodate the providers' request to have all Spanish speaking patients assigned to one nurse but was wondering if anyone has experienced something similar and if so, how did you mitigate? To add to the language barrier, the patient population includes low literacy, chronic comorbidities, multiple SDOH.

Thoughts?

------------------------------
Roxanne Flores MSN RN
Population Health & Clinical Quality Nurse Manager
Austin Regional Clinic
Pflugerville TX
(512)483-9512 (35512)
------------------------------

Hi Roxanne, 

I manage a clinic for the underserved. A large majority of our patients are Spanish speaking with the same SDOH as yours. Our organization pays for an interpreter service. We have access to more than 70 languages. We have a number of IPADS in the department. We may call the interpreters via voice or video. Most days we will advise the interpreter that we will need them for an hour , two hours depending on how. many patients. We seem to do ok with it. Hope this helps. 

------------------------------
Janette Morgan, MSN,RN,AMB-BC,HN-BC
Director Community Care,
The Valley Hospital,
Ridgewood, New Jersey,
973 427 7676
------------------------------

First of all, thank you for having a team of chronic care nurse navigators! Here's hoping that spreads to the state of North Carolina where I live.

What we learned when supporting practices through their journey to becoming a patient-centered medical home is that they were  unaware of the Civil Rights Act requiring communication in the patient's preferred language (i.e. access to interpreter services) if the entity receives federal funds like Medicare and Medicaid.  

Here is a patient - facing fact sheet https://www.hhs.gov/sites/default/files/ocr/civilrights/resources/factsheets/yourrightsundertitleviofthecivilrightsact.pdf

and the OCR page for providers of healthcare and social services: https://www.hhs.gov/civil-rights/for-providers/provider-obligations/index.html

------------------------------
Leslie McDowell ANP-BC, DNP, RN
QI Specialist / Curriculum Developer
Northwest AHEC / Wake Forest University School of Medicine
Winston Salem NC
(336)972-7852
ANP-BC, DNP, RN
------------------------------

Original Message:
Sent: 02-08-2023 22:23
From: Janette Morgan
Subject: Spanish Speaking Patients

Hi Roxanne, 

I manage a clinic for the underserved. A large majority of our patients are Spanish speaking with the same SDOH as yours. Our organization pays for an interpreter service. We have access to more than 70 languages. We have a number of IPADS in the department. We may call the interpreters via voice or video. Most days we will advise the interpreter that we will need them for an hour , two hours depending on how. many patients. We seem to do ok with it. Hope this helps. 

------------------------------
Janette Morgan, MSN,RN,AMB-BC,HN-BC
Director Community Care,
The Valley Hospital,
Ridgewood, New Jersey,
973 427 7676
------------------------------

Thank you for sharing! Yes, we have a language line and a tablet device that is available (1-3 per clinic) for all to use. Specifically some providers want to only work directly with bilingual staff which I am unable to accommodate. I've saved the document you shared and the link, very valuable. 

------------------------------
Roxanne Flores MSN RN
Population Health & Clinical Quality Nurse Manager
Austin Regional Clinic
Pflugerville TX
(512)483-9512 (35512)
------------------------------

Original Message:
Sent: 02-09-2023 08:53
From: Leslie McDowell
Subject: Spanish Speaking Patients

First of all, thank you for having a team of chronic care nurse navigators! Here's hoping that spreads to the state of North Carolina where I live.

What we learned when supporting practices through their journey to becoming a patient-centered medical home is that they were  unaware of the Civil Rights Act requiring communication in the patient's preferred language (i.e. access to interpreter services) if the entity receives federal funds like Medicare and Medicaid.  

Here is a patient - facing fact sheet https://www.hhs.gov/sites/default/files/ocr/civilrights/resources/factsheets/yourrightsundertitleviofthecivilrightsact.pdf

and the OCR page for providers of healthcare and social services: https://www.hhs.gov/civil-rights/for-providers/provider-obligations/index.html

------------------------------
Leslie McDowell ANP-BC, DNP, RN
QI Specialist / Curriculum Developer
Northwest AHEC / Wake Forest University School of Medicine
Winston Salem NC
(336)972-7852
ANP-BC, DNP, RN
------------------------------


Original Message:
Sent: 02-08-2023 22:23
From: Janette Morgan
Subject: Spanish Speaking Patients

Hi Roxanne, 

I manage a clinic for the underserved. A large majority of our patients are Spanish speaking with the same SDOH as yours. Our organization pays for an interpreter service. We have access to more than 70 languages. We have a number of IPADS in the department. We may call the interpreters via voice or video. Most days we will advise the interpreter that we will need them for an hour , two hours depending on how. many patients. We seem to do ok with it. Hope this helps. 

------------------------------
Janette Morgan, MSN,RN,AMB-BC,HN-BC
Director Community Care,
The Valley Hospital,
Ridgewood, New Jersey,
973 427 7676

Hi Janette,

Thank you for your response. We do have a device for the clinic but not for our team. We have to utilize language line which is burdensome. But, this brought a good idea to get our own device. Thanks again!

------------------------------
Roxanne Flores MSN RN
Population Health & Clinical Quality Nurse Manager
Austin Regional Clinic
Pflugerville TX
(512)483-9512 (35512)
------------------------------

Original Message:
Sent: 02-08-2023 22:23
From: Janette Morgan
Subject: Spanish Speaking Patients

Hi Roxanne, 

I manage a clinic for the underserved. A large majority of our patients are Spanish speaking with the same SDOH as yours. Our organization pays for an interpreter service. We have access to more than 70 languages. We have a number of IPADS in the department. We may call the interpreters via voice or video. Most days we will advise the interpreter that we will need them for an hour , two hours depending on how. many patients. We seem to do ok with it. Hope this helps. 

------------------------------
Janette Morgan, MSN,RN,AMB-BC,HN-BC
Director Community Care,
The Valley Hospital,
Ridgewood, New Jersey,
973 427 7676
------------------------------

Good Morning,

As a Spanish speaking nurse who has worked in FQHCs for many years before moving into leadership I can tell you that there aren’t as many bilingual RNs out there as you would want to match the patient population. It clearly has its benefits for bonding directly to the patient and is more efficient overall. That being said, the right nurse using and interpreter service can be just as effective with training on how to engage the patient while using interpreter services and also some cultural humility training. The in-person portion of their job would be very important to reinforcing that bond.

Another tactic would be to begin conversations with local nursing programs to engage early with any bilingual nursing students that might be interested in a care coordinator role.

Best,

Sent from my iPhone

Hi Amy,

Great feedback, much appreciated!

------------------------------
Roxanne Flores MSN RN
Population Health & Clinical Quality Nurse Manager
Austin Regional Clinic
Pflugerville TX
(512)483-9512 (35512)
------------------------------

Original Message:
Sent: 02-09-2023 08:57
From: Amy Cadoret
Subject: Spanish Speaking Patients

Good Morning,

As a Spanish speaking nurse who has worked in FQHCs for many years before moving into leadership I can tell you that there aren't as many bilingual RNs out there as you would want to match the patient population. It clearly has its benefits for bonding directly to the patient and is more efficient overall. That being said, the right nurse using and interpreter service can be just as effective with training on how to engage the patient while using interpreter services and also some cultural humility training. The in-person portion of their job would be very important to reinforcing that bond.

Another tactic would be to begin conversations with local nursing programs to engage early with any bilingual nursing students that might be interested in a care coordinator role.

Best,

Sent from my iPhone