SPUC Spotlight Podcast
Robin Henson, DNP, CPNP-PC
Cook Children’s Medical Center
Fort Worth, Texas
In this issue’s podcast we’re talking to Robin Henson. She is a pediatric nurse practitioner at Cook Children’s Urgent Care in Fort Worth. One of the things we’ve been doing in these segments is, first, is talking to people about how they came to medicine, to pediatrics and to urgent care. So, why don’t you talk a little bit about your path.
Oh, absolutely thank you very much. So I have, I’ve been a nurse since the early 1980s, I entered into nursing . . . basically, I have an uncle who’s a physician, and he and his wife and my cousins invited me to come live with them while I went to nursing school here in Fort Worth, Texas. So I jumped on that immediately, fell in love with nursing and then while I was in my rotations in nursing, fell in love totally with pediatrics. My career moved forward when I graduated and I did a variety of things: I worked in emergency room; I worked in women’s health, labor and delivery, eventually ,found my home in pediatrics in the late eighties and haven’t left since. In the 1990’s I obtained my Master’s Degree, got my Pediatric Nurse Practitioner certification and have been practicing ever since. So, it’s really, it’s been a long journey over a couple different decades but pediatrics has been really where my heart has been
You mention you fell in love with pediatrics. What was it specifically about that area of medicine that appeals to you?
I really just think, getting down on kids’ levels, being able to talk to them, helping to watch them relax while you explain procedures, making it not be such a very scary thing. You know, thinking back as a kid getting stitches in my chin and being put into an adult emergency room to get stitches put in was terrifying to me as a child. And I never would want to have a child ever have that same feeling that I did. So I work really hard to make sure that kids feel comfortable, feel relaxed so that we can take care of them the best we can, and give them a really positive experience .
Can you talk a little bit about how the work happens between physicians and nurse practitioners and nurses and other staff at the urgent cares at Cook Children’s?
In the state of Texas, nurse practitioners and physicians, which are called advanced practice providers — or APP’s– we work under the delegation of a supervising physician. So, it doesn’t mean that they dictate everything we do; however, it does require that we have collaboration with them through the TMB, the Board of Nursing and for PA’s, where they are licensed also. So we, as physician assistants and nurse practitioners, we see our fair share of sick kids; we collaborate with the physicians that are currently in the Urgent Care with us at the time and if we have questions. We practice independently; we write prescriptions; we manage their care, we refer to specialists, we refer to the emergency room, and as well, from our specific urgent cares, we can actually directly admit to the overnight short stay unit at the hospital. So we have a lot of autonomy, however we do work closely with physicians and I think it works out really well. We have a great collaborative relationship together.
What kind of patient population do you have?
Currently we have five locations and our largest location is in Fort Worth. We see approximately 400 to 600 patients a day and this population tends to be a little more Medicaid-heavy, multilingual area. In some of our outlying clinics we have a lot more private health care, less diversity but equally sick kids at all locations and we see just a variety of illnesses and diagnoses at every location.
Do you require a second language for any of your staff?
We do not require a language. We strongly welcome it and encourage anyone who wants to go through the translation process to be medically certified. At the hospital we certainly welcome that. However we do have computerized translation services as well as LanguageLsine, via telephone, which offer multi, multi languages so that not can we help the Hispanic population, the French population, but just multiple, multiple langages that we can help all of the families that enter our clinic.
From talking to other members of SPUC and other medical groups from around the country, do you find that you have a different kinds of problems that come to you, or more of some kind or another because you’re in Texas and the weather might be different, or whatever?
That question probably can be answered a couple different ways. One way, for sure, we could be very seasonal, right, so we definitely can see a lot of sunburn in the summer, a lot of insect bites and snake bite and things. In the summertime, kids of course they’re going to fall and break their arms and legs because they’re outside playing. . . a lot of water injuries, unfortunately because of our hot summer months, kids can swim six months out of the year here. The wintertime, we see our share of RFB, flu, things that I’m sure they see across the country.However, not as much frostbite and snowmobiling injuries happen here in Texas like other parts of the country. But we do have our fair share of kids that have gotten kicked in the head by horses and different animals — so, yeah, in some of our more rural areas we definitely do see a lot of these things.
Go back to the snake bites a minute? What kinds of snakes?
Like I said, it just depends on the location. I particularlyand haven’t seen them all, depending on what the snake is and where the bite occurred, what the snake looked like you know they would definitely refer those kiddos down to the emergency room for further evaluation. I’m not saying it’s a very common thing, but we do see it here.
And it would seem to be maybe an extra bit of a problem with someone who’s not as verbal, who can’t describe the snake that he or she had the encounter with?
Correct. it can be a little bit challenging but isn’t that true in pediatrics, period, with some of these things? Even trying to identify where they get a certain rash, we see a lot of poison ivy, poison oak. those kinds of things, it’s trying to get the parent to explain what the particular plant looked like or perhaps if they have a certain insect bite, parents get very concerned about certain spider bites and so we have to have a lot of conversation with them about that, use a lot of pictures, have a lot of education that goes along with that.
I mentioned that you had come to urgent care pediatrics after a number of different specialties in pediatrics along the way. What are you focusing on these days ?
What I do right now, my new role has been for the past, almost year and a half, I am the supervisor for the Urgent Care Advanced Practice providers, for the PA’s and the NP’s, myself and I have a partner, Dana Landovaso, and the two of us supervise, we have approximately forty-five APP’s that work in our five urgent cares. We take care of their scheduling, their annual reviews, make sure their licenses are up-to-date. We handle any kind of questions and concerns; we do the hiring, the onboarding, make sure that they’re staying current with all their certifications. We have a lot to juggle plus we do schedule ourselves in the clinic so that we don’t lose those skills, because, really our love our first love is always seeing patients. So we meet with the leadership of all of our Urgent Cares; we help collaborate and coordinate, make sure that we’re all giving the best care possible with the providers that we have available, providing the best service that we can to the kids in our area. What hours and how much staffing do your various urgent care centers operate?
We have the five Urgent Cares: four of the five Urgent Cares are open from 11 am until 10 pm and the staff is scheduled to work from 11 to 11 for those shifts. The Fort Worth Urgent Care, because of its volume and its location (directly across the street from the emergency room fpr the hospital,) the clinic doors open at 7 am and in the summer time they close at midnight; in the winter time we extend the hours till 1 am.
And I know that you’re going to be doing some presentations at the SPUC conference, which is at Cook Children’s this fall. Can you give us just a little bit of a preview about what you’ll be looking at?
Absolutely. One of the workshops that Dana and myself will be hosting is called “Hooks, Rings, Splinters and More.” It’s a minor procedures skills workshop that we’re looking forward to helping people understand how to remove some of these things that definitely will walk into their Urgent Cares at any given time. The other workshop that I’m going to be doing is called “The Art of the DART” — managing expectations with the dialogue around respiratory treatment between provviders and families. It’s really how to have that conversation with families about viral illnesses and the reason we don’t want to order antibiotics and, really just help with antibiotic stewardship and to give providers the tools that they need to have successful encounters with parents and patients, so they leave satisfied — but not necessarily with the antibiotic prescription.
What do you do if a parent comes in and has in his or her mind that ‘my kid needs antibiotics’ and you don’t feel that that would be appropriate in this case. How do you approach your dialogue.
One of the tools that we recommend using is called “the bundle,” and so the bundle is a four-part tool that we really encourage all of our providers to use. It’s used nationwide. It’s basically, you know, explaining to the parents what you’re seeing while you’re examining the child. You go through the exam out loud: you know, “the ears look great. . . I see some nasal congestion. . . the nose, the chest is clear; I’m not hearing wheezing. . . your child looks well hydrated.” You kind of walk through the steps of the exam out loud and at the end of your exam you’ll give the parents the verbiage of just basically, “your child doesnt feel well and I understand that, but I’m not terribly concerned.” And then you then move on to “I know you know that this is a viral illness and for viral illnesses antibiotics are not recommended. But here’s what we can do; here are some comfort measures that we can provide for your child.” And then the fourth thing that we add as part of this bundle is, and then we say, “so, based on what we found, if X, Y and Z occurs in the next couple of days you need to seek a higher level of care: you need to come back to see us, you need to go to the emergency room, or you need to call your pediatrician. And here’s what these things would look like. ” And so we give them the tools that they need to manage the viral illness and when to know if things are not getting better, when they need to come back and visit with us.
So you treat the patient and the parent.
We do. And we like to provide education, because we do find that a lot of times parents really don’t want antibiotics per se, they just want their child to feel better. And so instead of saying “your child has a virus,” you know, it’s better to say “your child has a really bad cold” and parents understand that a little bit better; they don’t feel quite as dismissed and they feel like you’re giving it a name. And so the literature does support using a different kind of language to help parents feel like you’re at least not brushing them off and they feel like their concerns are being addressed.
What do you see Pediatric Urgent Care doing going forward?
There’s a lot of speculation about where Urgent Cares are going and I’m sure there are some Urgent Cares they’re doing a lot more than what our five Urgent Cares are doing. For us, in particular, we’re growing. We’re going to be expanding; we’ll be at seven Urgent Cares, probably around Thanksgiving next year. But I do think that some Urgent Cares are performing physical exams, they’re providing immunizations and flu vaccines. Some Urgent Cares offer more imaging; ours unfortunately just does X-rays, but some might offer ultrasounds. Instead of POC labs, some might, in the future, be opening up and offering more lab work in an effort to maybe offset emergency rooms. . . there’s just a lot of things that I think are coming down the pike that I think some Urgent Cares are experimenting with. But I think in the pediatric population, I know for us we have to just make sure that we’re able to handle what we promised and we don’t want to overextend ourselves and so we are just moving cautiously forward, just trying not to overwhelm our staff and do too nuch. There has been talk about, you know, will we do physical exams, sports exams, but that’s a whole ‘nother conversation.
Thank you very much. We look forward to seeing the folks at Cook Children’s this fall.