Sutter Health – Street Nurse

What is it?

The Street Nurse works on the street, connecting directly with homeless individuals who need immediate medical care and/or medical advice. A registered nurse and employee of longtime Sutter Health partner (and local federally qualified health center) WellSpace Health provides on-demand care to the medically fragile homeless population in the area surrounding Sutter Medical Center, Sacramento (SMCS). From dressing wounds and performing diabetic tests, to personally driving patients to clinic, and connecting them with medical and other services, she has become a vital resource to people living on the streets, who are in desperate need of medical care.

The Street Nurse works in close partnership with another community benefit program, the Community Navigator. The Community Navigator works in the .25 mile radius around SMCS and connects with homeless individuals, slowly building relationships with them and eventually connecting them with services such as housing, medical care, alcohol and drug treatment and other social services. The Street Nurse and Community Navigator frequently work side-by-side and provide care coordination around shared patients/clients. The integration of these programs, along with Sutter Health’s ED Navigator program, was done intentionally and strategically, to ensure a continuum of care for homeless patients both within the walls of the hospital and out in the community.

Currently, the Street Nurse program is a pilot at SMCS. As with any new program the Sutter Health Community Benefit team develops, program leaders engage their strong, collaborative team made up of community partners (in this case, WellSpace Health and Sacramento Steps Forward) and Sutter staff members from Case Management, Social Work and the ED. They talk openly about best practices, patient trends, efficiencies, innovative ideas and what they want to accomplish with any new program. Additionally, they analyze data regularly to ensure that any program they develop is done so in a strategic and well-informed manner. Following the launch of any new program, program leaders always “over communicate” with staff and community partners to ensure that the launch is seamless and that any early hiccups are worked through in a timely manner.

Who is it for?

Area homeless individuals with medical care needs.

Why do they do it?

This program was designed in response to the growing and complex needs of the homeless population in the SMCS health service area.

Impact

In seven short months, the Street Nurse has worked with well over 200 patients. Each week, her numbers and services continue to grow. In addition to providing on-site care, medical advice, disease management education and wound care, the Street Nurse has begun to help patients navigate the health care system by getting patients established with a medical home and accompanying them to primary care appointments to help demonstrate how to be active participants in their own health care.

From July 2016 through September 2016, the Street Nurse made 167 contacts. She provided 206 assessments in the field, including skin assessments, wound care, mental health and disease knowledge. The Street Nurse made 88 service referrals in the field, including primary care physician appointments, mental health/crisis services, basic needs/income assistance/support services and transportation. In addition, she provided 291 services in the field, including nutrition education, therapeutic conversation, wound care and health education.

Contact: Kelly Brenk
Community Benefits Coordinator
Telephone: 916-541-0519
Email: brenkkm@sutterhealth.org