Project New Hope: volunteers caring for children in need

AORN Journal,  Nov, 2007  by Kit L. Landis,  Christine W. Loar

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Approximately 10 years ago, a young plastic surgeon new to the Reno, Nevada, area approached the leaders at a local hospital with a request to care for a pediatric patient in need of a reconstructive procedure. The procedure was not life saving in nature, but it would add incalculably to the quality of the child's life. The parents of the child had no health insurance or means to cover the cost of the surgery. This young surgeon was willing to donate his services but needed assistance from the hospital for supplies, support staff, and use of the OR.

At that time, the hospital's missions committee handled requests such as this on an individual basis. For each request, the committee had to locate donors who were willing to sponsor the patient's care. This process was slow, and it often took months to obtain sponsorship. The care of these patients created a significant financial burden, and the hospital could write off only some of the expenses. Because of the complexity of the process, momentum often was lost, and many children did not get the help that they needed.

MEDICAL CARE FOR NEVADA'S UNDERSERVED POPULATION

In the last 15 years, Nevada has consistently placed low in national ranking of per capita state spending on health care programs and high in number of uninsured children living in poverty. (1) In an April 2007 study released by Public Citizen, a national, nonprofit consumer advocacy organization, Nevada was listed as fortieth of the 50 states in providing Medicaid coverage. (2) In its actual ranking for eligibility and scope of service, Nevada was placed in the bottom five states. (2)

Conversely, Nevada is currently ranked in first or second place nationally for population growth. (3) Many people moving to Nevada are attracted by low unemployment rates, but they fail to take into consideration Nevada's relatively high cost of living. Additionally, many of the jobs that are available do not provide health insurance benefits. In 2004, Nevada ranked fourth in the country for the highest percentage of uninsured residents, amounting to 18.5% of its population. (4) It is estimated that more than 100,000 of those who are uninsured are children. (5)

Nevada has no state income tax, so the state's tax base is inadequate to provide basic health services for the burgeoning population's health care issues, much less for quality-of-life procedures. The state legislature currently is searching for ways to meet the basic health needs of the population, including an attempt to provide some sort of bridge coverage for the huge number of people who are uninsured.

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THE GENESIS OF PROJECT NEW HOPE

Saint Mary's Regional Medical Center is a 380-bed, nonprofit health care delivery system with multiple facilities in the Reno, Nevada, region. From the time it was established almost 100 years ago, Saint Mary's has sought to meet the health care needs of the poor and provide a resource of hope and health. (6) With this in mind, a perioperative nurse and the young plastic surgeon who was seeking to help the pediatric patient began to plan an outreach project. They had worked together previously on a free-surgery project in the San Diego, California, area, and they discussed their vision of creating a similar program with several medical supply vendors.

The vendors indicated their willingness to donate supplies to an outreach program designed to help uninsured children who needed surgical procedures to enhance their quality of life. Through several one-on-one meetings, the idea of the program continued to grow until a small group of medical professionals, including perioperative leaders, staff nurses, and surgeons, met together to share their support for the idea and to outline how the program might proceed.

Using examples from the San Diego project, the perioperative nurse and plastic surgeon presented the idea to members of the Plastic Surgery and Anesthesia Departments, who voiced their support for the project. With the encouragement of these key stakeholders, the plastic surgeon then presented the concept to the hospital's leadership team and board of directors, detailing the support of both vendors and key stakeholders and emphasizing the program's compliance with the mission of the hospital. The hospital leaders and board of directors approved the initiative, allowing for the creation of Project New Hope to address the surgical needs of Northern Nevada's uninsured children.

The program's founders began by building a referral base and were strongly encouraged by community partners such as neighborhood clinics, the health department, the school districts, and social services. Many supported this new program, believing that it would be an unparalleled benefit to the area's indigent children.

DEVELOPMENT OF THE PROJECT: SUCCESSES AND CHALLENGES

The first group of pediatric patients was referred to Project New Hope by area school nurses, pediatricians, and parish nurses. The local hospital donated use of its facility and time, and many vendors donated the required supplies. Volunteers were gathered from support staff in the hospital as well as staff members from other surrounding health care facilities. If a volunteer was unfamiliar with perioperative pediatric patient care, he or she was paired with a staff member who had this experience. Additionally, some community nonmedical volunteers also wanted to participate in the first surgery day. This outpouring of support came from spouses of staff members, high school students, radio disc jockeys, and both nursing and medical students.