There are currently more than a dozen nurses working in various capacities and programs at Trilogy, and the value these nurses bring to the organization becomes apparent in the stories of their impact on clients’ lives. Dr. Alice Geis describes an account from this summer when, “A client presented at the clinic with symptoms he had been experiencing for weeks. The registered nurse (RN), TJ Thurlow, identified the symptoms as those of deep vein thrombosis (DVT), a blood clot in the leg, which when left untreated, can travel to the lung and become fatal.” A nurse practitioner on staff confirmed the likely diagnosis of DVT and the client was escorted by staff to a nearby hospital for urgent attention. Considering the crucial role nurses play at Trilogy, it is hard to imagine that less than 10 years ago, there were no nurses employed at the organization.
In 2008, opportunities in the field of nursing at Trilogy consisted of academic projects for nursing students. At the time, two advanced practice nursing students from Rush University College of Nursing (RUCON) were engaged in the process of developing an assessment of the medical and coordination needs of the clients. This project required an RN facilitator on site, and Dr. Geis, a faculty member at RUCON at the time, agreed to act as facilitator after hearing about it through her faculty chairperson. Shortly thereafter, Dr. Geis accepted an offer to join Trilogy in an official capacity as Medical Services Coordinator (MSC), a position made possible through a small foundation grant received that same year. Dr. Geis remains engaged with the Faculty Practice program at RUCON, maintaining a formidable relationship between the two organizations.
Multiple nurses from RUCON have come to work as RNs or psychiatric advanced practice nurses (APNs) at Trilogy as a result of the partnership. Dr. Geis, now the Director of Integrated Healthcare at Trilogy, leads twelve RNs, as well as APNs and multiple student nurses, all working in various functions and programs throughout the organization. She has also overseen the integration of nursing into the model of care at Trilogy, which took off thanks to the organization’s first federal grant.
In 2009, Trilogy applied for a Primary Care and Behavioral Health Integration (PBHCI) grant from the Substance Abuse and Mental Health Services Administration (SAMHSA). The application was successful and $1.5 million was awarded for a 4-year period to further develop the Integrated Health Program. This grant, along with changes in the healthcare environment, allowed for great growth in nursing at Trilogy, enlarging the diversity of clinical roles available and continuing to incorporate the academic partnership.
At Trilogy, nurses find themselves working as Integrated Health Nurses, taking not only their client’s psychiatric illness into account, but also their medical illnesses and substance use disorders. In their roles, the nurses are also asked to consider their clients’ needs for health education and coordination, wellness services, and assistance with chronic disease self-management. This framework of looking at the whole person and their path to wellness is integral to Trilogy’s philosophy of care. The practice of Integrated Health Nursing involves elements of psychiatric nursing, medical-surgical nursing, and public health nursing or population health. In addition to servicing clients, many of the nurses participate in providing educational experiences for student nurses.
Mary Ross, a RN at Trilogy, first worked with the organization during a clinical rotation as a Rush student. After her studies, she took up employment in a more traditional health care practice for nurses, a neonatal ICU at a hospital. After some time, she found herself wanting to return to a role in the community. She says “I loved the population that I worked with [at Trilogy] and the health, wellness, and preventative medicine that the ACT RN’s got to do in their everyday work.” To her, an important aspect of her role at Trilogy was, and still is, building trust and relationships with clients. She says “I am able to see improvements in their overall health over long periods of time, rather than have 3 patients during a shift that I will most likely never see again.” Ross explains that these long-term relationships with clients are valuable for achieving positive health outcomes. Over time, the practitioner can build rapport with the client and help them achieve their long-term goals for health and wellbeing. “That is why I love coming to work each day!” she reveals.
Nursing interventions can include teaching clients as well as staff members about health issues affecting the clients, administering medications, coordinating care with internal and external primary care and behavioral health providers, medical specialists, and other health services (like home health care). They provide health counseling and motivational interviewing to assist clients in making health behavior change. The settings in which these take place are as diverse as the interventions themselves.
Nurses work in various programs and settings at Trilogy. Programs include the Trilogy Heartland Integrated Health Clinic, the Assertive Community Treatment (ACT) teams, the Residential programs, the Williams and Colbert Transitions Teams, and the Employment Services team. This means that nurses at Trilogy provide care not only in the clinic or office sites, but also Trilogy residences, client homes, medical provider offices, nursing homes, emergency rooms and hospital inpatient units. The specific tasks a nurse does in these various settings may differ somewhat, but the overall framework of care is the same.
With Trilogy expanding service areas and programs in the Chicagoland area, opportunities for nursing students and professionals at Trilogy are expanding. ACT team nurse positions, APNs for our First Episode Psychosis program, and RNs supporting clients seeking to reenter the workforce are some of the available opportunities at Trilogy. Details of open positions can be found at www.Trilogyinc.org/careers.