For 12 years, Tarnesa Martin, RN, BSN, managed a busy medical-surgical unit at association member Hurley Medical Center, in Flint, Mich. There, she faced numerous challenges caring for patients experiencing housing instability, mental illness, and other socioeconomic struggles. But this year, she faced her biggest challenge as a health care provider: bringing care from the hospital into the community as Hurley’s inaugural patient resource and community advocate.
Hurley Medical Center often sees patients with high readmission rates, especially patients with chronic conditions. While the hospital has robust community services that could mitigate the root causes of these conditions, patients don’t always take advantage of the available resources.
“We have these services, but some community members in certain zip codes … don’t know about them, or they’re not receptive to receiving the services,” Martin says. “So that’s basically what my job was created for, to bridge the gap … to connect with the community and see what can be done … and why are they waiting so long to come to the hospital.”
Martin’s first step was to attend a planning meeting for the city’s Juneteenth celebration. While she was active in the community as a volunteer, she was still “a little nervous” about representing Hurley Medical Center in this capacity. When she introduced herself, a few heads turned.
“They all [said], ‘So, how do you think your service is going to benefit here?’” Martin remembers.
She explained that the hospital could set up a medical tent and share resources, but attendees still seemed skeptical. Martin knew in that moment that more than anything else, she needed to be transparent and honest to gain her community’s trust.
“I said, ‘I’ve been a nurse for 19 years, I care about the city of Flint. I left a job, [which] was 99 percent guaranteed, to come out into the community, so I took a leap of faith to come out here to serve the community that I love,’” Martin says. “‘I’m here because I want to be a part, and I want to make a difference and impact health and wellness in your life.’ And so, they looked, and they were like, ‘Okay, she’s in.’”
Engaging the Community
Because essential hospitals serve large numbers of patients who tend to have lower levels of institutional trust — people of color, communities living in poverty, and uninsured patients — they must work harder to gain trust.
A survey of 1,000 consumers showed community integration was one of the top five dimensions of trust for patients and their caregivers.
“The one thing that I did ask the community is, ‘What matters?’ And they said, ‘Well, Nurse T, we just want you to be consistent. If we start seeing you, and you’re out here, we want to keep on seeing you.’ And so that’s what builds trust,” Martin says.
Nurse T, as she’s come to be known, has demonstrated her commitment to her community simply by showing up. With a focus on conditions that primarily affect people of color, including heart failure, stroke, diabetes, chronic obstructive pulmonary disease, and kidney disease, Martin’s community outreach meets four challenges, starting with mistrust in the health care system — and systems in general.
“Flint is complex,” Martin says. “Because I know there’s a mistrust issue … I go to wherever they are, so that they can feel comfortable to not have to come out of their setting.”
A regular fixture at football games and basketball camps, Martin provides basic first aid and educates a captive audience of parents, teenagers, and community members about health and wellness, healthy relationships, and decision-making.
“When the kids are huddling, we talk about not playing through the pain, because that’s been a myth in our communities,” Martin says.
She partners with faith-based organizations, barber shops, senior centers, and nonprofit organizations, often attending community fairs and events to mobilize Hurley Medical Center services. Recent efforts included Breast Cancer Awareness Month events with local nonprofits.
Martin also fostered Hurley Medical Center’s partnership with Inmate Growth Naturally and Intentionally Through Education (IGNITE), an initiative with the Genesee County, Mich., jail that provides employment opportunities for returning inmates.
“If we want to improve health, and we want to improve our economics, we have to put people in positions and give them opportunities for that second chance,” Martin says.
Empowering the Community
A second challenge Martin faces is literacy; she keeps her resources between a third and fifth grade reading level. As Hurley faces record emergency department (ED) wait times, Martin has focused recent community education on when to visit the ED and when an urgent care visit might suffice. She works to ensure people are aware of Hurley’s resources and aren’t ashamed or embarrassed about their lack of knowledge.
“I create atmospheres where people can create a health care power,” Martin says. “So, I say, you’ve got to activate your health care power. Activation starts with you. It doesn’t start with your provider, it starts with you wanting to be healthy and well, and being well informed, so that you can make decisions to become a better version of you.”
Finally, Martin acknowledges that stereotyping by health care providers can keep patients from activating that health care power.
“Some patients will say, ‘I’ll come to the hospital, and I have pain, and the first thing they start thinking is that I’m a drug seeker,’” Martin says. She tries to acknowledge those stereotypes and make patients feel heard while encouraging them not to let their frustration keep them from getting the care they need.
“Just because we work in an underserved population, they’re not undeserving,” Martin says.
Above all, Martin hopes to make her community members feel valued and to build confidence in their ability to make informed health care decisions.
“To be able to mobilize services and be able to go places and see the smiles on their face when you show up somewhere where nobody has ever thought to come, and they’re like, ‘We’re special too,’ that’s important,” she says.