A Sense of Kinship Draws Nurse Practitioner Toward Children in Need

Nurse practitioner Donna Skouby, M.S.N., always dreamed of becoming a nurse while growing up in the housing projects of Madison and Granite City, Illinois, near East St. Louis. Circumstances delayed—but didn’t deter—her dream from becoming a reality. That happened in her mid-30s when, married and with two children, Skouby graduated with a B.S.N. degree from Southern Illinois University.

During her clinical training, Skouby realized that she would rather work with the underserved. “It was more rewarding,” she explains. “I had the same sort of childhood that my patients do now. I lived in housing projects when I was younger and lived with relatives. I felt a sense of kinship with these individuals, especially the children.”

After graduation, Skouby went to work for Touchette Regional Hospital in Centreville, where she first learned about the NHSC. Touchette is affiliated with the Southern Illinois Healthcare Foundation (SIHF), which employs a number of NHSC clinicians who work with uninsured and underserved patients at 12 clinics located in the inner city streets of East St. Louis and the rural counties surrounding the city.

Skouby’s determination to learn and serve drove her to earn a master’s degree at St. Louis University as a pediatric nurse practitioner, which required her to take out a student loan. She eventually went to work at the Koch Health Center, a community health clinic, to continue her work with underserved children. SIHF acquired the Koch clinic after Skouby’s arrival and applied for its certification as an NHSC-approved site. That recognition enabled her to apply for, and receive, an NHSC loan repayment award.

Skouby has her hands full at Koch, providing an array of primary care services for her pediatric patients, which include sick visits, school physicals, and well child and baby checkups. She works very closely and talks regularly with the clinic’s two full-time pediatricians. In addition, the clinic staff includes an OB-GYN, an internist, and a certified nurse-midwife. “I can walk across the hall anytime I need to consult with any of them, and that’s wonderful,” Skouby says.

Most of her patients are on Medicaid or are uninsured. In the latter cases, the clinic strives to get children enrolled in Illinois’ “KidCare” insurance program. They also offer sliding scale fees, based on patients’ ability to pay. “We’re not turning away any patients,” she says.

Skouby is sensitive to the special challenges of treating patients with limited resources—financial and otherwise. “We have to remember that many of our patients don’t have transportation or phones. So it’s difficult for us to reach patients and for them to reach us. We need to adjust for that when our patients show up late for an appointment or come into the office without a scheduled appointment.” She expects that SIHF will be expanding its free transportation service to cover patients at the Koch Health Center.

She has also learned to become attuned and responsive to the relationships between children and their parents. Skouby finds that this level of awareness can have a significant impact on clinical outcomes. “I had a child recently with severe asthma, and I was able to work with her father rather than her mother,” she notes. She adopted that approach after noticing that the child’s mother wasn’t doing enough to help ensure compliance with her child’s treatment. In contrast, Skouby has seen “good cooperation from the father thus far, and that’s quite gratifying to me and good for the child.” Skouby is also looking forward to getting involved in SIHF’s Asthma Care Training (ACT) educational program, which is geared toward children aged 6 to 12 and their parents. “I’ll be teaching the medication part of that class,” she says. “I’m pretty excited—we have a lot of children with asthma and this will be a great help to them.”

As the mother of two teenagers, Skouby is especially tuned in to the needs of her adolescent patients. “I’ve gained some pretty good insights by having children of my own, so I’m able to communicate fairly well with teens.” She finds that candor is the best policy with her older patients. “I address issues of drug abuse and sex with every single teenager that I see. It’s part of responsible care for this age group.” Skouby believes she has had an impact in lowering rates of teenage pregnancy and sexually transmitted disease with her patients.

The rewards of helping those most in need far outweigh the challenges, she believes. “We get to see results. We see these children and their families and usually they come back. I don’t see a lot of my patients going to other providers and getting fragmented care. We’re able to pretty much provide for all of their care, including referring them to specialists as needed,” both within SIHF and with outside physicians.

“I learn more from my pediatric patients about life than they learn from me,” Skouby finds. “It keeps me balanced. If we’re able to provide good care, and these patients know that we are there for them—especially these young children—down the road, they’re going to grow into productive and happy members of their community.”