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A history of GNP care

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GNP Care

Familiar ground: GNP Jean Yoder, in the main conference room at KVH’s Radio Hill Facility. The room was once a dining area for assisted living residents at Royal Vista, where Yoder made weekly rounds. (Thumbnail photo: Radio Hill exterior.)

Jean Yoder has been a local fixture in senior patient care for the past 23 years.

“I’ve always liked working with elderly people,” says Yoder, who first ventured into the world of healthcare as a young candy striper, bringing meals and other items to patients in their hospital rooms. Years later, Yoder found her calling as a Geriatric Nurse Provider (GNP), bringing medical care to patients in their homes.

Yoder’s was the first class of GNPs at the University of Washington. “We learned from them and they learned on us,” she laughs. Then, after working with geriatricians in the Seattle area, Yoder learned about a program in Ellensburg led by then-director of Home Care and Hospice Carol Detweiler.

A fellow UW GNP graduate, Detweiler’s vision was to bring medical care delivery out of the traditional patient care setting and into the community, particularly for the frail elderly. It was a vision Yoder shared. “We wanted to make care available for those who couldn’t access it,” she recalls, “whether they were physically frail, struggled with dementia, or had other issues that made it difficult to get in and out of the home for medical visits.”

Soon, the program was underway with Yoder as the sole practitioner.

Yoder’s territory included Royal Vista (a skilled nursing facility) and Kittitas Valley Health and Rehabilitation. Every week, she spent two days at each location, and was on daytime call for both. Nights and weekends were covered by patients’ primary care physicians.

From the outset, the program included a collaborative practice with physicians in the community, starting with Drs. Wise, Schmitt and Anderson in Cle Elum, later expanding to Ellensburg and physicians such as Dr. Solberg, who was struck by the increased level of care his patients were receiving under the GNP program. “He and I made monthly rounds together in the skilled nursing facilities for years,” says Yoder.

The steady presence of a GNP helped fill the care gap for patients and their physicians, whose schedules didn’t often allow for regular visits to these facilities. “We could be on-site, evaluate an individual, see where their code status was, talk to family, talk to staff, and get a plan in place to set up and provide care.”

“We were very busy,” she recalls. “With up to 65 patients in each facility, there’s a lot that goes on from one day to the next.”

Covering the community.

Soon, a second GNP was hired, and Yoder began spending a day each week seeing assisted living patients at Mountain View Meadows (now Meadows Place), and eventually Hearthstone.

“It’s not quite as intense as a skilled nursing facility,” says Yoder. “We focus on treating patients in their environment, keeping them healthy and hopefully away from the E.R.”

The GNP team worked with staff to prevent or treat conditions like urinary tract infections, pneumonias, skin tears, cellulitis, etc. With so many variables, says Yoder, “you never knew what your day would be like.”

Another major shift occurred when GNP Anna Collins entered the picture, joining forces with Yoder to divide up days and locations, increasing overall coverage. Collins took on Meadows Place, while Yoder continued at Hearthstone. “We added on Dry Creek (now Pacifica). And in the middle of all that, we started doing home visits.”

According to Yoder, GNP home visits serve those “who fall through the cracks, in the sense that they have many medical problems, but don’t qualify for the Medicare A Home Program” which covers services from KVH Home Health.

Thankfully, Medicare does allow nurse practitioners to do home visits. “It used to be called a doctor’s home visit,” explains Yoder. “We go through the physician to get a home visit, evaluate the patient and, with the patient’s permission, set up a care plan.”

Once they’ve established care with a patient in their home, GNPs make monthly visits unless a change in health brings them by sooner. “If there’s a spell of illness, or an issue like a wound needing frequent dressing changes, or someone is really fragile and needs more attention and services, we work with a physician to bring in Home Health.”

Taking on the trends.

One big change Yoder’s seen during her time as a GNP is the amount of medications taken by seniors. “It used to be that five medications was remarkable. Now, we have people on 15 or 20,” she says. “We look at the whole picture to see how it’s all working, and focus on comfort while getting rid of unnecessary medications and testing.”

Another trend Yoder sees is a faster discharge from hospitals. “Even if a patient rehabs in a skilled nursing facility, what happens once they get home?” The GNP program will soon begin making home visits after patients are discharged. “You can see when you walk into the environment, what’s working, or isn’t, and what we need to do. It involves quite a bit of detective work.”

The next chapter.

Last month, the GNP office relocated to KVH’s newly remodeled Radio Hill facility – formerly known as Royal Vista, the place where Jean first began her GNP rounds in Kittitas County.

Now that things have come full circle, Yoder is set to retire. “I’ve let go of a lot of things already,” she says, as the GNP team has grown to include practitioners Nenna Nzeocha, Marquetta Washington, and Mary Nouwens. “It’s great to have them here. They want to do this work, and they’re not frightened by the scope and intensity of it.” And while she’s ready to focus on family and home remodeling, there are things Yoder will deeply miss – especially her working relationship with Anna Collins. “We’ve enjoyed each other and we communicate well together. We worked hard!,” she laughs.

Yoder is confident that the GNP program, under the visionary direction of KVH Chief Medical Officer Dr. Kevin Martin, is positioned to continue a pattern of growth in caring for patients throughout the county. Yoder’s optimism rests on a legacy shaped by years of faithful service.

“Nurse practitioners make a difference for patients, family, and staff,” she says. “I really believe that.”

Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

The making of two M.A.s

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“I’d been working at Starbucks for 8 years and 3 months, and it was about 8 years and 3 months too long.”

No disrespect intended to the international coffee giant. Life just had other plans for Alisha Liedtke.

After a stint selling bamboo sheets for Costco across the continental U.S., Liedtke found herself wanting something that kept her closer to home, and to husband Drew, who at the time was getting his Master of Fine Arts from CWU.

“We’d lived in Ellensburg for three years,” Liedtke recalls, “but I’d never been part of the town.”

She was ready for a change.

Photo: Flores and Liedtke take a moment to confer in a clinic exam room.

Liedtke found a local job opening for a scribe in a clinical environment at Kittitas Valley Healthcare. She applied, and was chosen out of more than forty applicants for the position. “I thought it was an established program,” she laughs. “Turns out I was the first one.”

Soon, Liedtke found herself working alongside teammates José Diaz, April Grant, Laurie Rost, and Carrie Barr, laying the groundwork for the program now in place at KVH, where scribes serve in exam rooms alongside patients and providers, handling the computer charting during the visit.

Rightfully proud of what the team accomplished, Liedtke sees the scribe’s role as “helping the provider to focus on patients.” Now, much of the documentation work that added hours to a provider’s already long day rests in the capable hands of scribes.

Six months before Liedtke began her journey at KVH Family Medicine – Ellensburg, Flores became the newest dietary aide in Food and Nutrition Services at KVH Hospital. Unlike Liedtke, the healthcare setting was familiar to Flores. The daughter of an RN, “I’ve always worked in the medical field,” she explains. “I got my CNA (Certified Nurse Assistant) when I was 16.”

She put that degree to good use for the next 16 years, working as a residential trainer for people with disabilities, then at a nursing home.

About a year into her time in the KVH kitchen, Flores underwent surgery. While convalescing, she received a call from Chief Clinic Officer Carrie Barr, asking Flores if she’d be interested in becoming a medical assistant (MA).

It was a tough decision for Flores to make.

“I’ve always wanted to work in a doctor’s office,” she admits, “but I was thinking about my family in the hospital kitchen. I loved working with everyone there. It was comfortable, and I didn’t want to leave them hanging.”

Around the same time, Liedtke got a call of her own. She was summoned to the manager’s office for a private meeting. “I was terrified! What did I do?” she’d wondered. She then learned that KVH was about to launch another program in the clinics, this time an apprenticeship for medical assistants.

They asked me, “Are you interested?”

That one question led to some sleepless nights for Liedtke, who would be facing yet another major transition. Being an MA “is a whole different ballgame,” she says. “And I’d also be leaving a job that really nurtured me into becoming the person I was supposed to be.”

Despite their initial hesitancy, both women ultimately made the courageous decision to move forward into the exciting world of medical assistants.

Things took off quickly once the apprenticeship began. After a one-day orientation, they shadowed with their coaches (certified MAs), who roomed patients, gave immunizations and EKGs, and did documentation and data entry. “By Day 3, we felt comfortable,” recalls Liedtke. “The coaches were still there, but we were ‘driving.’”

Now that the one-year apprenticeship is drawing to a close, Flores and Liedtke both agree they made the right decision.

“I can’t believe how much I love it,” beams Liedtke. “I’m doing things now that in the past I’d only hoped for. I’m living this life I never could have imagined for myself. I get to wake up and put on PJs (scrubs) and go to work and help patients all day. It’s like the greatest job in the world!”

Flores agrees. “It’s never boring.” As a mother of two, Flores is a hit with the clinic’s pediatric patients. Other than her son Colton and daughter Dakotah, “I’ve never worked with children before,” says Flores. She quickly got past that barrier, finding ways to encourage youngsters who often aren’t thrilled about being at the clinic. “No matter how they do, with their parents’ permission, I give them a popsicle and tell them ‘Thanks for being a good kid. You’re a super hero!’”

The two women’s families are also thrilled, with both mothers aspiring even more for their girls. “My mom thinks I should become an RN,” says Flores, who loves her work as an MA and is content to continue in that role. Young Dakotah feels the same way: “‘It’s more of a mom job you’re doing now,’” she recently told Flores. “’I can say I’m proud of you.’” That, along with the clinic’s family-friendly schedule, is as much of a reward as Flores could ever want.

In the same selfless way that they care for their patients, Flores and Liedtke encourage others to join them in considering an apprenticeship. “If you love the idea of patient care, it’s absolutely the way to go,” says Liedtke. And while program graduates agree to stay with KVH for at least one year, both women find the idea of working elsewhere amusing.

Says Liedtke, “I’m never leaving this place.” Flores nods and smiles gently, “I’d say we’re spoiled.”

Surely, these remarkable ladies’ shared passion for patient care somehow makes us all a little better.

Wendy Hinckle

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Wendy Hinckle

She’s got a spring in her step and a gleam in her eye. While that’s nearly always been true of Wendy Hinckle, there’s now an unmistakable air of gratitude behind her smile.

It’s the kind of expression that tells a story all on its own.

“I feel so lucky,” beams the retired elementary school teacher.

“I’ve had mammograms regularly since I was probably 40.” As the years passed, Hinckle’s friends began their private battles with breast cancer. “Statistically, I became a bit fearful of what the results of my own tests might be.”

Last year, at age 68, she received the news she’d been dreading.

“I got a call from KVH that something was spotted and they needed an ultrasound,” recalls Hinckle. “So I had my ultrasound the day before I went to Arizona for the winter.”

In November 2017, a little over a year after The Foundation at KVH began its focused campaign to bring digital mammography to Kittitas County, KVH Hospital went online with the service.

In January, Hinckle underwent a biopsy in Tucson. On February 6, she was diagnosed with breast cancer. “Grade 1, stage 1, level 1. Thank God.” The cancer had been caught in its early stages.

What she learned next was shocking.

According to the radiation oncologist, “I’d probably had the cancer for 5-8 years,” said Hinckle. What she heard from other Arizona providers supported that claim. “One doctor said it wouldn’t have been picked up on a traditional mammography unit because it was so small,” she remembers. “Another said because of where it was located, it might not have been picked up earlier.”

Two weeks after the diagnosis, Hinckle had a lumpectomy, followed by 20 days of radiation. Upon returning to Ellensburg, her oncology care resumed at Yakima’s North Star Lodge, with checkups every three months, and a mammogram just before the one-year mark.

“I’m not a super dynamo, I don’t have a huge amount of energy. I just have to manage my time,” says Hinckle, who stays active as a rule and even found a way to keep busy during her cancer treatments, focusing on training her shih tzu, Yumi, for novice and intermediate tricks certification. “The day after I was diagnosed, I went to the tricks class and we started training. It was great because it kept my mind off of what I was going through.”

Today, Hinckle stays active in the local SAIL program, and enjoys tai chi. “I also love to play games,” she admits, meeting each week for pinochle with a group that includes other retired teachers. And while she and her husband Kirk flee to warmer climes each winter, Hinckle maintains her deep roots in Kittitas County, where she’s served as a Gallery One board member for nearly two decades. A lifelong lover of the arts, her pride in the gallery’s current direction is evident: “We’re really getting involved with schools now and reaching out to the community.”

That’s the passion of a teacher with plans to give and grow, for many years to come. It’s also why she’s happy to share her cancer story – so that others can learn. “I strongly encourage women to get mammograms,” she says, recalling a friend who recently had her first mammogram after learning of Hinckle’s experience.

“I really want to express my gratitude to KVH – the hospital and the foundation – for raising the money for digital mammography,” says Hinckle. “For seeing that Ellensburg needed to catch up with the technology that’s out there, because it’s possible if I would have had another traditional scan, it would have been missed again.”

Stephanie Brown

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Stephanie Brown

She’s an active retiree who loves to travel, spend time with family, go RV camping and spend a month each year at Mariners spring training in Arizona. But when Stephanie Brown’s left knee kept going out and pain threatened to disrupt her step and her lifestyle, she knew she had to do something.

Brown, a Yakima resident, turned to Dr. Gary Bos of KVH Orthopedics in Ellensburg.

Bos may not have an organized fan club like the Mariners do, but if he did the 69-year-old Brown just might be at the helm. In 2015, Bos replaced her left knee. Duly impressed, two years later she had him do the other one.

That Brown turned to Bos was hardly accidental. After all, when her husband Ron needed knee replacement surgery in 2012, their oldest daughter – then a surgical tech in Yakima – insisted he have Bos do it. “She knew Dr. Bos. She’d watched him do surgery and she knew his reputation,” Brown says.

The rest is history.

With Ron readily sharing his experience, word spread. Ron’s best friend soon followed suit and had a knee replacement. Then came the best friend’s wife, who also happens to be Stephanie Brown’s best friend. Stephanie’s first surgery followed a week or so later.

“Another friend who’d had surgery done by someone else came up to see Dr. Bos and had some repairs done,” Brown says. “I have another girl friend who had her knee done six or eight weeks ago.”

But Brown is nothing but serious when she talks about Bos and her experience at KVH. Besides his professionalism, Bos was warm, personable and a good communicator who not only listened to her concerns – but heard them. “One of the nice things was that he did a local anesthesia so I didn’t have to recover from general anesthesia,” she says. “That was one of my big fears.”

And it isn’t just Bos who makes the KVH experience memorable, she says. It’s the atmosphere of warmth and caring she says permeates the KVH environment. “I don’t know who is responsible,” she says. “My husband raved about it when he had his surgery done. You see it everywhere in the hospital. The girls at the front desk are very friendly and helpful as are all the other people you meet in pre-op, radiology, everywhere. I absolutely cannot complain about anyone. Everyone takes great care of you.”

They also go above and beyond when they see a need, she says. Case in point: When her best friend’s husband began to feel badly while waiting for his wife during a pre-op appointment in Bos’s office. “He was not feeling good, not looking good,” Brown says. “One of Dr. Bos’s receptionists saw that and said, ‘I’m taking him over to the hospital’ and put him in a wheelchair and took him over to the Emergency Department,” Brown says. “They immediately got him in. Because it was a heart problem he was transferred to a hospital in Yakima.”

On the day the man’s wife had her knee surgery, he stopped by Bos’s office to personally deliver a bouquet of flowers and an appreciative “thank you” to the staff member who helped him. “He says she saved his life,” Brown says.

“If I could come here for everything I needed to go to a hospital for I would be here in a flash,” she adds with a smile. “ It’s that good.”

Connie Dunnington

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Connie Dunnington

When her husband Bob died in a motorcycle accident sixteen years ago, Connie Dunnington understood that life as she knew it had changed.

The couple, married 13 years, were parents of two daughters, then 12 and 10.

Connie knew she needed to redefine her family’s life, creating some new traditions while preserving others. So she resumed an old love – horseback riding, sold the building that had housed Bob’s orthodontic practice and built an arena, and introduced her children to the Stirrups and Irons 4-H group, the same club she’d belonged to as a child. She went on to become the club leader, a position she still holds.

She also embraced one of Bob’s traditions – and made it her own. A dedicated community volunteer, he’d signed on early as a member of the board of The Foundation at KVH, a non-profit that works to improve community health care.

Two years after Bob’s death, Connie got a call. Bob’s seat on the board was still vacant, the caller said. Would she be interested in filling it? The answer was yes.

It was a way of continuing his legacy and adding to her own. The board was trying to raise $1 million for an endowment fund but some were questioning whether the effort should continue. She knew Bob had been determined to reach the goal.

“Being on the board maintained some continuation, some kind of a sense of tradition,” she says, noting that she and Bob both served terms as president. And after all, she was no stranger to the nuts and bolts of board service. She’d been there helping Bob from the beginning.

“Back in the early days there was no hired director. The board basically worked out of the trunks of their cars,” says Connie, who recalls putting together the organization’s annual mailing on her kitchen table while her children napped.

Eventually the hospital helped the foundation hire a director. “At that point everything changed,” she says. “Everything got easier. We reached the goal. We came up with a plan for how to use the income off the million dollars.”

Since 2005, The Foundation has donated over $1.5 million to KVH, including income from the endowment along with other fundraising, to support a variety of projects. Currently, the foundation is running a campaign to help fund the purchase of the first digital mammography machine at KVH.

Foundation director Michele Wurl calls Connie an enthusiastic volunteer who helps with “virtually every foundation activity.” That includes helping organize the annual Magical Evening, the foundation’s primary fundraising activity as well as leading the annual Tough Enough to Wear Pink campaign during the rodeo. Last year, proceeds funded a free mammogram day.

“We sell beads, t-shirt, bandannas, anything that isn’t tied down. One year we sold a pink bucket because someone wanted it,” Connie says, laughing.

Her laughter – warm and engaging  – is also energizing. That’s classic Connie, Wurl says. “She’s always willing to do whatever it takes to get the job done. She’s smart, funny and truly dedicated to improving health care in this community.”

That the foundation has been as effective as it has been is no accident, says Connie who lauds the relationship between the foundation and KVH administration. “You have to have a good relationship and work together,” she says. “In the past, it wasn’t always that close.”

What makes her proudest she says is “just to hear the positive attitudes of people working here. Every time this hospital gets named in the Top 100 you know people are doing things right.”

How long will she remain on the board? Connie, now 60, flashes a smile. “It’s the same thing I say about 4-H,” she says. “I will do it until I don’t enjoy it – and right now, I enjoy it.”

Jim & Pam Daly

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Jim & Pam Daly

Jim and Pam Daly know a good investment when they see one.

Case in point: Kittitas Valley Healthcare (KVH), where they’ve been investing time, talent and money for years.

Blame selfishness. They do.

Unabashed Cougar fans, the Dalys’ road to Ellensburg began at WSU. She was 19 and majoring in elementary education when they met; he, 20, and a marketing major. They married 45 years ago this coming September, just before the start of their senior year. Jim landed a banking job in Enterprise, OR, after graduation, then moved on to a job with Pacific Bank in Ellensburg in 1975. They considered it just a stop along his career path until an unexpectedly early promotion to bank manager changed their plans.

Over time, they found plenty of reasons to turn to KVH. There was the night their son Curt landed in the hospital Emergency Department with croup, the C-section Pam had when their daughter Megan was born, the nine arthroscopic surgeries, two knee replacements and shoulder surgery that are part of Jim’s medical history. In the early 1980s, Pam began volunteering with KVH. In 1986, she signed on as a regular volunteer with the hospital’s Imaging Department. That same year, then serving as president of the KVH Auxiliary, she was one of eleven founding members of The Foundation at KVH.

Nearly three decades later, the Dalys decline to specify exactly how much they’ve contributed to the foundation. Suffice it to say, they’re major donors. Pam, now auxiliary treasurer, continues to volunteer in Imaging. Jim, who left banking to become an investment counselor and stockbroker, has served 20-plus years as a member of the foundation board, his expertise instrumental in guiding the foundation’s conservative and successful investment approach.

Supporting KVH is a no-brainer, the Dalys say. The seed for their involvement was planted in the soil of pragmatic self-interest.

“We did it for selfish reasons,” Jim insists. “When you have children you know there are going to be times when they’re going to need medical care and you want them to have good medical care. Our philosophy has always been that we wanted a good place for our family to turn to – and we knew as we got older we’d need a good place, too. It’s putting our money where our mouth is.”

Good investments pay good dividends.The Dalys are pleased with the return they’ve seen on both their time and money.

In the past five years alone, the foundation has raised more than $1.1 million through special events, major and estate gifts, an annual donation appeal and investment earning. In recent years that money has helped fund a new entrance to the Emergency Department, a security system for the Family Birthing Center, state-of-the-art orthopedic surgical equipment and renovation of the Medical Surgical Unit. The auxiliary, which operates the hospital gift shop, helps in various ways, from awarding scholarships to students studying medicine to providing teddy bears for the Emergency Department to knitting caps for newborns to providing flat screen TVs for patient rooms after the hospital was remodeled.

“We’ve seen some really great things happen that we’ve been able to be part of,” Pam says. Jim says he’s “proud of the quality of care and the people who give it – and I’m not just talking doctors. The whole staff really cares about you.”

While there are many good causes, Pam prefers to give locally which makes KVH a slam-dunk. “We believe in this hospital and its focus on community,” she says.

Jim nods agreement, smiling broadly. “Giving back,” he says, “is what we do.”

Jim Pappas

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Jim Pappas

From minor injuries to the most painful day of his life, retired Central Washington University administrator and professor Jim Pappas has relied on KVH Hospital for quality care and outstanding compassion.

He’s seen both up close and personal. Case in point: what happened when Pappas’s wife Denise fell critically ill.

The love of his life and the heart of her family, Denise was also afraid of doctors – so fearful that for several years she ignored symptoms of potential heart problems, repeatedly refusing pleas from her family to see a doctor.

Flash back to May 19, 2006. Unable to shake persistent shoulder and back pain that eventually spread to her chest and legs, and with her husband begging her to go to the hospital, Denise refused — right up until 11:30 p.m. when Pappas called 911. “I know now,” he says, “that she was dying before my eyes.”

Paramedics put her in the medic unit. Alarmed when he saw them struggling to get a heartbeat, Pappas walked circles in the front yard until the ambulance pulled away, then drove himself to KVH. Relief mingled with fear, he says. “I was so scared. But I thought she would finally get the help she needed.”

At the hospital, Pappas sat beside his unresponsive wife, holding her hand and talking to her as medical staff tried to restart her heart with defibrillation multiple times. The effort failed. “They did everything they could. They were just outstanding but Denise passed away in ER,” he says.

She was 67. They had been married 42 years. Stunned and numb with grief on what he calls “the worst day of my life,” Pappas sat beside her waiting for family to arrive, a nurse and doctor at his side until a pastor came in. “They didn’t leave me alone,” he says.

It’s not the only time Pappas has witnessed a level of care – and caring – that he finds unforgettable.

When a longtime friend dying of cancer was hospitalized, Pappas was a regular visitor – so regular, he says with a smile, that some staff assumed he was a son.  The 97-year-old patient and his 94-year-old wife had been married 73 years. “What I saw was that everybody who came in, the guys as well as the gals, took time to talk to her,” says Pappas who at 77 is a walking testimonial to a hospital he believes in.

There’s good reason. Since arriving in Ellensburg from Chicago in 1980, he’s turned to KVH for care on multiple occasions. There was treatment for diverticulitis, emergency room visits for a fish hook that got stuck in his hand and a nosebleed that wouldn’t stop, treatment for a stomach ulcer and bacterial infection, endoscopies, colonoscopies, MRIs and X-rays, rotator cuff surgery and surgeries on his fingers and both knees.

“Dr. Dan Hiersche (an orthopedic specialist) repaired me so many times,” says Pappas who lauds a host of other providers. Among them: his longtime primary care physician Dr. Don Solberg whom he calls “cerebral and a straightforward professional with good bedside manners.”

Nurses consistently have been “absolutely professional and caring, showing interest in me, explaining what they were doing but most importantly answering my questions,” he adds.

While some people may think they’ll find better care at a bigger hospital, Pappas says, he’s found everything he’s needed in a comforting high quality setting close to home. “This hospital has served me well,” he says. “They identify what the problem is, address it, operate if they need to and you get it fixed. I’ve been very pleased.”