Going into my seventh rotation, I was extremely excited to be getting one step closer to completing the program. I was also so glad to be able to have my Long-Term Care rotation at this time because of the restrictions due to the COVID-19 pandemic. It was thrilling to be the first student back for this rotation, and at a new site at that. I was so grateful that Far Rockaway Center for Rehabilitation and Nursing allowed me to rotate there. This facility is actually affiliated with the same system I completed my Ambulatory Care rotation with, so it was interesting to see how they operate in a different kind of setting.

I rotated at the facility with my preceptor, Pam Cornacchia, PA-C. She was relatively new to the facility, having been hired there for only two weeks before I arrived, so we did a lot of learning about it together. One of the major challenges of this rotation was that my preceptor only worked 2 days per week and for only a few hours, so I had to find ways to supplement the time there to meet the requirements for the rotation. I mainly did this by staying after my preceptor finished for the day and following with patients’ results, checking in on them, and doing chart reviews. Otherwise, I paid attention to when the wound rounds were happening or when other providers would come to the facility. Pam also gave me assignments for outside of our time in the facility together, supplementing to the experience. By the end of the rotation, I had done presentations on Beer’s List and Dementia, had case discussions, and answered clinical questions outside of the face-to-face time with my preceptor, contributing to my learning.

On a typical day on this rotation, Pam and I would first check on any consult notes, new labs, and follow-up with any patients that might have had acute events overnight or in the last few days. Then, we would make our way through the day’s patient list and complete any regular checks and monthly follow-ups. Generally, we would see around 30 residents out of the upwards of 90 in the facility on a given day. Halfway through the morning, we went to the morning meeting, which integrated all the teams in the facility: medical, nursing, nutrition, social work, physical therapy, and occupational therapy. Each team brought up any concerns they had and then we went into the high-risk meeting to discuss specific patients and the care plan meetings. There were also some new programs implemented during my time at the facility, like the Respiratory Management Program, which also got discussed at the morning meeting. Following this, my preceptor and I would go follow-up with any other patients we had not gotten to yet.

Pam was a wonderful preceptor who has over 20 years of experience, so she was able to do a lot of teaching in a short amount of time. She and the other staff in the facility were also great in making me feel heard and considering my suggestions. For instance, many of the patients in the facility had primary psychiatric diagnoses, so I was able to give a lot of input considering their medical management (to be approved by the psychiatry NP doing telemedicine visits, of course).

One of the most surprising aspects of this rotation and this facility for me was that there were so many patients who were not the “typical” nursing home residents I, and I imagine any one else, would think of. This facility had a good population of younger residents who required skilled nursing services. For instance, there was one patient in his early 30s who suffered hemiplegia following multiple gunshot wounds, as well as another patient around the same age with a very severe case of bullous pemphigoid. As I mentioned earlier, many of the patients were also admitted for primary psychiatric diagnoses, as well. Of course, most of the facility did consist of the typical type of patients one would expect with dementia, heart disease, diabetes mellitus, and post-CVA deficits.

I enjoyed my time at this facility, but I do with I was able to be a bit more hands-on in terms of procedures. There generally were not many to be done and I spent a lot of my time there doing monthly checks. I did get the opportunity to remove a midline and PICC line from two patients, which was the first time I had done those.

The transition from this rotation from my surgery rotation was a really tough one. It was great because the schedule was much less demanding and I was able to apply my wound care knowledge from my previous rotation, but the change of pace was really extreme for me. This taught me that I would definitely be more well-suited for a more fast-paced environment where I could be more hands-on. Thinking of my past rotation experiences, I think the psychiatric emergency setting and urgent care settings were great fits for me so far. In the same way, I hope emergency medicine, through which I am rotating in my next rotation, would fit similarly.

One patient interaction that stuck with me was with one gentleman who was consistently refusing his insulin and had finger-sticks consistently between 350 and 450. When I went in to speak to him to figure out why, I found that there was a deficit in the patient education concerning diabetes mellitus; as far as he was aware, he thought it was normal and that his blood sugars should be that high or else he will “pass out.” Also, he was initially on 50 U of long-acting insulin and just felt that this number was too high so he did not want to take it. I was able to educate him on his condition and the consequences if he did not get his blood sugar under control. As per Dr. Davidson’s suggestion during my site visit, I also shared with him what my blood sugar usually is so we can better relate to each other. Ultimately, he was still reluctant to take insulin, but he became agreeable to taking 25 U for a week and re-evaluating his numbers together to see if we would have to increase those numbers. This really reinforced the importance of not only explaining to a patient about their condition and treatment, but also making sure it is explained plainly enough that they understand.

I learned a lot during this rotation. This setting integrated so many different areas of medicine and it was truly great to be able to see the interprofessional collaboration that goes into the care of a single patient.