Raising the Level of Care in a Rural Community

Neil Melvin started his career as a pediatric nurse practitioner in Lake City, Fla, a small town just 45 miles north of Gainesville. The pediatrician Melvin worked with had a branch in Live Oak, Fla., another small, rural town between Tallahassee and Jacksonville just 30 miles north of Lake City. Melvin spent most of his time at the Live Oak office. It didn’t take long for him to notice that children there, and in Lake City, had insufficient access to quality health care. Melvin, a USF College of Nursing alumnus, knew he had to do something to improve the level of care these children were receiving.

“As I began to work in pediatrics in Lake City and Live Oak, I realized that a lot of families in these towns had limited access to care for various reasons. While it was challenging, I thought, ‘This is where I need to be,’” Melvin says. “These kids need quality health care. So it became important to me to stay in the area. I thought several times about moving to Jacksonville, but I realized that these kids and their families really need help.”

In December 2008, Melvin began working with Amber Ingram, a fellow nurse practitioner who opened her own practice, Horizon Pediatrics, in Live Oak. His alliance with the nurse-practitioner-owned-and-operated practice allows Melvin to serve children from surrounding rural areas while providing excellent care for patients from his previous office.

One of the obstacles Melvin and his patients face is the lack of pediatric health care services in the area. The local hospital in Live Oak does not accept pediatric patients, while the hospital in Lake City only admits children three years and older.

“Patients in the area certainly do not have access to what you would consider state-of-the-art medicine,” Melvin says. “The families we take care of have limited financial resources. An hour and a half drive to Gainesville or Tallahassee is not feasible.”

Working independently of a physician, Melvin and Ingram create visibility for the work pediatric nurse practitioners do in the community. Patients and their families see how valuable they are, particularly in rural medicine.

At the same time, Melvin and Ingram are building strategic relationships to expand the health care options for children in the rural community. They collaborate with a local physician and pediatric specialists in the area. Soon, a local speech pathologist will have an office in the same building as Horizon Pediatrics,
and Melvin is working to bring a children’s mental health counselor to Live Oak.

In a tight-knit community such as Live Oak, Melvin can also work closely with pharmacists to get his patients the medication they need. He once negotiated with the local chain pharmacy to reduce the price of medication for an asthmatic boy in critical condition whose family could not keep up with the cost of caring for him.

Likewise, Melvin’s relationship with a local family-run pharmacy has proved beneficial to his patients.

“There was once a very sick boy in need of an antibiotic injection in my office at 5 p.m. on a Friday,” he says. “I called the family-run pharmacy and they personally delivered the antibiotics to my office.”

When Melvin began the ARNP program at USF, he questioned his choice to focus on pediatric primary care until Dr. Mary Ann Krisman-Scott, the former director of the pediatric nurse practitioner program, guided him through the process. Dr. Krisman-Scott’s attentiveness helped Melvin transition from pediatric nursing to practicing medicine.

“I remember when I started the program I had a lot of fears and anxiety, especially in clinical rotation,” says Melvin. “Dr. Krisman-Scott is the primary person I look back on and think that if it weren’t for her, I would not be practicing primary pediatric care.”

Melvin attributes his success as a pediatric nurse practitioner to the training, resources and first-rate facilities available to him at the USF College of Nursing.

“We had the equipment and tools we needed to be successful, not to just get by,” he says. “But the mindset instructors gave us was to be aware that in nursing you have to think outside of the box.”

The college prepared Melvin to be successful in an environment where there are many disadvantages and to turn them into opportunities to make the quality of life in a small community better.

“In rural medicine you have to figure out how to get things done and still provide the best care,” Melvin says. “So far, it’s been really great.”

Story by Marilyn Bistline
Photo – Neil Melvin
Originally published in the Fall 2009 Nursing Life magazine