Tunbridge’s town nurse steers through shortages to boost community health

by Robert Gamache, Community News Service Jodi Hoyt recalls her time recovering from a spinal injury toward the end of 2012 — and the seeming disinterest and outright hostility of the nurses responsible for her care. 

She was a senior at the University of New Hampshire then, studying nursing. And her experience in that hospital after a car crash proved pivotal for reaffirming her path. "It got me really motivated to be like, 'I know I'm meant to be a nurse, and you guys are just bad nurses.'" 

She graduated, though the accident interrupted her original degree plans, then joined Dartmouth Hitchcock Medical Center and later Alice Peck Day Memorial Hospital. In 2017 she got a registered nurse degree from Vermont Technical College. She became a nurse care manager at the Scotland House, an adult day program in Woodstock, but after Covid-19 hit she worried about exposing her family and left, taking a job as a virtual registered nurse for Hope Home Care Services out of Barnard.  

In Tunbridge — just down the road from Hoyt’s hometown of Chelsea — voters in 2022 approved hiring a community nurse who could serve townspeople by performing vitals screenings, coordinating health care, providing education and advocacy and planning wellness clinics.

Intrigued and anxious to help, Hoyt, now 33, contacted town leaders, hoping she could serve their community.

Around the start of the new year, she went to work.

In Vermont's rural areas, community nurses like Hoyt are often lesser known as caretakers yet can be essential for health care. To figure out how easily people can seek health care, the state divides towns into 38 areas on a map based on how far residents would reasonably travel for medical services. Of those areas, four are designated as health professional shortage areas by federal officials — and Chelsea and Tunbridge belong to one of them.

For every full-time equivalent primary care provider in the two towns’ service area, there are over 2,000 people, according to state data published in 2019. Randolph, by comparison, sits in the center of an area where there are fewer than 750 people for every full-time equivalent primary care provider, according to the report. 

Faced with funding shortages, professional isolation and the logistical challenges of rural care, Hoyt knowingly accepts these challenges.

Her work shows how embedding a health care provider within the local government can help residents avoid the messy communication and confusing processes of hospitals — and provide them with closer attention than usual.

She started talking with the Community Nurse Connection, a New Hampshire organization that supports town nurses with resources like budget guidance and proposal preparation, which helped jump-start the program in Tunbridge.

Despite the support, Hoyt faces the distinct challenge of nursing as a young professional in a typically veteran field. 

"There's not a lot of young nurses that are passionate about community nursing, and/or they don't have the experience to be able to handle it," she said. 

"You are on your own completely,” she said of community nursing. “You have no support, and you have no mentoring. The only thing you get is a monthly meeting on Zoom with a couple of other nurses … We have to work other jobs. We can't live off community nursing, unfortunately."

To build healthier communities, Hoyt is looking to move toward a nursing model in which she would oversee several towns at once, not just Tunbridge. With more towns to care for, she believes she would receive more funding and be able to live more comfortably.

Still, Hoyt has proved herself a valuable asset over the two years she's been working in Tunbridge. The town increased its budget line for the nursing role to $24,000 in this year's town meeting, nearly double what it was before.

To Hoyt, it was a sign that community nursing works. "Tunbridge is hearing me loud and clear," she said.

She recalled her first year and a half in the role, when she had to find funding outside what was allocated.

"It's challenging as nurses — we're not all grant writers. We're trying to be a nurse in the community, but then we're also trying to fund ourselves," she said.

She received a $5,000 grant last year but couldn’t get it again because it is only for startup operations. "That's $5,000 that I have to deduct from my budget this year,” she said. “It's not just salary; it's supplies and the IRS gas reimbursement. We donate a lot, and we take lower rates because we're just trying to get this program going.”

Hoyt remains optimistic: "Our hope, just like anyone's, is that we're appreciated and paid what we deserve to be paid, get benefits and maintain workable hours. Ten hours a week is not liveable."

On her end, she’s tried to up her game by improving case management to better facilitate treatment plans for patients.

Hoyt received a certificate from the National Registered Nurse Practice Development Center in case management in April and has already put her skills to use helping a local who uses a wheelchair but didn’t have a ramp at home.

"All I had to do was research some programs that help low-income people with disabilities,” she said. “I got in touch with Vermont Independent Living. We got their grant application filled out, and they had the client's ramp built within a few months."

Robert Gamache reported this story on assignment for The White River Valley Herald. The Community News Service is a program in which University of Vermont students work with professional editors to provide content for local news outlets at no cost.

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