By Hayden Burfitt (UNLV School of Nursing Student Worker - Communications)
A supportive environment for pregnant people is everything. UNLV Nursing graduate student Janice Enriquez knows this too well, specifically the importance of being guided through an unsure situation from her own experience. A first-generation college graduate working in a private OB-GYN practice, Enriquez has devoted herself to creating judgment-free environments to treat patients as a maternal health advanced practice registered nurse. As she pursues her Doctorate of Nursing Practice (DNP) at UNLV, Enriquez hopes her current research on maternal and neonatal care levels will provide expecting parents and their children with the aid they deserve.
Finding the Right Level of Care
Enriquez’s DNP project seeks to evaluate the levels of maternal and neonatal care in Nevada. A hospital’s level of care measures the equipment, specialists, and procedures that they have readily available for patients. “The levels of care for NICUs in Nevada are formally recognized, but we haven’t done a formal assessment of the maternal levels of care,” Enriquez explained. “If I have a patient who is close to having their baby, but has issues like a preexisting cardiac problem, we want to make sure they go to a hospital that has the equipment, staff, and/or technology available to address any complications that might occur as a result of the preexisting cardiac issue.”
Enriquez hopes to remedy the current lack of information on maternal levels of care in Nevada. To collect data, Enriquez is employing the Centers for Disease Control and Prevention’s (CDC) Levels of Care Assessment Tool (LOCATe). LOCATe is a web-based questionnaire that Enriquez provides to hospitals and birthing facilities. The data is sent to the CDC, which provides an unofficial designation for each surveyed location. From there, If the hospitals' maternal child units wish to seek a formal designation of maternal level of care, they can apply for accreditation from the Joint Commission.
Helping pregnant patients could be only the beginning of Enriquez’s research. By publishing maternal levels of care, hospitals can better recognize gaps in their capabilities. “In our Northern Nevada area, there’s a lot of space between counties,” Enriquez began. “[We could] figure out, ‘Do we need any improvements on transfer protocols? Do you need someone to come and do outreach and education for the nurses?’ There are so many different avenues we can take.”
Enriquez was first introduced to maternal care when she became a mother at a young age. “When I went into labor, the nurse that originally took care of me was rough with me,” Enriquez remembered. “The next nurse that took over while I birthed my daughter, however, was compassionate and caring.” The stark difference between her nurses made Enriquez realize the impact she could have on people. “It was enough to inspire me to go through nursing,” Enriquez said. “I want to make sure that young people are not going through a situation where they feel bad about their decision or the people who are supposed to take care of them are judging them.”
Given the opportunity to enter labor and delivery nursing at Sunrise Hospital, Enriquez put her goals in motion. “There are situations when you can tell people have been through interactions that cause them to be defensive when you meet them,” Enriquez explained. “They think, ‘Oh no, is this one going to judge me? I’ve already had to defend myself and I’m just here to have a baby.’ I try to make sure that patients feel safe and comfortable. I let them know that I am working with them and not just doing things to them.”
Enriquez adds, “All people have their backstories, their traumas, their experiences; as you go through a history with a patient, you pick up on that because it could potentially affect how you care for them. I’ve learned to finesse the way I ask questions so they don’t put themselves in a defensive mode. When they shut down, I’m not going to be able to get the information, and I’m not going to be able to help them the best way that I can.”
After five years at Sunrise Hospital, Enriquez moved to Southern Hills Hospital and decided she was ready to pursue advanced practice. Enriquez began attending California State University, Fullerton while working in Las Vegas. “I worked Friday through Monday and then I would commute to California for classes and training,” Enriquez explained. “I was a single mom with four kids when I did grad school the first time. I would alternate weekends co-parenting and working. If I worked the weekend, I would leave at 2:00 AM to make it to my clinicals. Tuesday, I would be in clinicals all day, then Wednesday and Thursday would attend lectures, head back to Las Vegas Thursday night so that I could be at work on the floor at 7 am on Fridays.” She was able to graduate with both her women’s health nurse practitioner and nurse midwife degrees after two years of hard work, but she wasn’t satisfied.
The desire to provide the best care she could led Enriquez to join UNLV in the DNP program. “From the time I was a kid, my parents would come to Vegas all the time for vacations, and I’ve always wanted to go to UNLV,” Enriquez remembered. “It’s home. The bulk of my career has been here in Las Vegas. It makes sense to give back to my community.” Enriquez says that the UNLV School of Nursing has provided her support in her own unsure situation. “This is my second project that I’ve worked on,” Enriquez explained. “I switched jobs and went from a focus of breast care and oncology to maternal-child. It was hard because my original project wasn’t going to play out. I thought, ‘That’s it, I’m going to have to drop out because I don’t have a project and I’m not sure what I’m going to do because I haven’t been back in women’s healthcare long enough to figure it out.’” Enriquez’s committee and advisors helped her readjust to the women’s health field and explore possible routes for her research. “Through support and mentorship, I’ve been able to find opportunities.” Enriquez said. “The last eight months was a crash course on what’s current in practice for maternal health. It’s been great getting all the resources from the college and my mentors.”
Improving Future Maternal Health Care
Enriquez has recognized some areas of maternal health that she believes could be improved, including reducing cesarean section rates, lowering morbidity rates, and increasing education for expecting parents. Enriquez hopes her data creates new opportunities for change in nursing, saying, “I would love to be a part of improving access to care, increasing education, and helping with other implementation projects that are out there to improve maternal care.” She believes that earning her DNP degree will open new paths for her to take in advancing women’s health. “It’s what I wanted. It’s what I needed. If I’m going to do it, I’m going to do it right.”