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In nursing, clinical experience is about learning the skills needed in a health care career – but it encompasses much more than that.

It’s also about learning about life through the people being served. According to two Senior I students doing their community health (NUR 481) clinical rotation at the Central Arizona Shelter System (CASS) adult shelter in central Phoenix, they are learning a lot about both – and being changed by the experience.

The students are not taking their clinicals at just any shelter. The CASS shelter downtown is the largest in Arizona and serves 6,000 clients annually – 400 women and men on a given night. Community health faculty members Kay Jarrell and Judy Hightower arranged for the clinical site in 2002. Jarrell takes her students there in fall and spring, while Hightower brings her ASU West campus nursing students in the summer. Few leave without being affected by the experience.

Students enter the rotation with varying experiences and expectations. One of them, Judy Sirkis, was familiar with the homeless and poor from growing up in metropolitan Phoenix. Aaron Dorcy, on the other hand, grew up in a small town in rural Washington and had never encountered homeless people.

“Several in our group of 10 viewed our future clients as ‘unhelpable’ when we started the rotation,” says Dorcy, a native of Shelton, Wash. “I have to admit I was one of them. But it didn’t take long to see how resilient these people are – and that there is not any one type of person who ends up in a homeless shelter.”

Expectations based on life experiences

Sirkis started her rotation with different expectations based on life experiences.

“I was a child of the 1960s and early 1970s and had a natural affinity to helping people in need,” she says. “When I first graduated from school, I worked as a VISTA volunteer in southern Georgia, giving impoverished people legal services advice.”

By working with the homeless at the shelter, Sirkis says she rediscovered her “comfort zone,” in addition to the excitement she has in serving a population with which she has a great affinity.

The shelter is a setting that is open to developing personal styles in caring for clients. Dorcy encourages clients to take part in the health care screenings he conducts.

“I ask the clients to hold the blood pressure gauge as I take their pressures,” he says. “It helps them to see that good health is their responsibility, too. It is the experience that you do not often get in clinical rotations in hospitals.”

The students follow a set routine during their six-week rotation. Working from 2 p.m. to 7 p.m., they start with a conference session with Jarrell, who advises them of the chronic illnesses and social problems faced by the homeless and the need to listen and respect their views. Following the hourlong meeting, the students spend the rest of the time conducting blood pressure and diabetes screenings, treating wounds or giving vaccine shots.

When dealing with clients on a weekly basis, a health care worker gets to know them and forms a bond, Dorcy says.

By learning the problems the homeless face, he says, the health care workers might even feel badly about complaining and appreciate what they have.

The students bring their own stories and life experiences to the clinical setting. Sirkis, for example, was an attorney with a large Phoenix law firm. When her husband died at a young age, she experienced a sense of vulnerability of not knowing enough about his condition to help to the extent she desired.

“My husband’s long terminal illness drove me to learn about medical knowledge and bring my legal advocacy skills and experience to nursing,” Sirkis says. “The change process took several years, because I had a child at home when my husband died. But now I am nearing the start of an exciting new career of helping more people.”

Impact on students and community

Both students have been affected by their experience in the community. Dorcy cites the insights his clinical rotation at the shelter has given him into the realities of life. Sirkis puts it more prosaically. Despite the enormous, endless need she has seen, Sirkis takes heart in something from the Talmud of Judaism: “He who saves one life … it is as if he saves the whole world.”

Chief executive officer Mark Holleran says CASS measures the impact of all service program collaborations against the question, “Is this good for those we serve?”

“Our partnership with the ASU School of Nursing & Healthcare Innovation has assisted us in addressing many unmet needs of our homeless men and women clients,” Holloren says. “Most importantly though, the ASU nurses, however briefly, have been able to positively affect our clients’ physical and emotional well-being through their professional, caring and compassionate efforts. We believe this not only helps our clients but will ultimately provide our community with better caregivers.”

Perhaps the best long-term measure of the impact of the clinical rotation comes from the faculty who observe the results over time. Jarrell believes the commitment of the students to vulnerable populations continues long after their rotation is completed.

“The students become advocates for people who are vulnerable and often ask to be assigned to their care in hospitals in their careers,” she says. “They also educate others about the unique needs of the homeless. After working with the shelter residents, I often them hear them say, ‘This is why I became a nurse.’ ”