At first, the homeless woman who was wearing a jacket told nurse Lorraine Romero that the discomfort in her pelvis might be a urinary tract infection.
Romero ran a urine screen, which was negative. When she had the woman take off her jacket so she could perform an abdominal exam, it appeared the patient was pregnant.
"She denied it," said Romero, who went on to find a fetal heartbeat and determined she was well along in the pregnancy.
The woman was recommended for prenatal care and the shelter where she was staying was notified. She went into labor the next morning and safely delivered the baby at a hospital.
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The free clinic held at the Modesto Gospel Mission was one of the highlights of Romero's two years of training to become a nurse practitioner. She and 10 other classmates graduated with master's degrees last week, a small graduating class that could have an impact on health care in the area.
The Family Nurse Practitioner and Master of Science in Nursing Program at California State University, Stanislaus, is a distance learning program offered in cooperation with Sonoma State University.
The nurses enter the program with bachelor's degrees and are trained to become family nurse practitioners. Many of the graduates will work in clinics or other medical facilities that provide health care for the poor in Stanislaus and nearby counties, program officials said.
"There is a big need with the way the economy is now," said Romero, a Riverbank resident who was a public health nurse for San Joaquin County until last week. She will start work as a nurse practitioner in a Modesto clinic in August after taking some time off.
"Since I am bilingual, I feel it is a benefit to patients," she said. "A lot of the patients I serve are Spanish-speaking."
Family nurse practitioners are not doctors but work within protocols to deliver primary care in urgent care centers, private medical offices and community health clinics.
Although they are under the supervision of a physician, they work independently with patients to do routine medical diagnoses and treatment.
Most nurse practitioners are women, so they often work in women's health, including obstetrics. If they are puzzled by a medical condition they see, they are required to call in the physician.
"It fills a huge need in our valley," said Judy Richards, the program coordinator at CSU, Stanislaus. "We are lacking in primary care providers."
It takes two to three years to complete the degree program. Most of the students continue working in health care while going to school.
Students participate in classes over the distance learning television network or take in lectures online from their home computers. Some classes are held at CSU, Stanislaus.
The students receive 675 hours of clinical training and take part in free clinics at the Gospel Mission and the Del Puerto Health Center in Patterson.
Matthew Haskett, director of education for Emanuel Medical Center in Turlock, was the only man in the 2009 graduating class. He has no plans to work as a nurse practitioner, but the knowledge he acquired will help in developing health education programs for patients, he said.
"I wanted to be exposed to a different side of nursing," Haskett said.
"As a nurse, I come from a background of working in intensive care units. Taking care of patients in an outpatient primary care setting was an interesting and rewarding challenge."
One of his memorable experiences came at a health fair in Patterson last fall. He was part of a team performing women's health exams and detected symptoms of uterine cancer in a patient. The diagnosis was later confirmed.
Two other patients at the Modesto Gospel Mission clinic had serious medical conditions and were sent to Modesto hospitals.
No difference in pay
This was the fourth graduating class for a program that has turned out more than 50 nurse practitioners in 10 years. Richards said that five of the 11 recent graduates have positions lined up to work as nurse practitioners.
Right now, pay is not the incentive, as nurse practitioners are paid about the same as nurses. As long as they have an agreement with a supervising physician, nurse practitioners can run their own practices and bill government health programs for services rendered.
Renee Pimentel, a program graduate and director of emergency services at Emanuel Medical Center, plans to work part time as a nurse practitioner for a physician in Hilmar.
"It was extremely interesting going through the training," Pimentel said. "I really enjoyed the clinical piece, the hands-on care with the patients."
Bee staff writer Ken Carlson can be reached at firstname.lastname@example.org or 578-2321.