On a cool fall morning, Abby Buechner and four other University of Wisconsin-Eau Claire nursing students are unpacking their equipment and medical supplies in a break room inside a barn on a Buffalo County farm when a farm worker, Alejandro, walks in.
An immigrant worker from Mexico, Alejandro smiles as the nursing students greet him by name and talk with him in Spanish. As Buechner checks his blood pressure and cholesterol levels, Alejandro asks and answers questions and then heads back to work. During the next hour, the students — under the supervision of a nursing faculty member, and with guidance from a Buffalo County public health nurse and a Spanish interpreter — provide influenza shots, immunizations and health screenings to a handful of other farm workers.
When the last worker leaves, the team loads its gear into a vehicle and heads down the road to the next farm, where more workers are waiting to receive hard-to-come-by health care.
"We get good attention from the nurses and it's important for us to learn a little bit about our health," Alejandro said. "They give us vaccinations and information about our health and how to avoid accidents and sickness. This is something that's of great help to us."
It's also something the immigrant workers would go without if not for UW-Eau Claire's innovative Health Care for Immigrant and Local Farmers Clinical Immersion program, which each semester sends senior nursing students to 10 western Wisconsin farms to provide health screenings, and to share health and safety information with immigrant and rural farm workers, said Dr. Susan Peck, a UW-Eau Claire nursing professor who developed and helps oversee the program.
"This program provides an underserved population with much needed health care services and gives our students an understanding of the diverse populations they may someday serve as nurses in their local areas," said Peck, adding that all the students in the program have some Spanish skills, and many have traveled or studied abroad in Spanish speaking countries. "It's an opportunity that both the workers and our students say they greatly appreciate."
Now in its fourth semester, five to seven nursing students enroll in the clinical course each semester. Students spend the first weeks of the semester creating health and safety related educational materials in English and then translating them into Spanish. Dale Omtvedt-Gable, a UW-Eau Claire Spanish lecturer who helped Peck develop and implement the project, works with the students on the translations and serves as an interpreter throughout their clinical experience.
In the early weeks of the semester, the students also research the immigrant worker population to educate themselves about the workers, their reasons for being here, and health and safety concerns often associated with the farm work they do, Peck said.
For the remainder of the semester, one day a week the students visit three or four farms where they do on-site screenings for blood and cholesterol levels; provide immunizations for influenza, tetanus and diphtheria; provide education about issues like diet, body mass and risks for cardiac disease; and provide agriculturally specific education on things like ergonomics, and hearing and respiratory protection. The nursing students meet with an average of 10 workers at each farm.
"This has been an incredible and different experience," said Buechner, a nursing major from Madison who graduated in 2013. She had never been on a dairy farm but now has milked a cow and witnessed the birth of a calf. "I'm learning about the culture of the Hispanic workers and the culture of a farm. It's a completely different way of life than I'm used to."
Buechner said her dream is to be a nurse abroad, perhaps through a program like the Peace Corps or Doctors Without Borders. Eventually, she would like to settle in a large American city where she will be immersed in multiple cultures.
"This experience is helping me prepare to do those things in the future," Buechner said. "It's giving me more confidence in my ability to interact with (people of) different cultures."
Recognizing that nurses often work with diverse populations, UW-Eau Claire offers nursing students immersion experiences to help them better understand other cultures, Peck said. Among those is a Costa Rica Study Abroad Summer Nursing Program, in which students explore a different kind of health care system while immersed in a Spanish-speaking country. Many students who enroll in the immigrant farm clinical have participated in the Costa Rica program.
"The Costa Rica program is a fantastic first step for our students to build their Spanish language skills, but we were searching for a way for them to use both their language and nursing skills in a diverse and culturally different setting," Peck said.
The idea to partner with farmers came to Peck after a Spanish speaking nursing advisee told her about her summer work on farms in Virginia that hire immigrant workers.
"It clicked then that we had a great opportunity to offer a meaningful immersion experience close to home," Peck said. "We did a pilot run of the project in 2011 and the program has grown since. It's incredible for our students to be able to combine their Spanish language and nursing skills while working with a diverse population so close to home."
Buechner said the Madison schools where she grew up were diverse but she had little interaction with diverse populations while a nursing student at UW-Eau Claire. That changed when she enrolled in the immigrant farm immersion clinical, she said.
"In Costa Rica, I learned how to talk about diabetes and blood pressure in Spanish," Buechner said. "In this clinical, I'm adding so much to what I learned there because I'm providing health care to diverse patients while speaking with them in Spanish. It's exactly the kind of experience I wanted."
The opportunity to use both her Spanish and nursing skills in a real-world setting also attracted Rachel Philipps to the clinical.
"I'm excited to speak Spanish with patients," said Philipps, from Dodgeville. Philipps graduated with a degree in nursing in 2013. "Usually, I have my patients and then I speak Spanish with people I know. This is different from talking to people in class who have the same level of Spanish as me and don't have accents. On these farms, it's more challenging and that's what I wanted."
Sarah DeYoung, another 2013 graduate, from Winneconne, was intrigued by the clinical because it models some aspects of the Costa Rican health care system that impressed her most.
"In Costa Rica, they go home-to-home to do immunizations and health screenings," DeYoung said. "That's not something we typically do here, but we do it in this clinical. I like that we're doing a preventative piece for this population and that we go to them to deliver it."
The program is especially valuable because, as Buechner noted, students gain an understanding of two cultures: the Hispanic culture and the rural culture, said Dr. Lisa Schiller, an assistant professor of nursing who works with Peck to oversee the clinical.
"A lot of these students are from cities and I hear them talk about how much they are learning about how a farm works and the work that goes into farming," said Schiller, who lives on a farm in the area. "These nurses are going to take this experience into all different settings. Whether they work in an emergency room, a clinical setting or in public health, this knowledge will apply. I feel strongly that what they're learning here are things they'll never forget."
Since many UW-Eau Claire nursing graduates go to work within 150 miles of Eau Claire, many of them will work in rural areas where farms and other businesses employ large numbers of immigrant workers, Peck said, noting that canning factories in Rice Lake and Baldwin and Ashley Furniture in Arcadia are examples of businesses that employ immigrant workers.
As a result, nurses who speak Spanish and are comfortable interacting with the immigrant population are highly valued in health care organizations in Wisconsin and elsewhere, Peck said.
"Every health care organization in our area now has someone who speaks Spanish or has someone they can call in when they have a Spanish-speaking patient," Peck said. "Language skills are becoming increasingly important in nursing. If you have two graduates with similar nursing skills but only one speaks Spanish, the Spanish-speaking nurse will be the one hired."
Elora Blomberg grew up in Ogema, a rural community where people have limited access to health care. That experience has shaped how the 2013 graduate thinks about her nursing career, she said.
"I'm interested in rural nursing and in the needy and underserved populations," Blomberg said. "This clinical is helping me see the populations out there and what kinds of things we can do for them. I've always known that I wanted to help people but (after) being out here to see the need, I'm going to be better prepared to care about, think about and work with different populations."
Peck said nursing students often limit their thinking about career options to hospitals. But this clinical shows them there are many paths to follow, including public health nursing, she said.
Elizabeth Erickson, a 2013 nursing graduate from Madison, said she's grown more confident in her ability to earn the trust of the workers, a skill that will be valuable in the future when she works with diverse populations. When nurses visit a farm for the first time, the workers often are wary of the students and uneasy sharing any personal information, she said, noting that asking for something as basic as their name can make the workers uncomfortable.
Talking with workers in Spanish and reassuring them that they don't have to get shots or screenings helps to build trust, Erickson said, adding that some of the workers have not previously had a shot or met with a health care provider.
"I want to work with people of different cultures, so what I'm learning here will help me," Erickson said. "I'm learning problem-solving skills and how to communicate with people who have limited English skills. I can take what I learn and apply it anywhere I go as a nurse."
It's rewarding to see the students grow as nurses during the clinical, Schiller said.
"I see so much growth in the students' cultural skills, in their language skills, in their confidence and in their understanding of what it means to live on a farm," Schiller said. "In the beginning, they tip-toe in the door and quietly say, 'hola,' when a worker comes in. A couple weeks later, they are relaxed and eagerly engaging the workers in conversations."
Peck said she's been impressed by the students' ability to gain the trust of the workers. By asking the right questions, one student learned that a worker had been kicked by a cow, though the man had not indicated during the screenings that he was in pain, she said. Once they learned he was injured, an exam revealed that he had broken ribs, which the nurse practitioner supervising the project could treat to ease his pain, Peck said, noting that both she and Schiller are nurse practitioners so, when necessary, they provide services beyond what students can offer.
"As the level of trust increases, the kinds of conversations the students have with them relating to their health deepens," Peck said. "Learning to make those connections is an important skill in nursing because it increases the quality of care we can provide."
The clinical gives students a broader and more accurate understanding of the immigrant population and the issues that surround their being here, said Shaun Duvall, an interpreter who works with the nurses at the farms. Through their research, a visit with the Mexican consulate in St. Paul and the weekly interactions with workers, the students leave the clinical with facts that will help them think and talk about immigration and related issues differently, she said.
"This experience changes the way these students think about so many issues that touch the populations they are interacting with," Peck said. "It broadens their thinking and gives them information that will help them form opinions about things like legislation relating to farming or immigration. They'll better understand what is a myth and what is real."
Given the state's increasingly diverse demographics, it's important for nursing students to be exposed to that kind of information and to interact with the immigrant workers, Duvall said.
"The more you understand, the more compassionate you can be," Duvall said. "And these young women have shown a lot of compassion. This experience will make them better nurses."
Duvall, who works with immigrant workers through the Puentes/Bridges program she founded, said most immigrant workers on western Wisconsin farms come from a poor and remote area of the mountains in the state of Veracruz in Mexico. She organizes trips to the region for farm owners to help them better understand the immigrant workers they hire.
Chris Weisenbeck, an owner of Weisenbeck Dairy in Buffalo County who has been hiring Hispanic farm workers since the 1990s, has twice traveled to Mexico with Duvall.
"Going into their communities in Mexico was like a step back in time," Weisenbeck said. "So for these nursing students, this experience is giving them an opportunity to gain knowledge and have an experience that they wouldn't normally have in this area."
Weisenbeck said he welcomes the student nurses to his farm because they provide health care his employees need but may not otherwise receive, and they share important safety information with his workers.
"Agriculture is the most dangerous industry in the United States so it's important that nursing students be aware of agricultural health and safety issues," Schiller said.
The clinical program is becoming well known and respected among farmers as people like Weisenbeck talk with their neighbors about its value, Schiller said.
"This program has created a culture of health and safety in the area," Schiller said. "We have farmers saying to other farmers, 'you should have this program come to your farm,' and they agree. There has been a lot of talk among the farmers who think it's great for everyone."
Schiller, who has expertise in farm safety and is certified in agricultural health and safety by the University of Iowa, said she hopes to secure funding to expand the occupational health and safety curriculum associated with the project.
The Health Care for Immigrant and Local Farmers Clinical Immersion clinical is funded through the Blugold Commitment, an initiative that provides UW-Eau Claire students with high-impact learning experiences. It's supported by differential tuition funding.
"As a nurse, I expect I will take care of patients in different settings, not necessarily just in a hospital," DeYoung said. "I'm going to be a nurse in a changing world so I have to be prepared to adapt and change, too. This isn't a cookie cutter nursing program. It's teaching us to be flexible and to think differently. That's going to make us better nurses. These kinds of experiences are what make UW-Eau Claire such a great school."