Small Town Caregiver

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Recently the family of a newborn brought the baby to Jan Penn, a nurse practitioner at Essentia Health Ashland Clinic.

They didn’t need medical advice; they needed Jan to pose for a photo with the child, the fifth generation of this family to come to Jan for care.

“It just about made me cry,” Jan says. “I had known this baby’s great-grandmother.”

After 40 years of practice, mostly in the Ashland, Wisconsin, area, Jan has seen plenty of babies grow, thrive and start new families. That’s the privilege of a small-town practice.

“I’m really blessed because I know generations of families.”

Jan laughs about how she and other longtime clinic staff members watch the local newspaper for word about “our babies.”

“We like to see who is on the honor roll, who is getting married and what is happening in their lives.”

Jan’s career has worked out just how she hoped it would when she graduated from the University of Wisconsin-Milwaukee in 1971 with a bachelor’s degree in nursing.

Right from the start, she wanted to take her skills to the kind of family-centric community she’d grown up in north of Milwaukee. “I grew up in German Catholic farm country. The kind of community where there is a high sense that people are there for each other.”

After college, Jan set her sights on becoming a public health nurse, a role that involves caring not just for one patient, but for a whole community – educating about health, improving a community’s health and safety and making care more accessible to everyone.

Before finding that public health job, though, she first worked as a nurse at St. Mary’s Hospital in Rhinelander. While there, she met the man who would become her husband, Rick Penn, an Ashland native.

On one visit to Ashland’s East End to see Rick’s grandmother, Jan called the Ashland County Public Health Department on a whim to see if there were any job openings.

“In those days, each county health department in the state of Wisconsin needed a bachelor’s degree nurse on staff.”

Ashland County did not yet have one … but it soon would.

“My interview on the phone,” Jan recalls, “went something like this: ‘You’re related to the Penns?’ ‘You have a bachelor’s degree?’ ‘You’re hired.’”

Thus began Jan’s role as a strong thread in the health care fabric of northern Wisconsin in a four-decade career of caring primarily for women and families.

Jan first worked in southern Ashland County and in Odanah on the reservation of the Bad River Band of Lake Superior Chippewa. In her role as public health nurse, she visited the communities rather than having patients come to her. This gave her a true sense of people’s conditions and an understanding of holistic care.

“It was a great experience. Being on people’s turf taught me so much. When you walk into someone’s home and see the situation of a household, it teaches you to be flexible, and to be sensitive to the fact that sometimes economic issues prevent what may otherwise seem normal or easy. You really had to think on your feet to come up with answers.”

While she found public health nursing to be a challenge, Jan also found it was fun. In the early ’70s, the job allowed for innovation. Jan helped write a grant that established a health cooperative in Mellen. Then, as part of that experimental program, she was sent to Case Western Reserve University in Cleveland, Ohio, to become a nurse practitioner.

She took her coursework at the school, undertook her intern work in Ashland County and earned her degree in 1975.

Nurse practitioners (or NPs) are registered nurses with an advanced degree who care for patients from premature infants to the elderly. They become the primary caregiver and annual medical contact for patients. Sometimes in extremely rural locations, an NP may be the sole health care provider in town.

When Jan got her degree, nurse practitioners were a new concept.

“At that time, I was the only NP north of Marshfield,” she recalled. “The medical community didn’t quite know what to do with me.”

She jokes in her typical forthright manner that at the time, Drs. Howard Sandin and Edward Vernier, who ran an obstetric practice in Ashland, were “the only two guys who had the balls to hire a nurse practitioner. … They trusted me.”

Jan became part of a health care team serving thousands of women through critical life events, coming of age to growing into old age.

Through multiple mergers of that practice, Jan continued her work and now does adult health care for Essentia Health Ashland Clinic next to Ashland’s Memorial Medical Center complex.

Jan sees up to 15 patients each working day. Years of experience and her practical, gentle character taught her to listen closely when her patients describe what ails them. She watches for the hidden clues to health issues not immediately apparent.

The holistic health approach popular in the 1970s has served her well through changes in medical technology and a push toward specialization, Jan says.

“When I started practicing, family practitioners were the norm. If someone came in with a sore throat, you could be talking and some other issue would arise and we would take care of it.”

Throughout her work day, Jan is surrounded by family and friends. There are, of course, her patients, but even her office is filled with reminders of family and friends – a photograph of her smiling, blonde twin granddaughters takes center stage amid the memorabilia, books, plants and paperwork.

“All the people who are the most important to me in my life are in here,” Jan says of her happily packed office.

Jan’s quiet energy, calm voice and soft touch could lead a casual observer to underestimate her strength and commitment to health care. A commitment that remains her passion after 40 years in practice.

Jan’s philosophy can be seen on her wall, where a framed copy of the “Nightingale Pledge,” a modified version of the Hippocratic Oath named for Florence Nightingale, ends in “With loyalty, will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.”

Nearby is a state award from the League of Women voters for being an “Outstanding Leaguer.”

While technological advances improve health care, Jan also fears that as medical systems evolve, “whole person” care may diminish. While she practices, however, that will remain her goal. “You can’t turn off what you know is right.”

For Jan, whole person care means sometimes setting paperwork aside temporarily to make more time for conversation with patients during office hours. She makes up the difference later, typically spending two hours at home each night on dictation for patient updates and getting up early to put in another hour before heading into the clinic.

“Even within a specialty, there can be a commitment to whole care,” Jan says. “I’ve had specialists who have discovered patients living in abusive situations and they have taken the time to help. That’s true healing.”

Many advances in technology, though, Jan welcomes. She favors patient access to health records online and appreciates the ability to consult with far-flung colleagues via email or text messages.

“I put questions out and often get answers back at 2 a.m. from some dedicated doctor.”

Given her wealth of experience in dealing with all types of patients and all situations, younger medical professionals often seek her out, too.

Of all the advances, Jan is most pleased with the level of care now available in rural areas.

“In the past, patients had to travel to Madison or Minneapolis. Now, for example, we have a pediatric neurologist coming to work with kids in Ashland.”

While embracing change, Jan remains rooted in her conviction that nurses are a critical component of health care, and are especially vital in rural health care.

“Rural life is unique,” Jan says. “The reality of the homes we have, the resources we have, the belief systems we have are all unique. Still, we can do it. We can have excellent health care in rural areas.”

9 Things to Know about Nurse Practitioners

  1. 2010 censuses logged 180,000 nurse practitioners in the United States and 2,554 in Canada.
  2. Canada has 1 NP for every 13,727 people (with a total population of about 35 million). The U.S. has 1 NP for every 1,755 people (with a total population of about 316 million).
  3. NPs are approved to prescribe medications, to order, perform and interpret diagnostic tests, such as lab work and X-rays, to diagnose and treat acute chronic conditions.
  4. In the United States, 75.6 percent of NPs practice in at least one primary care site. Some 916 million visits are made to NPs in the U.S. each year.
  5. In Canada, 93.8 percent of NPs work in direct patient care; 3.2 percent in education; 2.7 percent in administration; and 0.3 percent in research.
  6. Men represent 5.1 percent of the NPs in Canada and 9 percent of NPs in the United States.
  7. In 2010, the U.S. Census Bureau for the first time expanded collection of nursing data to specify five occupations: registered nurse, nurse anesthetist, nurse midwife, nurse practitioner and licensed practical/vocational nurse. Prior to that, there were only two categories: registered nurse and licensed practical/vocational nurse.
  8. The first Nurse Practitioner program was created in 1965 at the University of Colorado by Dr. Loretta Ford and Dr. Henry Silver.
  9. In 2013, the U.S. Census Bureau listed unemployment rates among nurse practitioners at less than 0.8 percent nationally.

Claire Duquette, a longtime area resident and freelance writer, is also a patient of Jan Penn. Claire says, “I have been looking at that ‘Women Hold Up Half the Sky’ button in the exam room for years, and I bet a lot of other women have, too!”