Nurse Manager, VA Central Western Massachusetts Healthcare System
Her Work Caring for Veterans Is Grounded in a Sense of Mission
After a decade and a half in the nursing profession, Julie Lefer Quick was looking for a change, and found one at the Veterans Administration’s (VA) outpatient clinic in Springfield.
She also found a level of passion and mission-driven commitment she hadn’t experienced before.
“I can honestly say that I’ve never seen nurses more dedicated to their population; I feel the dedication,” she said. And so do the patients. “Last week, a nurse forwarded me an email that she received from one of her veterans’ caregivers about what great care she took of that veteran, just going above and beyond. And she said, ‘I love my job.’
“Every one of the nurses who works with the VA goes above and beyond every single day,” Lefer Quick added. “And it’s really wonderful to be a part of that, serving such a deserving population.”
She started at the VA in July 2018 as a primary-care nurse. Before that, she worked for a pediatrician in solo practice, including as practice manager, for two and a half years, followed by more than 11 years in the Springfield Public Schools.
“When my son went off to college, I thought, ‘now is a great time to try something new, get back into primary care.’ So that’s when I got the job at the VA.”
When they hear mention of the VA Central Western Massachusetts Healthcare System, most people think of the hospital in Leeds, which houses services ranging from inpatient psychiatric mental-health and substance-misuse treatment to primary care; from rehabilitation to specialties like orthopedics, radiology, cardiology, and many others.
“Every one of the nurses who works with the VA goes above and beyond every single day. And it’s really wonderful to be a part of that, serving such a deserving population.”
“And we also have five community-based outpatient clinics, where we primarily do primary care and then, depending on the clinic, some specialties to support the veterans,” she explained, noting that these are located in Springfield, Fitchburg, Greenfield, Pittsfield, and Worcester. “In Springfield, we have a very large mental-health department, and we also have a small lab, physical therapy, a registered dietitian, a clinical pharmacy, and what’s called home-based primary care.”
As it happens, Lefer Quick loves primary care, and missed that during her years working in the schools. “I had missed the ongoing, deep relationships with patients and their families.”
So, with her son graduating from the school system, she craved a return to care in a medical-office setting, and happened to meet some VA nurses at a Learn to Row event through the Pioneer Valley Riverfront Club in Springfield, where her husband, Ben Quick, is executive director.
“They were like, ‘oh you should come work at the VA,’” she recalled. So she did — and, not surprisingly, she loved the work. Which is why she was hesitant to take the position of nurse manager when it became available last October.
“I wasn’t really sure I wanted to be a nurse manager. I love taking care of my patients. I love working with my team in the VA,” she said. “Nationwide, we practice a primary-care delivery system called the PACT model, which stands for patient-aligned care team. So there’s one provider, one RN, one LPN, and one admin; it’s sort of like a mini-practice within a group practice.
“We always see the same patients, and I had a great team that I worked with,” she went on. “It’s a good model for the patients; they really love it. So I didn’t want to leave my team or my patients.”
But a mentor encouraged her to try something new, and she accepted the detail.
“As a PACT RN, I was providing direct patient care and education, working with my team to meet population health-management goals, such as certain levels of control for diabetes or hypertension. And now I work for the other PACT nurses, supporting them in their practice.”
As nurse manager for two clinics — Springfield and Greenfield — she currently supervises 23 LPNs and RNs, with about three more to be hired soon. And she quickly found she could apply her passion for care in this overseeing role.
“In the VA, we have a unique understanding of the military culture that other providers in the community don’t necessarily have,” she said. “It’s a very sad truth that a lot of our veterans have emotional issues when they come back, but we are on the cutting edge of all types of mental-health treatment modalities and therapeutic options, and we also have the support of Congress — it’s a single-payer system, and we don’t have to be bogged down by some of the stuff that community providers have to deal with. So we, as nurses and providers, can really focus on our veterans and come up with innovative ways to care for them.”
A Passion for Patients
A quick look at the typically full parking lot at the VA’s Springfield CBOC, which stands for community-based outpatient clinic, testifies to the need for the services it provides, from laboratory and pharmacy to primary care and behavioral health.
“From what I have learned as the spouse of a VA nurse manager, it seems that, while most of these workers could get paid more elsewhere, they stay with the VA because they are passionate about caring for our veterans, and they are energetic about supporting each other in this difficult, important work,” Ben Quick wrote in nominating his wife for the Healthcare Hero recognition.
Yet, nursing wasn’t her first career. After graduating from college, she worked briefly in human resources, found she didn’t like that career, and went back to school for a nursing degree.
“Coming out of nursing school a little bit older than the typical students, I kind of took the first job that I could get,” she recalled. “I had a small child, so I didn’t want to work hospital hours, even though I loved the idea of being in the hospital, so I went to work for a pediatrician.”
Which surprised her, considering that her nursing-school rotations caring for youngsters tended to make her cry because she didn’t want to see them hurt or sick.
“I think there’s more of an awareness of mental-health needs in general in healthcare right now. And certainly, veterans who have seen combat are going to need support afterward. So that’s part of our mission.”
But as a pediatric nurse, “I loved seeing the kids grow over the years, seeing new babies born into families, working with parents on all kinds of different diagnoses to help their kids,” she recalled, and her next move was born of wanting to keep caring for children. “Working in the public schools was a way to be available for my son while also reaching a big population of kids. And I loved it.”
So Lefer Quick felt torn about leaving pediatric care for the VA.
“I remember leaving the public-school job for this, and I was very, very excited, but I had this moment of, ‘oh my gosh, am I doing the right thing?’ I said to one of my friends, ‘but I love my kids so much here.’ And she said, ‘you’ll find new patients in a while.’ And I did.”
In doing so, she’s taken to heart Abraham Lincoln’s famous quote that the VA — established 65 years after he uttered it — has adopted as a sort of mission: “to care for him who shall have borne the battle and for his widow, and his orphan.”
“One of the things that almost kept me from accepting the detail to nurse manager was all my patients,” she said, but she understands that all her roles have been supportive in some way: “supporting kids and their families, supporting students at school to be optimally healthy and ready to learn, supporting our veterans, and now supporting the nurses who provide that care to veterans.”
Some of that care is behavioral and substance-related. “We recognize the need for that integrated care for our veterans. I think there’s more of an awareness of mental-health needs in general in healthcare right now,” she noted. “And certainly, veterans who have seen combat are going to need support afterward. So that’s part of our mission.”
She said the VA has felt the strain of a nationwide nursing shortage as much as any other facility, but added that the nurses who take jobs there value the mission President Lincoln put forward — and many are veterans themselves, or come from a strong military family, or are drawn for some other reason to caring for a veteran population.
“That was how I talked myself into the manager position. I thought, ‘well, if I can be a manager with my background, already doing this job, I can support these nurses, which ultimately provides better care for the veterans.’ So I’m not just doing it for my team; I’m helping every single team.”
The COVID pandemic posed challenges across the spectrum of healthcare, but Lefer Quick said the VA was uncommonly prepared for it, as it had already implemented a remote monitoring platform called VA Video Connect, so VA facilities were able to pivot to virtual appointments more quickly than other organizations.
For instance, before the pandemic, “I had a patient who needed monthly monitoring for medication he was on, and he liked to travel. So we would do video visits, and we would have a set appointment to do the follow-up for his medication, wherever he was. So we already all knew how to use this,” she recalled.
And when COVID struck, “we very quickly pivoted to using video for several months, almost exclusively. A lot of our patients did not want to come to the clinic. Nobody wanted to go anywhere. And we already had this in place.”
Their concerns were warranted, as the pandemic hit the elderly population hard in the earliest days of the pandemic. “As you can imagine, a large percentage of the VA population is elderly. I had a father-son set of patients — and the son was 74. So a lot of them, being elderly and therefore immunocompromised, were scared, but the VA already had this amazing video platform, and we had already trained everybody how to use it.”
Meanwhile, “the nurses that I worked with were coming up with great ways to rotate the staff through the clinic so that we could spread out more to allow for that social distancing and masking in a more comfortable way,” Lefer Quick explained. “And we took on new providers and new nurses, even during the pandemic. We didn’t slow down much.”
In his nomination, Ben Quick boiled his pitch down to three thoughts: the VA’s quality of care is second to none, downtown Springfield has a busy medical practice devoted to healing America’s heroes, and the workers there are humble, passionate, professional patriots. “That’s a Healthcare Hero story that everyone needs to hear,” he wrote.
And now they will.
“The VA is the best employer I’ve ever had in my entire life,” Lefer Quick said. “They value creativity and innovation, and they support us to explore that.
“We really are on the cutting edge,” she added. “The people I work with are doing amazing things and love to be there. No matter where they are, in Springfield or any other part of this country, if someone is eligible for VA care, they really ought to look into it.” n