Navigating Barriers to Care for Vulnerable Patients (Podcast)

Insight on caring for patients who lack adequate insurance, a social support system or financial stability


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Nurses focus on providing the best possible care for patients, but should caregivers also consider how lack of adequate insurance, social support or other barriers affect patients? Kris Adams, MSN, CNP, associate chief nursing officer for care management and ambulatory nursing at Cleveland Clinic, asserts that they should.

“I look at the struggles our patients have even on a good day. How do we help them navigate this – the complexity, first of all, of healthcare, plus you layer in all the social determinants of health,” says Adams. “There’s a really good reason why we’re not in a good place in healthcare in this country.”

After becoming a nurse practitioner, Adams worked in a free medical clinic, where she developed a passion for helping the most vulnerable patients. She shares insight gained in this role, and as a nurse leader in care management, in a recent episode of Cleveland Clinic’s Nurse Essentials podcast. She discusses:

  • The impact insurance status has on a patient’s financial and emotional wellbeing
  • Why nurses need to understand their patients’ social determinants of health
  • Conversations with patients to ensure they have the necessary support and resources after discharge
  • The role EMR documentation plays in determining what insurance companies will cover
  • The importance of using the Schmitt-Thompson nurse triage guidelines in ambulatory care

Click the podcast player above to listen to the episode now, or read on for a short edited excerpt. Check out more Nurse Essential episodes at or wherever you get your podcasts.

Podcast excerpt

Podcast host Carol Pehotsky, DNP, RN, NEA-BC: What should I be thinking about from my nursing perspective to really identify some of those hurdles you talked about? So I’m really making sure that I’m treating the whole person and not their chief complaint or their reason for admission?


Adams: That’s a good question. So, there’s been a lot of focus on the social determinants of health, and as we look toward 2024, CMS is really asking us to assess that in our patients. The issue is how are we going to act on whatever answer we get? That’s going to be our challenge.

But as nurses, we can come at this with the philosophy that food is medicine, housing is medicine, transportation is access. All of these things start to frame up in our head as to what – beyond just my teaching about the biological issue that’s at hand or the medications at hand or the follow-up that has been planned in the care plan – what other things do I need to look at globally to make sure that they can even deliver on this?

Going back to my free clinic days, it was always so hard for me – especially with a diabetic – to impress upon them the need to not ration their insulin. But they’re looking at me saying, “I can’t pay the rent this month. I don’t have food.” I mean, these were really real issues, and they’re issues that we face today.

Even, you know, back in 2010 when I started in the free clinic and we were going through, at that time, the throes of Obamacare – you know, the Affordable Care Act. It was a step in the right direction. And it was actually completed. The ACA was completed in 2014. But we need to go further. It’s time to look at this from a healthy perspective and how we’re going to move patients to stay well. Because that is going to be how we at least address some of these issues going forward.


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