R e t u r n   t o   t a b l e   o f   c o n t e n t s

A public health nurse at heart, Barger has a distinguished track record in setting up health care clinics run by nurses and developing models of faculty practice in schools of nursing.

 

Sara has been a pioneer in establishing nursing centers in several southern states. These centers not only provide patient care but also give faculty an opportunity to practice—to keep their skills current and maintain job satisfaction.

—Annette Frauman,
associate professor of nursing at Emory

Sara was very intelligent, very
hard-working,and never hesitated to speak her mind. She knew where she wanted to go. She was a challenge but an exciting one, even when you locked horns.

—Mary Hall 49N, 62MN, 83PhD,
Emory professor emerita of nursing

Everyone in the town is thrilled to have us there, including the mayor and the city council. The nurse practitioner who runs the clinic grew up there. That makes an incredible difference to people in the community because they know and trust her.

—Sara Barger, 73MN,
who oversees the Capstone Rural
Health Center in Parrish, Alabama

 


Ever since high school, Emory Medal winner Sara Barger has shunned tradition to do what she loves best—providing health care for people in rural areas.

by Pam Auchmutey

June 4, 2001, was a day of renewed hope and celebration in Parrish, Alabama. After more than a year without a primary care facility, residents of the small Walker County town had a local health clinic once again. As those associated with running the clinic will quickly tell you, business has been steady ever since.

“We’re seeing between 15 and 20 patients a day,” reports Jeri Dunkin, program director for the Capstone Rural Health Center and a professor of nursing at the University of Alabama (UA) in Tuscaloosa some 55 miles away.

In a short time, the health center has become a trusted resource for folks in Parrish and beyond. Like much of the state, Walker County is made up of rambling farms and tiny communities, miles away from the nearest physician or hospital. When residents there get sick, they often depend on Medicaid or Medicare, while many others are uninsured. For those reasons, people put off going to the Capstone Rural Health Center until they are quite ill.

Caring for those patients requires a lot of quick thinking and resourcefulness, according to Kathleen Williams-Thomas, the family nurse practitioner who operates the center. To handle the caseload, she relies on a licensed practical nurse, an office manager, and eager students from the Capstone College of Nursing at UA’s Tuscaloosa campus. Seeing patients in a rural setting like Parrish can be quite an eye-opener for student nurses as they jump in to assess patients, draw blood, and help with whatever else needs to
be done.

“It’s a worthwhile experience, but it can really be hard for students,” says Williams-Thomas. “Our patients have no routine health care. When they come in, they’re falling apart. The challenge is to educate them and find creative ways to care for them when they don’t have the money to pay for medications or risk losing their jobs if they take time off to come and see us. We don’t have a social worker, so we have to use every resource in the community. It helps students to see these patients and what they’re going through.”

That’s exactly what Sara E. Barger, 73MN, had in mind for students when she became dean of Capstone College of Nursing in 1995. A public health nurse at heart, Barger has a distinguished track record in setting up health care clinics run by nurses and developing models of faculty practice in schools of nursing. And she continues to serve Emory as an adviser to nursing faculty and students involved in statewide public health efforts and local community service projects.

“She is one of the most valued leaders in nursing today,” says Annette Frauman, associate professor of nursing at Emory, who has worked with Barger over the years. “Sara has been a pioneer in establishing nursing centers in several southern states. These centers not only provide patient care but also give faculty an opportunity to practice—to keep their skills current and maintain job satisfaction.”

Last fall, Emory recognized Barger’s contributions to her profession and alma mater with an Emory Medal, the highest award given to university alumni. She is the seventh alumna from the School of Nursing to receive the honor—a distinction that Barger ponders to this day.

“I’ve always done what excited me, but I’m still not sure that’s the best way to build a career,” explains Barger good-naturedly. “I never intended to end up in nursing education. My mother and sister won’t let me forget that!”

Breaking the mold early
Barger is referring to her childhood on a farm in southern Maryland, where the women in her family traditionally became teachers. She broke that mold in high school by joining the Future Nurses Club and working summers as a nurse’s aid at the local hospital, where her supervisor was a graduate of Emory’s nursing school.

“I was so impressed by her,” says Barger, who to this day cannot recall the nurse’s name. “She knew so much, yet she was very caring with patients. And she was very kind to me. She had the most unusual cap, and she looked great in her uniform. Those things really impress you when you’re 15 years old.”

Another chance encounter through the Future Nurses Club fueled Barger’s admiration for nurses and her determination. “After I went out with a public health nurse for the day, I was totally sold on becoming a public health nurse. The opportunity to see what she did made a real impression on me,” says Barger. “Those of us who practice nursing tend to forget how important that can be.”

With her goal clearly in mind, Barger enrolled in nursing school at the University of Maryland and tried hard to follow the traditional route of becoming a medical-surgical nurse after graduation. She chose instead to begin her career as a public health nurse in Prince Georges County, Maryland. Barger was assigned to a large rural tract where she practiced home health care, provided mental health care services to the community, rotated among five different schools, and counseled families about their health and well-being through well-baby clinics and the like.

“I loved the diversity,” she recalls. “I would never make a good assembly-line person.”

Barger served five years as a public health nurse and nursing supervisor in Maryland and Virginia before moving with her husband to Atlanta. She enrolled in the master’s program at Emory’s School of Nursing and soon made herself known.

Governor George Busbee presented Sara Barger with her certificate in public management in 1978. At the time, she was based in Athens, Georgia, with the state’s Department of Human Resources.

“Sara was very intelligent, very hard-working, and never hesitated to speak her mind,” says Mary Hall 49N, 62MN, 83PhD, now professor emerita of nursing. “She knew where she wanted to go.She was a challenge but an exciting one, even when you locked horns.”

During one of her graduate classes, Barger heard a visiting nurse practitioner describe setting up and running a primary care clinic in northeast Georgia. “There was no physician or community clinic in the area—she was it,” says Barger. “I was excited about what she did because it was so important.”

Ironically, after completing her master’s degree, Barger joined the Georgia Department of Human Resources and began to establish primary care clinics in the very same health district. She secured the federal funding, found space for the clinics, had them spruced up, hired the nurse practitioner to run them, set up the record-keeping system, and reported back to the federal government on their progress.

Intent on strengthening her administrative skills, Barger became a certified public manager with the state and eventually completed a doctorate in public administration at the University of Georgia as she continued to operate nurse-managed clinics outside of Athens, Georgia.

Coming in through the back door
She never imagined doing anything else, even when a colleague called from South Carolina to ask Barger if she would consider a teaching post in the nursing college at Clemson. Of course Barger said no. But then the caller talked up another position that involved running a clinic. “That caught my interest,” says Barger. “That’s how I got into nursing education—through the back door.”

She arrived at Clemson College of Nursing in the early 1980s as coordinator of its Nursing Center and a spanky brand new assistant professor. She subsequently rose through the ranks to become the department head for professional services and a full-fledged nursing professor. The move to Clemson afforded her the luxury of implementing projects and programs free of mandates set by state or federal law. “Suddenly, I could do anything I wanted,” Barger says. “It was up to me to figure out what to do and how to pay for it.”

Understandably, she bumped into some brick walls along the way, which ultimately deepened her appreciation for mentors like the late Mary Lohr, then dean of nursing at Clemson.

“Before I moved to South Carolina, I had worked in public health for 17 years and knew how to set up clinics, but I had no experience in nursing education,” says Lohr’s protégée. “She took it upon herself to position me. She made sure that I got on the right committees and met the right people on campus and around the country.”

Eight years later, Lohr’s patient mentoring, coupled with her own drive, led Barger to take on a new role as professor and chair of the nursing school at Northern Illinois University. Once there, she received a federal grant to set up a rural health clinic at a local community college to serve students, their families, and nearby residents, including Latino migrant workers. Yet, with all the leadership and organizational skills she had to offer, Barger realized that running a clinic and running a nursing school were two different animals. She often sought the counsel of Billie Brown, the retired nursing dean of the University of Texas at Austin who had recruited her to Northern Illinois.

Brown offered some sage advice. Choose your battles carefully and decide what hill you want to die on. Consider whether your decision will make or break the quality of your program. Find a way to make a decision you’re comfortable with that will propel the school forward.

“Those were valuable lessons for me to learn,” says Barger. “One of the things I’m proudest of is having spent half of my career in practice. That has made me broader as a dean than if I had spent my entire career in education. I love partnering with people. I love interdisciplinary projects. The result is much better than what any of us can pull off by ourselves. The seeds of that are in public health nursing. The nurse heads the team that brings different resources to the table to help a patient who has a particular set of needs.”

By the time Barger arrived at Northern Illinois, she had lived in the warm Deep South for nearly 20 years—a fact made more apparent after Barger and her husband experienced the harshness of Midwestern winters. An opportunity to return south arose four years later, when the dean of UA’s Capstone College of Nursing retired. There was an added attraction. During Barger’s interview at Capstone, she met Dr. Sandral Hewlett, the director of a large primary care clinic system, and saw the possibilities unfold. “I began to think of all the partnerships we could form to expand health care services in the area,” Barger says.

Kathleen Williams-Thomas (left) and Jeri Dunkin help provide much-needed primary care services and valuable learning experiences for nursing students at the Capstone Rural Health Center in Parrish, Alabama.

The Capstone Rural Health Clinic in Walker County is the result. When plans to partner with the primary care clinic system fell through last spring, Barger encouraged Dunkin and Williams-Thomas to look for an alternate site, which they found in Parrish. The three-room house, just shy of 1,000 square feet, had stood vacant since the previous clinic closed 17 months earlier.Townspeople pitched in to repair the storm-damaged roof, while prisoners from the county jail painted the 1950s structure. When the toilet backs up or something else goes awry, health center staff call on the town’s mayor, who doubles as the clinic’s janitor. The health center also has a community advisory board comprised of laypersons and professionals.

“Everyone in the town is thrilled to have us there, including the mayor and the city council,” says Barger. “The nurse practitioner who runs the clinic grew up there. That makes an incredible difference to people in the community because they know and trust her.”

Williams-Thomas has quite a loyal following, with some patients driving 60 miles to see her. She travels a good many miles on her own—often with nursing and other students in tow—to visit homebound patients, schools, and group homes for mentally ill and mentally retarded citizens.

Things at Capstone Rural Health Center are about to change. A second nurse practitioner is being hired to help run the clinic and expand its services to cover five counties served by the Northwest Alabama Mental Health Authority. That means more site visits for Williams-Thomas and more hands-on experience for Capstone students, UA medical scholars, and Auburn pharmacy students.

Back on campus in Tuscaloosa, Capstone students follow a new curriculum focusing on the primary, secondary, and tertiary levels of prevention instead of a traditional one emphasizing courses such as medical-surgical and psychiatric nursing. At first, Capstone based its new curriculum on a purist model of prevention across the lifespan. But that proved too difficult for nursing undergraduates.

“Some pieces just didn’t work,” says Barger. “Students at the undergraduate level can’t think as broadly at that point in their nursing education. We’re still using the primary, secondary, and tertiary prevention model, but we’ve broken it down for certain population age groups instead of looking across the lifespan.”

Mary Hall, professor emerita of nursing, was there for her former student when Sara Barger received the Emory Medal during Alumni Weekend 01.

Further changes are in store for Capstone. After attending the Emory Medal award ceremony last fall, Barger toured Emory’s new School of Nursing building to glean ideas for a new college of nursing building at UA. “This university (UA) is 155 years old, and there has never been a building on campus designed to educate nursing students,” says Barger. “Nursing students have special needs, and the facility for educating them needs to reflect that.”

A new building, a prevention-based curriculum, and a diverse clinic experience in Parrish will go a long way toward attracting the type of nursing students that Barger wants to reach. Capstone has also introduced a graduate program on case management for rural populations, the only offering of its kind in the state.

“Our niche is rural—there’s no question about that,” Barger emphasizes. “We’ve had four hospitals in the surrounding area close in the past two years, and they’re not going to reopen again. So there is a real need for someone to work in those areas with client groups who may have a particular condition, such as diabetes, or special population groups, such as pregnant women, to determine what services they need and where they can find them.”

“We want to recruit nurses from those areas into our program,” she adds. “Our data tell us they are going to stay in those areas because that’s where their families are.”

Barger’s efforts to advance nursing education and practice have not gone unnoticed, even before she received the Emory Medal. She has been honored by the Alabama State Nurses’ Association for outstanding nursing administration. In 1988, the South Carolina legislature passed a resolution recognizing her achievements in nursing, and the American Nurses Association awarded her the Honorary Nursing Practice Award. She also received awards for nursing excellence from the Illinois Nurses Association and the Alabama League for Nursing. Currently, she holds a prestigious Robert Wood Johnson Executive Nurse Fellowship.

“I want to learn more about how to get things done through people,” says Barger of her latest opportunity. “I’m not always good at that. I can be much too driven at times than is good for me or the people I’m trying to lead.”

That drive has been propelling her forward since the day a willful young farm girl decided to break with family tradition and become a public health nurse.

“I tell nursing students to follow their passion,” says Barger. “The wonderful thing about our profession is there are different avenues to take. You have many experiences as a nursing student, some of them more appealing than others. Set aside what you’re supposed to do and follow what you love doing. You’ll never regret it.”

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