How can you make the mousetrap car travel a longer distance? What are the five themes of geography for your favorite movie? At Derryfield, the teachers taught us to look beyond what is right in front of us by asking the questions to gain a deeper understanding. Now I spend the majority of my day asking the questions, sometimes to the dismay of my teenage patients. I think it is the most important part of my job as a Nurse Practitioner (NP) because that additional information helps me to individualize plans and optimize health outcomes for my patients.
My interest in medicine started in Ms. Keefe- Hancock’s ninthgrade biology class, and strengthened as I studied Cellular Neuroscience at Colgate University. At Colgate’s health care conference, I learned more about the NP profession. What sparked my interest was the ability to work and build relationships with patients after completing a two-year Master’s program, having my own patient panel, and focusing on holistic care and patient education. That is why I am still very happy with my decision to become a Pediatric Nurse Practitioner.
I graduated with my Master’s degree in Nursing from Boston College in 2013 and since then, I have worked as a Pediatric NP at Child Health Services at Manchester Community Health Center. CHS was founded by Dr. Selma Deitch, who was also one of the founders of The Derryfield School. Our clinic site provides care to over 3,000 children. Almost half of the families are refugee or immigrant families. While many families are thriving, many also struggle with psycho-social issues.
Research has shown that childhood experiences and their environment can affect brain development and health outcomes. Toxic stress, such as poverty, bullying, socioeconomic disparities, exposure to violence, parental untreated mental health or substance abuse, can increase the risk of behavior problems and chronic diseases. Protective factors, including positive relationships with adults, a safe environment, social-emotional and coping skills, can reduce the effects of toxic stress to optimize development. Dr. Deitch’s unique design of the CHS model encourages a team approach. I work closely with our Pediatrician, Dr. Lisa DiBrigida, and the team of family support workers, behavioral health consultants, nutritionists, nurses, and our child development program to reduce toxic stress and promote protective factors.
There is no typical workday at our clinic. Usually I see 18 to 24 patients in a day. I diagnose and treat acute illnesses, manage chronic illnesses, and complete well child exams. For each patient there is a different story and plan. A visit for an ear infection is never just prescribing an antibiotic. It is routine to ask about psycho-social health at each visit and to coordinate introductions with the rest of the team as needed. The family support worker will meet with a family who is homeless or help set up robotics camp for a ten-year-old who loves science. The behavioral health consultant will talk with a mother who is struggling with substance abuse or help a boy who has observed domestic violence. This is all part of our team approach to integrative health care.
The best part of my job is asking the questions— both to find out how we can help the families and to hear their stories. For every story of hardship, there are countless more stories of joy and accomplishments. I love asking my patients “What do you want to be when you grow up?” and watching their faces light up with their answers. During most visits, the children are smiling and playing with toys, and the adolescents humor me by putting down their phones to talk about their accomplishments and goals for after high school. Every day they teach me about resilience. It is a privilege to work with them.
Kristie Migliori ’07
Pediatric Nurse Practioner, Child Health Services at Manchester Community Health Services