Entering DNP student focuses on populations to affect health policy

Laurel Machiele

Most doctor of nursing practice (DNP) students have spent some time working as RNs before they return to school for a terminal degree. Laurel Machiele is instead entering the DNP program fresh from graduating with her bachelor’s of science in nursing from Calvin College this past spring.

“I didn’t think I wanted to be in school forever, but I really like learning,” she laughs.

Serving as an advocate

Machiele struggled in deciding between going into the workforce as an RN or continuing for more school, but ultimately decided that the DNP would allow her to better focus on advocacy for health policy, health promotion, and disease prevention.

“I hope that someday we can have more just systems in the U.S. so that everyone can have access to health care and healthy lifestyles,” she said.

Her interest in policy comes from her understanding of how laws can create broad scale change. She cites the example of air quality controls that decreased asthma rates across the entire country.

Overlooked obstacles to health

As an undergraduate, Machiele participated in a research project to assess the perceptions of obesity and exercise in neighborhoods adjacent to Calvin College. She helped to facilitate focus group discussions in four lower-income neighborhoods, one predominantly Hispanic, one predominantly African-American, one multi-racial, and one mostly comprised of homeless residents.

From residents, she heard about obstacles to exercise that she had not imagined or read about in the scientific literature.

“It was eye-opening to see the needs that people are facing, and the issues that I never even imagined. Some of the African-American men said they didn’t feel comfortable running, because if someone saw them, even if they were just running for exercise, the police might question them or the neighbors might not feel safe,” Machiele said.

A runner herself, Machiele competed in the 1500 meter run on the Calvin College track team in her senior year.

“Being a white female, this just didn’t occur to me until they talked about it,” she said.

“Systemic obstacles to health go beyond not having access to healthy foods and not having grocery stores in the area.”

Serving the underserved

Understanding these systemic obstacles and addressing them through policy is how Machiele hopes to take on an advocacy role in the future. Advocacy for underserved populations is part of her experience of faith.

A lifelong member of the Christian Reformed Church, it was on a physician-led mission trip in high school that Machiele saw firsthand how medical training could be a part of one’s faith work.

“I think we all have our ways that we can serve people around us, and the gift that I have is to be a nurse. As a nurse practitioner, I hope to be able to focus on upstream prevention, to prevent pain from happening. For me, this is the way I live out my faith,” she explained.

Occupational health to address population groups

As she enters the family nurse practitioner program in the DNP, Machiele will also complete a concentration in occupational health nursing. The occupational health nursing concentration trains nurse practitioners to provide health and safety programs for workers, worker populations, and community groups.

Directed by UMSN Professor Marjorie McCullagh, Ph.D., RN, APHN-BC, COHN-S, FAAOHN, FAAN, the occupational health nursing program is offered in collaboration with the University of Michigan Center for Occupational Health and Safety Engineering.

Occupational health nursing will allow Machiele to work at the level of community or population. This is important to her because she sees community spaces as the way to create lasting change.

“Much of the literature I have found shows that the best way to focus on health promotion and disease prevention is in a community setting, because that is where culture is changed. I believe there does need to be a cultural shift, overall, to value health,” Machiele said.