Jennifer Etkin (left) and Nancy Warden lead Vascular Wellness.
mehmet demirci
About this project: The 52-week project showcases accomplishments, challenges and opportunities of individuals and businesses run by people of color, women, immigrants, veterans, representatives from the LGBTQ+ community and a few other groups forwarding the mission of diversity, equity and inclusion in the greater Raleigh-Durham metro area. The project also will delve into important trends and issues relating to DEI.
Access to health care should be available to everyone, regardless of their socioeconomic standing or where they live. That philosophy has been a guiding principal for Jennifer Etkin and Nancy Warden, co-owners of Vascular Wellness, a mobile health care provider that sends nurses who are highly skilled in vascular access to hospitals, long-term care facilities and patient homes throughout North Carolina and the surrounding region.
Both native North Carolinians, Etkin and Warden are mindful of the need for providing equitable health care largely because of their family histories.
“My family is Jewish and my mother’s family fled Poland in 1929 to escape the Holocaust,” Etkin says. “Most of the family died in the concentration camps, something my grandfather never recovered from, but he rebuilt a life in Argentina when they were not able to gain entry to the United States. My mother was born there, and, by 1951, they had saved enough money to move to Pennsylvania.”
Even in America they faced tough times, living, as Etkin describes, “on the wrong side of the tracks” and for the second time rebuilding their lives in a new country, with no one in the family who spoke English.
Warden grew up in rural west-central North Carolina, in the rolling hills of Yadkin County, where her family has a centuries-old farm that has been in her family “since before North Carolina was a state.” 
“We operate our business on a remote platform so we have folks all over North Carolina and in Virginia and South Carolina. I live on our family farm in Yadkin County so I’m about two hours from the office in Cary,” says Warden, who believes strongly in the value of providing access to quality health care in rural areas as well as cities.
Advanced vascular access became an even more critical service during the pandemic, when nursing professionals were in short supply, hospitals were unable to provide as many services and, increasingly, people received treatment outside of a medical center, in many instances in their own homes.
The Centers for Medicare and Medicaid Services (CMS) set the stage for increased flexibility in the delivery of health care in March 2020 with the Hospitals Without Walls program, which allowed hospitals to provide services in other locations. And in November 2020, CMS broadened the regulatory flexibility to include acute hospital care in patients’ homes.
“The fact that our clinicians go to patients extends the reach of health care to rural areas and wherever patients are – they could be in a prison or other facility. We’re able to bring medical care to patients who may have transportation challenges or aren’t near a medical center,” Etkin says. “We all have our own struggles; it is critically important that we don’t make judgments because we don’t know what the circumstances are for each of us. We have to show compassion and treat everybody equally.”
In 2019, Etkin and her husband, Alan, along with Warden, acquired Vascular Wellness from a group of health care providers who had started the company in 2008 to serve a need they saw in the market, primarily from their work in the areas of interventional radiology. The need, and the opportunity for growth, was even stronger when the new owners took over. By January 2020, the transformation to more advanced vascular care was well underway.
At the end of 2021, services performed had increased 18 percent year-over-year and revenue was up 21 percent. The cost of services had also risen sharply, up 38 percent, but interest in growing the company remains high. Vascular Wellness’ services are performed on individual patients, but the company’s customers are other businesses – hospitals, long-term care facilities, pharmacies fulfilling prescription services, and other facilities providing medical services. 
The majority, roughly two-thirds, of Vascular Wellness’ business stems from hospital contracts, but skilled long-term care facilities and nursing homes are also a large part of the company’s business. And there continues to be interest for in-home care.
“We get inquiries frequently from other regions, including New England and the Midwest,” Warden says. “It goes back to hospitals struggling with health care staffing, so we look at expansion closely. Kentucky, Ohio and western Tennessee are the territories we’ll go into next.”
While hospitals have internal vascular teams to handle PICC (peripherally inserted central catheter) lines, during Covid and with the labor shortages that have ensued, those nurses were pulled into other areas, which left the vascular department in many hospitals operating at a deficit.
The demand for vascular access was unlike anything she’d ever seen. “Many patients had to be on ECMO (extracorporeal membrane oxygenation) machines, which oxygenate the blood and give the heart and lungs time to heal. Our central lines were more important than ever because, next to the breathing tube, the most important thing these patients had to have was reliable vascular access.”
As knowledge about treating Covid advanced, hospitals determined that many patients were able to breathe better if they were laying on their stomach.
When a patient is prone like that access to body parts is more limited, so having a clinician who was more experienced at putting lines into other areas of the body became very important.
“If you turn a patient over onto their back, it could send them into a code situation, so we had to figure out how to get vascular access when we couldn’t get to the underside of their arms. … We made it work,” Warden says.
Vascular Wellness also took care of Covid patients who needed to receive monoclonal antibodies through clinics they set up in hospitals to provide the therapy. 
The business has faced the same challenges that others in health care have grappled with and they continue to deal with supply chain constraints, particularly where Personal Protective Equipment is concerned, and recruiting talent. They’ve found recent nursing school grads are among their best recruits, largely because all of their staff require considerable training to reach the company’s standard of a 100 percent success rate – vascular access achieved with the first stick. Only about one percent of nurses have the skills and training to perform the ultrasound and vascular access procedures that Vascular Wellness provides.
A history of playing video games can work to an applicant’s advantage since the procedures entail making movements with your hand while looking at an ultrasound monitor. At least 20 percent of their clinicians are male.
Now their mobile workforce, who typically drive 25,000 to 30,000 miles per year, are coping with the rising costs of fuel. The company has structured its deployment to cluster visits and send the team member who is in closest proximity to each job.
“Hospitals have seen increased value in [utilizing] our business model, and we get inquiries from other organizations asking us to teach their staff proper procedures for [advanced] vascular access and to help them reduce infection rates,” Etkin says.
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