Like many nurses, Lori McLeer Maloney came into the profession as a second career. An economist with an MBA to her name, she’d spent a decade in finance and another on the homefront, raising three daughters, before she decided to go back to school for nursing. Making the shift was a challenge, but Maloney said she was motivated to pursue a change because her business career was unfulfilling.
“I didn’t feel like I was making a difference,” she said. “I felt like anybody with the education could have done the job, but I don’t feel like anyone with the education could do a nursing job. What I love about nursing is you can really change people’s lives; it’s very fulfilling.”
Even in her specialty – endocrinology – Maloney believes she’s a part of a field that offers a unique combination of opportunities and responsibilities. In her role at the Clinical Practices of the University of Pennsylvania (CPUP), a component of the University of Pennsylvania Health System (UPHS) in Philadelphia, Pennsylvania, Maloney has a job that’s equal parts patient education and laboratory work. Her patients are battling chronic conditions like diabetes, osteoporosis, neuroendrocrine disorders, hypogonadism, metabolic bone disorders and more.
“When someone can say you helped make my life better, it’s really fulfilling.”
As part of the nurse practitioner program, Maloney participates in clinical evaluations, a primary care rotation, and service in a long-term care facility. Some of the patients she sees are homeless, have been incarcerated, or rely on Medicaid to pay for their health care. When communicating with a broad cross-section of people who have such a variety of health care concerns, Maloney said she has to provide clear education on lifestyle modification that’s accessible to a range of listeners – particularly as a number of the conditions she treats can worsen without behavioral changes.
“I’m hugely into health behavior and prevention,” Maloney said. “In my primary care clinic, I’ll see some patients might have pre-diabetes, and they don’t understand how important it is to stop it where it is. If you’re not making the lifestyle changes to go along with medication, it’s rough. So then I’ll see you in my endocrine practice.”
“These are the patients who are mentally and physically well enough to seek the care of a specialist,” she said. “The ones in my long-term care, the only time they sought care was when they were in inpatient; they’re the ones who wind up with amputations.”
Maloney said neglect of nutrition and exercise regimens is “a nationwide crisis.” She encourages her patients to advocate for themselves both in making long-term lifestyle changes and in choosing practitioners who can tailor treatments to their personalities. The behavioral economics of health care are fascinating to her, and the continuity of care that her practice offers allows Maloney to see patients through various stages of their disease and their requisite challenges.
“I love that I know what’s going on with you, and for the next few months, we’re going to make some changes,” she said. “People have tremendous success when they want to do something. Patients know that they can reach me off-hours.”
Maloney said she’s especially interested in social determinants of health, particularly as they influence individual patient behavior. Food, exercise, and meditation are as much medicine as any pharmaceutical prescription, she said, but finding what works for one patient and customizing that motivational approach can truly make the difference between success and failure.
“I genuinely care that my patients are doing well,” Maloney said. “It’s finding what helps the patients to make the changes, and finding why the changes are in their best interests. Your health is not guaranteed, and it can turn on a dime. It should be the asset that you protect the most.”
Maloney describes how one morbidly obese patient who hadn’t gotten out of bed in three years was finally motivated to do so on a handshake. After six weeks of building a relationship, she worked the woman up to the idea of getting out of bed.
The plan involved switching up the patient’s medication schedule to synchronize its administration with a social coffee hour in the facility. She began a physical therapy routine, started visiting the hair salon with her peers, and started on a path toward a more active lifestyle. Afterward, the woman started to believe she could take care of her health.
“I said you need to get moving again,” Maloney said. “She said, ‘I think I can do it, and I want to shake on it.’ I went back to see her the next week, and she said she wasn’t going to do it. But then she realized that she’d shook on it. And then she got out.”
Maloney plans to continue her nursing education in the coming weeks and months, applying for a doctoral program in either nursing research or nursing practice. She graduated from the University of Pennsylvania NP program this spring, thanks in no small part to the support of her husband, Ferdinand, she said. Maloney will pursue a research-focused terminal degree, as she explores work that will improve health behaviors, and describes herself as an overall advocate for nursing as a career path particularly because of the diversity of options it offers.
“You will always have a busy, varied career,” she said. “You’re never pigeonholed into anything. And you’re helping people all along the way. When someone can say you helped make my life better, it’s really fulfilling. It’s hard work – they’re long days and they’re not easy days – but it’s very, very rewarding.”