By Bernadette Gillis

Nancy Payne, RN, MSN, doesn’t have an office. In fact, she often has to search to find a discreet space for delicate conversations with patients -- whether that means meeting in a corner near the cafeteria or in a hallway. But Payne, a 2007 graduate of the Duke University School of Nursing, says the meeting locations don't matter, just as long as she's able to fill the needs of an underserved group of patients: Amputees.

People can lose their limbs for myriad reasons. Some experience traumatic events, such as car accidents, while others become amputees due to cancer or vascular disease. The largest number of adult patients lose limbs because of diabetes.

Just as the reasons for limb loss are varied, so are the departments where each patient originates. Patients can come from oncology, cardiology, endocrinology, the emergency department, or orthopaedic, vascular, and plastic surgery. There is no such thing as an "amputee department," so as Duke University Hospital's only limb-loss clinical nurse specialist, Payne makes it her mission to find and educate as many of the hospital's amputees and candidates for amputations as possible.

"The first thing I tell them is that I'm sorry we have to have this conversation, but they're not expected to go through this alone," she says. "I tell them about surgery, recovery, and prosthetics. I'm there from wound healing all the way to prosthetic healing."

Being there for patients throughout this entire process means Payne often spends her day zipping across campus, working with colleagues from all over Duke. She collaborates with providers in the Duke Center for Vascular Diseases, the Wound Management Center, and the Center for Orthotic and Prosthetic Care. She recently partnered with Paul Tawney, MD, a Duke physiatrist at the North Carolina Orthopaedic Clinic in Durham, to set up a special clinic twice a month for limb-loss patients to receive care and advice.

Payne says her role as a patient educator is key, considering that information is sometimes hard for amputees to come by. "The education piece makes their outcomes better," says Payne. "Recovery is better, satisfaction goes up, pain and suffering is less."

She's there even if a patient and provider decide that amputation is not the best option. Such patients still need help coping with pain or mobility.

Payne also takes time to educate nurses, physicians, and other providers about caring for amputees. Though surgeons may have nurse educators on hand, Payne says many nurses have never worked with amputees. She helps by distributing Amputee Coalition of America (ACA) publications and other resources.

Aside from educating patients about their clinical care, Payne does her best to help them find support and mental health resources. She says many patients grieve the loss of their limbs, and some struggle with feelings of low self-worth. Others question their ability to be as active as they once were.

In addition to her clinical duty, Payne serves on the Medical Advisory Committee of the ACA. She recalls attending an ACA meeting one year and seeing amputees relaxing around the pool. She was moved by the sight of prosthetic limbs scattered about.

"The people sat around a swimming pool for the first time [since their amputations]," she says. "They had feared going into public swimming pools before."

On the second Tuesday of each month, Payne leads a support group for adult amputees and their families. She also helps coordinate and volunteers at special sports events for child amputees.

"When these children go to school, they may be the only amputees in the school," she says. "Having these youth events helps children see that they can do just about anything they want."

Payne attended Emory University School of Nursing to become a certified wound-care and foot/nail care nurse. The certification helps her better educate physicians and nurses about their options concerning wound care for the amputee population.

In February 2010 Payne went to Haiti with the first Duke Medical Task Force to help earthquake victims in Cange. "I hope to have another chance in the future to return and see the recovery efforts," says Payne.

She and her husband Alan, a researcher at Duke, have two children: Nathan and Erin.