When two New Jersey universities merged as a result of a state restructuring, it not only offered academic opportunities but also provided underserved patients in Newark more seamless coordination between nurse-led healthcare services designed to improve the population’s health.
“It gives us more access and services that are available,” said Cindy Sickora, RN, DNP, associate professor at the Rutgers College of Nursing, which recently merged with the University of Medicine and Dentistry of New Jersey. “Nurses play a critical role in the evolving healthcare environment, particularly in population health. If we want to make a difference in health disparities, we need to promote nursing in communities.”
Suzanne Willard, RN, PhD, APNC, FAAN, associate dean for advanced practice and a clinical associate professor at Rutgers, agreed.
“This is the wave of the future,” she said. “Nurses can and should be at the forefront of the changes the Affordable Care Act will bring.”
Changes under way
The New Jersey Medical and Health Sciences Education Restructuring Act resulted in the transfer of nursing at UMDNJ to Rutgers, the State University of New Jersey. That included the schools’ community outreach nursing programs – the Jordan & Harris Community Health Center, a community-empowerment project based at a public housing complex in Newark, and the New Jersey Children’s Health Project mobile clinic. Both work closely with the FOCUS Wellness Center, a patient-centered primary care provider developed and led by Willard.
“We are a center where people can come to improve their health and learn to take more ownership,” Willard said. “It’s a holistic approach to patients.”
Nursing faculty staff the FOCUS center, which treats many patients with diabetes, hypertension and other chronic conditions. The team monitors outcomes related to keeping hemoglobin A1C levels and blood pressures within acceptable range and ensures patients receive the recommended preventive services.
RNs at the Jordan & Harris center check on residents when they return from the hospital, monitor blood pressures, reconcile and manage medications, and educate residents about health issues. Full-time nurse practitioners and faculty members practice on the mobile health van.
The program employs eight community health workers who live in the neighborhoods served. The workers make sure patients have transportation to medical appointments, canvas areas looking for people in need of services and direct them to the nursing care program. The nurses then assess patients and can refer them to the mobile clinic, which travels to multiple sites and to the FOCUS center.
“Having FOCUS is an additional resource for the population I serve,” Sickora said. “They go to FOCUS for different services, for instance, mental health.” FOCUS also sends patients to Sickora’s program for vaccines.
“The mobile van can be a like a bridge for us,” Willard said. “It begins to break down the barrier a bricks-and-mortar building can be for many patients.”
Both programs build and depend on relationships and trust with individuals in the communities they serve.
“They will recognize it if you are not sincere,” Sickora said.
Educating the next generation
In addition to providing needed healthcare services, the programs create opportunities to educate nursing, medical and allied health students. At the mobile clinic, all of the students work together on different projects, promoting an interdisciplinary collaborative practice in terms of education and faculty development, Sickora said.
The FOCUS center uses an interdisciplinary model of care, with government funding to support a full-time social worker, as well as outreach and mental health services provided by a psychiatric NP. Students from Rutgers pharmacy, doctoral nursing and social work programs rotate through the center.
“Having the students increases the amount of services we can provide at a low cost,” Willard said. Students also conduct patient assessments in the community and reach out to people at health fairs and other events. They may see them at the center and can begin to educate them and make a difference in peoples’ health.
Sickora’s students have reviewed records and found the more encounters the patients have with an RN, the better controlled their blood pressure, blood sugar and asthma.
“My work is demonstrating how powerful nursing is in improving health outcomes,” Sickora said.”We are successful in preventing rehospitalizations and keeping people in their homes with some quality of life.”
Debra Anscombe Wood, RN, is a freelance writer.