Building Nurse Leaders to Improve Community Health

In 2016, the National Center for Interprofessional Practice and Education launched a $2.5 million initiative to help 16 nursing schools develop new community-based clinical programs for their graduate and advanced practice nursing students to learn to work in interprofessional teams. The 16 schools were chosen from a much larger group of applicants through a national competitive process. 

Together, these schools have built a cadre of nurse leaders who are bringing health care to schools, clinics, long-term care facilities, public housing and other community settings and making a real difference in the health of the people who live there. 

Care in the Community 

With more than 3 million members, the nursing profession is the largest segment of the nation’s health care workforce. Most often our nurses are trained in hospitals. But long-term chronic disease management—in outpatient clinics, community health centers, and other community-based settings—is the predominant work of health professionals today. The Macy Foundation, Robert Wood Johnson Foundation, Gordon and Betty Moore Foundation, and John A. Hartford Foundation envisioned the initiative based upon the 2010 Institute of Medicine Future of Nursing report. They funded the National Center to provide new educational opportunities for nursing and other health professions students out in the community. 

“Now more than ever, people are getting their health care in the community setting—in treatment centers, clinics, homes, and even schools,” says Dr. Barbara Brandt, director of the National Center. “We know care is being moved into the community where nurses are desperately needed, but we are still not training them fast enough in these new clinical settings.” 

A Focus on Teamwork and Community Collaboration 

Each of the 16 nursing schools has equally put interprofessional education, collaborative practice, and community engagement at the heart of their projects.

“These nursing students are not only training in new community settings, they are also training alongside other health care professionals,” said Dr. Brandt. “We are bringing education and practice into the community, and building new experiences for all health professions students.” 

The National Center’s project is intentionally designed to facilitate collaboration across the professions and with the community—each school has a nurse leader who is the principal_investigator investigator charged with building an interprofessional team, which includes members of the community—what Dr. Brandt calls, a “Nexus Team”—to help design and implement their project. 

“This initiative is also about teaching nurses and all of our health professions students what it means to truly partner with the community they serve,” said Dr. Carla Dieter, program coordinator for the Accelerating Initiative. “Our nurse leaders, their students and the other professions are working to engage the community from the very beginning. The community is part of the planning, implementation and evaluation of the project, and because the partnership grows to be so strong, we are seeing very promising and long-lasting results.” 

Each nurse leader receives ongoing coaching and mentoring using tools from the National Center to support leading their nexus team, working with the community and realizing their projects. 

Making a Meaningful Impact 

Each of the nexus teams has developed innovative ways to integrate nursing and other professional students’ learning while engaging student teams to meet the health needs of the community. And many of them are leaving a mark:

  • At the University of Utah School of Nursing, the nexus team partnered with the Housing Authority of the County of Salt Lake to work with chronically homeless adults in a low-income housing community. Student teams from social work and nursing worked on-site with individual residents and a case manager to overcome the social and other factors which affect the health of residents in the community 
  • At the Washburn University School of Nursing in Topeka, Kansas, the nexus team found, through a landscape analysis, that residents in a low-income neighborhood could not access health care services because of transportation, mobility, and childcare issues. This led the team to partner with the Topeka Housing Authority (THA) who built a new health care clinic in the housing community to make it easier for residents to access care. In partnership with THA and community residents, the nursing school partnered with Washburn University’s business school and design program to establish the clinic. Nurse practitioners are now serving as the key primary care providers who work in teams with social work and other professionals to provide safe, high quality, and affordable primary care for people where they live. Multiple stakeholders are enthusiastically getting involved in the clinic and plans for expansion of services is already underway 
  • At Arizona State University College of Nursing, a multi-organizational nexus team partnered with the Crossroads transitional housing program to deliver primary care services to patients battling opioid and other substance abuse problems. Northern Arizona University’s occupational therapy and physical therapy programs were also part of the team along with graduate nursing students. Since the clinical collaboration officially launched in February 2017, over 200 residents have been served through the care management team, and over 200 residents and family members through health promotion teams. Prior to the collaboration, residents at Crossroads were generally forced to leave the facility to take care of minor and moderate health concerns. This is particularly risky because when residents leave the campus during treatment, it heightens their exposure to relapse. In just one year, the housing program saw more residents completing their rehab programs, incident reports eliminated, and improvement of resident’s satisfaction. Several medical schools have also shown interest in joining the program 
  • At the University of Hawaii School of Nursing, the nexus team formed a partnership with a middle school to help reduce health-related student absenteeism while providing health professions students with a community-based, primary care practice experience. Nursing and dental hygiene student teams also provided primary care and oral health care in local elementary schools. Nursing leadership engaged the Department of Education and state legislators in conversations about the impact of the program, and there is now interest in scaling the model to more schools. 
  • At the University of Michigan School of Nursing, the nexus team partnered with the medical school—along with students from the school of dentistry and the college of pharmacy—to provide high-quality, team-based care at the U-M Student-Run Free Clinic (UMSRFC). Located in Pinckney—about 30 minutes from Ann Arbor—the rural town of about 2,500 people did not have a free clinic prior to UMSRFC’s establishment. Today, nursing students and other health professionals are now caring for patients on a weekly basis, taking time to look at not only their medical issues but also their social issues, their insurance issues, and what issues are preventing them from seeing doctors. 

“Through all these programs we are finding that a small investment, combined with coaching and mentoring, can yield big returns,” said Dr. Dieter. “Even though the grant will be ending later this year, these programs are gaining traction for sustainability. Coaching from the National Center has intentionally focused on sustainability, helping sites to develop a framework and expand thinking beyond financial sustainability We have also created nurse leaders who will continue to grow and mentor more nurse leaders. This is not just a one-and-done initiative. It’s all very exciting to see.” 

Lessons Learned 

While a formal evaluation is underway to assess the full impact the National Center’s project has had on the nurse leaders, its students and communities, the National Center says the initiative has taught them a lot about culture change. 

“We are creating a level playing field between academic institutions and the communities they serve,’’ said Dr. Brandt. “Our nurse leaders are showing students that if you first identify what the community needs are, you are going to build fruitful relationships that are long-lasting and lead to better results. Everyone gets a seat at the table. And if that’s not culture change, I don’t know what is.”

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