By Debra Wood, RN, contributor
Riding the roads in specially equipped mobile health units, nurses, nurse practitioners and students at the University of Maryland School of Nursing provide care to underserved patients throughout the state as part of the school’s Governor’s Wellmobile Program.
“I’m proud of my teams because they are able to provide high-quality care in difficult circumstances,” said Rebecca Wiseman, PhD, RN, director of the program. “Nurses say it’s the most rewarding thing they have ever done, because they feel they are really making a difference.”
The school operates four Wellmobiles, each equipped with two exam rooms, an intake and education area, and a laboratory. The program began in 1993, as a way to boost children’s immunization rates, but evolved to become a medical home to thousands of uninsured adults.
About 750,000 people living in Maryland lack health insurance.
“We only see 7,000 to 8,000. Sometimes I think we need to do more,” Wiseman said. “But that’s 7,000 people who have something they didn’t have before--high quality care. That’s what keeps you going.”
About half the patients regularly receive care from Wellmobile nurses, and the rest seek intermittent services. The school will attempt to secure other community services or health coverage for patients, if they qualify. Eighty percent of those requesting care are employed but do not have insurance.
“It’s hard when you are out there trying to piece together partnerships and resources for clients,” Wiseman said. “We take responsibility for helping find medication for the person. It’s hard. You burn out quick.”
A registered nurse coordinator serves as case manager and a nurse practitioner diagnoses and treats. The Wellmobile program takes a holistic approach to health care and prevention. It provides outreach into communities and offers opportunities for health screenings.
Wellmobiles operate four days per week, with the fifth day reserved for processing paperwork, referrals, consult requests, reviewing laboratory reports and maintaining records. Each unit treats about 15 to 20 patients per day, by appointment and as walk-ins.
The school receives funding from the state and from grants. MedStar Health in Columbia, Maryland, recently gave the school a five-year, $1 million grant to support the Wellmobile program.
“The state funding is completely inadequate to maintain the program,” said Steven S. Cohen, senior vice president of integrated operations at MedStar Health, and chair of the school of nursing’s board of visitors. “We felt it was a vital service. The school needed support and, as the biggest provider in the region, we needed to be part of that support.”
MedStar and the school plan to pursue other joint activities in support of the school’s environmental health, clinical research management and nursing informatics programs, and MedStar facilities will serve as clinical instruction sites for students.
Undergraduate students rotate through the Wellmobiles as part of their community health rotation. Nurse practitioner students use it as a clinical site, performing exams and making decisions with a nurse practitioner preceptor. Nurse midwife students spend one semester on the Wellmobile, which provides significant well women health care and family planning services. One doctorate of nursing practice student is completing a diabetes education project on the Wellmobile.
“Working on the Wellmobile is the true essence of nursing and a place where you can do it pretty autonomously,” Wiseman said. “Nurses want to do that. Our students love it. When they go out, they come back so excited. It sparks some of them to make a difference in what they choose to do.”
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