Nursing Schools Stepping Up to Improve Urban Health Care

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By Megan Murdock Krischke, contributor

September 20, 2013 - “A college of nursing, and the university in general, has a responsibility to be engaged with the community in which it sits,” began Suzanne Willard, PhD, APN, FAAN, associate dean for advance practice at Rutgers College of Nursing in Newark, N.J. “Making an effort to improve urban health care is the right thing to do if you are a nursing school in Newark.”

Cindy Sickora & Suzanne Willard say nursing schools can impact community health care.
Cindy Sickora, DNP, RN, (left) and Suzanne Willard, PhD, APN, FAAN, (right) are using interdisciplinary teams to meet the health care needs of the underserved in Newark, N.J.

One of the poorest cities in the country, Newark has lost five of its eight hospitals in recent years. Willard and her colleague Cindy Sickora, DNP, RN, associate professor and director of community programs for Rutgers School of Nursing (part of the former University of Medicine and Dentistry of New Jersey), also in Newark, are working with innovative models to address the health care needs of the people in the Rutgers community. 

Sickora oversees a mobile health center, the New Jersey Children’s Health Project, which has been in operation since 2007, as well as the Jordan and Harris Community Health Center, which has offices in public housing developments.  Jordan and Harris is a nurse-managed community health center staffed with registered nurses and community health workers. 

“The nurses at the Jordan and Harris sites do a preliminary patient assessment and determine if patients need to go to the van, or if their health care can be coordinated with a previous primary care provider,” Sickora explained. 

A mobile van provides primary care to a dramatically underserved population. It visits multiple sites including three housing developments, a homeless shelter for teens, and a community organization that serves a primarily Latino population. 

“The mobile van provides community-based nursing care and advanced practice nursing services,” she continued. “Some of the main conditions we treat are asthma, hypertension and diabetes. Additionally, our community health workers go out and knock on doors to find both children and adults in need of health care and health education.” 

Willard’s FOCUS Wellness Center has been in operation for a year and she and Sickora have collaborated since the center’s opening. 

“The aim of FOCUS is to provide quality health care to the citizens of Newark,” said Willard. “We began by assessing community health needs and forming an advisory board. The needs that stood out were obesity, hypertension, violence and HIV. In the community our center serves, there is little primary care access; many people are uninsured and many are undocumented.” 

FOCUS provides primary care, social services, counseling, psychotherapy, health education programs and complementary therapies such as Reiki. The center is also working to enroll clients in health insurance offered through the Affordable Care Act and to connect them with other specialty services they may need.  

These community health services are showing measurable results. 

“We have demonstrated how basic nursing care can reduce blood pressure,” commented Sickora. “The more contact a hypertensive patient has with nurses, the more control the patient has over blood pressure. We have also seen nursing care make significant improvements in blood sugar levels. Our aggregate data showed that over 15 months, the average blood sugar of our patients dropped from 175mg/dl to 115 mg/dl.” 

Patients aren’t the only ones benefiting from the programs. The health centers also offer professors and students community health opportunities. 

“The centers provide a place for faculty to work as clinicians, allowing them the clinical hours they need in order to keep up on certifications that are often required to teach certain courses,” remarked Willard.

“They also provide a unique learning environment for students,” added Sickora. “Not only do they get to observe and practice clinical skills, they are also receiving an education in health disparities. Teaching student nurses how to play a role in closing these disparities is what motivated me to start the community health center.” 

When asked what it would take for other schools to start a similar program, Sickora responded with a laugh, “You need to be a little insane!  More seriously, you need to have the passion to do the work and enjoy the work. It is hard work but the rewards are very high. You need persistence, patience and compassion.” 

PHMC Health Connection serves Philadelphia's community health needs.
Operated out of a townhouse in Section 8 housing, PHMC Health Connection provides interdisciplinary primary care.

“The first thing I did was visit Temple University,” she continued. “In 1996 they started a community health center in public housing and provide health care to a huge underserved population.” 

“The BSN program at Temple has a long history of focusing on serving the underserved in North Philadelphia,” explained Jane Kurz, PhD, RN, interim chair of the College of Health Professions and Social Work in the Department of Nursing at Temple University. “All nursing students complete part of their direct care experiences in medical homes, schools, day care centers and clinics located in urban North Philadelphia, in addition to the typical acute care experiences,” 

Public Health Management Corporation Health Connection (PHMC HC) is one of the ways that Temple is meeting the health needs of its surrounding community. Operated out of a townhouse in Section 8 housing, PHMC Health Connection provides interdisciplinary primary care. 

“The PHMC HC is invaluable to this community,” remarked Kurz. “In this community 21 percent of the people living in this area have not graduated from high school. The unemployment rate is at 48 percent and many are suffering from preventable diseases that result from a lack of access to health care, malnutrition and poverty.” 

Both Sickora and Willard emphasized the importance of having health programs in the community. 

“If you want good health outcomes, go to where the people are,” asserted Willard.

“A community health worker can reach 1,000 patients in one week,” Sickora noted. “We have made tremendous inroads in building trusting relationships between patients and health care workers--it is the relationships that keep our clients coming back.”

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