WCU grant allows nursing students to gain valuable experience in community settings
Maggie Henderson knew she wanted to be more than a nurse who only treats her patient’s symptoms in the hospital. She also wanted to be able to take the time to know them as people.
Through an innovative grant program at Western Carolina University’s School of Nursing, Henderson was able to participate in experiences that allowed her more interaction with her patients and gave her the necessary skills to work as a registered nurse in community settings. For the WCU students, the program provides enhanced internship placements in a community-health clinic, making it a different approach from most nursing programs across the country.
In fact, the partnership worked so well that Henderson, who did 60 hours of practicum work in Asheville’s Mountain Area Health Education Center, or MAHEC, was hired as an OB-GYN specialist after she graduated with her bachelor’s degree in nursing last December.
“I wanted to practice in a community health setting,” she said. “This program gave me the experience for what it would be like to work in an out-patient setting. I got to see the different roles registered nurses play in the community health setting – very different from the hospital.”
Registered nurses working as care managers in primary care provide care coordination services to help patients to navigate the healthcare system, provide education and improve health outcomes. There are also nurses who specialize in maternal fetal health, which is the nursing specialty in which Henderson was most interested.
“I got to see that variety,” she said. “I thought I was interested in learning in a hospital setting because I was interested in labor and delivery, and post-partum units. With this program, I got a lot of affirmation and confirmation that community health was the best setting for me.”
Last October, the Health Resources and Services Administration (HRSA) awarded WCU a grant for nearly $1 million over two years to develop community-based and primary care clinical experiences for students enrolled in the bachelor’s nursing programs. WCU is only one of nine universities across the country to be awarded this grant.
Kae Livsey, a WCU associate professor who serves as project investigator for the grant, said it provides students the opportunity to have expanded clinical experiences in nurse-led care coordination at both primary care and senior housing community settings.
Livsey said the response from WCU students was immediate and overwhelming. Originally, she planned for 17 students to take part in the program over the two-year period, but already five students have finished the program and graduated, with another four currently engaged in the program this spring. An additional 11 students are set to go through this summer and 14 more have signed up for fall 2017.
“We’ve exceeded the number of students who we thought would be interested in the grant, and we’re not even one year into the program. We’re super-excited about the level of interest.”
Most nursing programs at both the university and community college level heavily focus on hospital clinical experiences for its students. But Livsey said this program changes that paradigm.
“Future roles for baccalaureate-prepared RNs are going to be community-based, and our educational programs need to ramp it up to give them more experiences to prepare for that,’ ” she said. “We decided to embed students in federally qualified community health centers that tend to work with uninsured or under-insured folks in rural populations.”
Livsey noted WCU’s partnership with Blue Ridge Health and Appalachian Mountain Community Health Centers, which have helped to make the program happen. The program also works with Givens Gerber Park, a low-income senior residential community in Asheville.
The program is guided by a framework called the chronic care transition management model, which was developed by nurses. The framework involves registered nurses leading coordination of care for populations, often in primary care settings. According to Livsey, care coordination is focused on positive patient-centered outcomes and quality of life. She notes that this focus is somewhat different than case management, often provided in hospitals and by insurance companies, which focuses primarily on more efficient utilization of health care services.
“As reimbursement for primary care services is increasingly being based on outcomes instead of by volume, we’re seeing roles emerge for registered nurses to serve as care managers,” Livsey said.
As part of the grant, WCU put the infrastructure in place so that students can have these learning experiences, Livsey said. The students’ rotation is usually one or two semesters, and they follow a registered nurse but also assume the role of care managers themselves.
Livsey said the biggest challenge facing the WCU students as well as the other universities engaged in similar programs in breaking the old-school mentality that nursing graduates need to work in a hospital setting.
“One of things we’re trying to do is to help inform providers that these nurses are specially trained and can fulfill these roles,” she said. “That’s one of the barriers we have when you’re on the front edge of creating a new role.”
Students currently enrolled in the program, such as Janice Hill, are embracing the new role. Hill, a non-traditional student at 42, is set to graduate in May after working learning on the job at Appalachian Community Health Center in Asheville.
Hill, who previously worked as a photographer while raising her three kids, got back into nursing after deciding she wasn’t ready to enter the field when she first attended college and changed career paths. But now, she wants to serve as a role model for her children as well as contribute to community health care, she said.
“I wanted to build a relationship with my patients, and working in a community health care setting is the best way to do that,” she said. “I have a drive to help people live healthy lives. I want to be a practicing nurse at a health center or health department, or at a hospice. This program allows me to see what goes into that, so I have a broader understanding about nursing.”