AARP and the Future of Nursing: Campaign for Action, an initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation, proudly support the Summer Health Institute for Nurse Exploration and Success or SHINES program. SHINES is helping create a stable and diverse health care workforce to care for our nation’s 100 million older adults and their families. The two-week immersive summer camp at the University of California Davis Betty Irene Moore School of Nursing exposes teens and young adults to careers in nursing and allied health professions. Participants are equipped with health care career knowledge and training including CPR certification, mentorship, professional skill building, and career and college navigation skills. They also receive stipends and are incentivized to gain certification and immediate employment in critically needed health workforce positions.

A local CBS news station recently highlighted the program. To learn more about SHINES and other AARP and Campaign for Action Health Equity Innovation Fund projects, read more on our website.

Photo credit: (c) GETTY IMAGES/boonchai wedmakawand

The post Preparing Teens and Young Adults for Health Care Careers appeared first on Campaign for Action.

For her decades of policy work that have advanced compassionate care, Susan B. Hassmiller, PhD, RN, FAAN, was presented with the Lifetime Achievement Award for Policy by HealthImpact and the DAISY Foundation on Monday, September 12.

Hassmiller, the former senior adviser for nursing at the Robert Wood Johnson Foundation and former director of the Future of Nursing: Campaign for Action, dedicated her career to strengthening the nursing profession through strategic policy advocacy. Through her policy work, she has advanced compassionate care for vulnerable populations, under-resourced communities, and the nursing profession. The Campaign is an initiative of AARP Foundation, AARP and RWJF.

Congratulations Sue!

Read the announcement

About the DAISY Lifetime Achievement Award

The DAISY Lifetime Achievement Award was created to recognize nurses who have devoted their life’s work to the compassionate care of others. Recipients of this award are nominated for their dedication to nursing through active mentoring, role modeling, advocating for their patients and promoting the positive image of nursing. They serve as a beacon of inspiration.

The post HealthImpact DAISY Lifetime Achievement Award For Policy appeared first on Campaign for Action.

The American Nurses Association\California (ANA California) has created an important tool to assess the extent to which racism permeates nursing in California’s health care system. But it goes further than that. The tool, which is a self-assessment for both nursing staff and nursing managers, will analyze each person’s responses and offer individualized action plans designed to help the respondents take steps towards confronting and combatting racism in the organizations in which they work.

“Racism in nursing is a public health crisis,” explained Samantha Gambles-Farr, MSN NP-C CCRN RNFA, a member of the ANA\California taskforce that created the tool. “If we ever hope to address the vast systemic and institutionalized racism in our healthcare system, we must first address it within the institutions and professionals delivering care.”

Following a thorough analysis of relevant data and research, first-hand experiences and live dialogue forums, the task force identified four barriers impeding nurses’ ability to create transformative change:

1. Lack of Sustainable Conversations (the topic of racism too often devolves into ideological and semantic, rather than constructive, debates.)
2. Lack of Accountability and Confidence in Reporting Systems
3. Lack of Awareness and Unified Standards Among Decision-Makers
4. Lack of Diversity Among Decision-Makers

Recognition of these barriers informed the development of ANA\California’s Racism in Nursing Assessments and Action Plans. “Nursing has often held a culture of silence as it relates to racism,” Gambles-Farr said. “In developing the assessment, it was important to the task force to ensure the assessments and action plans foster safe and inclusive environments for a nurse’s varying levels of awareness, rather than isolating, labeling or shaming individuals for a lack of.”

Some of the 50 questions in the self-assessment tool are designed to get a sense of the person’s awareness, for example, asking them to identify statements that could be seen as microaggressions, or to define the concept of equity. Other questions seek a simple Yes or No, such as, Do you feel comfortable having a conversation about racism with your immediate manager? and Do you feel confident in the reporting system’s ability within your organization to hold persons accountable (for racism, discrimination, etc.)?

The assessment tool has been in pilot testing at three prestigious hospitals in Los Angeles this summer and has just been made publicly available at ANA\California’s website. The ANA\California has already enlisted researchers to analyze the results of those pilots and will share their findings in early 2022. For now, ANA\California encourages nurses and healthcare managers and directors in every state to take the assessment, and to follow up by taking action against racism that impacts both staff and patients in their healthcare institutions.

Find the tool here: https://www.anacalifornia.org/racism-in-nursing-assessments 

The post 50 Questions About Racism in Nursing appeared first on Campaign for Action.

The Need

The need for the expansion and growth of nurse-led clinics, to deliver primary and behavioral health services, is well supported by health data from national, state, and local sources. These data document the extent of primary care physician shortages in underserved communities, and the degree of health care disparities noted among both urban and rural ethnically diverse populations. According to new data published recently by the Association of American Medical Colleges, there is a projected shortage of between 54,100 and 139,000 physicians nationwide by 2033. Further, the physician shortage is expected to worsen as the nation ages and the overall population increases.  The gap between health care demands and the supply of doctors became increasingly more evident with the advent of the COVID-19 pandemic, and its impact across all sectors of the country.

According to recently published data in the California Health Care Almanac, racial health care disparities persist. Key findings of that report noted:

• Blacks fare worse on maternal/childbirth measures, with higher rates of low-risk, first-birth cesareans, preterm births, low-birthweight births, and infant and maternal mortality.
• One in four Black children have been diagnosed with asthma and do not have a proper asthma management plan

• Latinos were more likely to report being in fair/poor health, to have incomes below the federal poverty level, and to be uninsured. About one in five Latinos did not have a usual source of care, and one in six Latinos reported difficulty finding a specialist.

• About one in eight Latinos reported that they did not have health insurance coverage. While, Whites and Asians were most likely to report having health coverage through their employer, Latinos were more likely to report having Medi-Cal coverage.

The literature is replete with explanatory reasons for the disparate utilization patterns among the residents of under-resourced communities, some of which include the following barriers to access:

• Physical barriers – Often the location of clinic sites is more than several miles from a patient’s home. For those with ambulatory difficulties due to aging or physical disability, transportation and added costs are problematic, especially for low-income families living at or below the poverty level.
• Cultural barriers – Many cultures hold negative perceptions regarding the current health care delivery system. Help-seeking behaviors of culturally diverse populations are different from those of the dominant society, often many do not seek health care until late in the disease process.
• Financial barriers – Currently there is little incentive for health care providers to offer services to low-income populations, due to inequitable reimbursement schedules of third-party payers. Many minority groups are either under- or uninsured, and many insurers do not provide coverage for preventative care.
• Language barriers – Non-English speaking patients are often unable to understand the spoken or written English language.

In contrast to the typical program of study for physicians, the nursing curriculum addresses the needs of the patient from a more holistic perspective, taking into account the biophysical, socio-cultural, and spiritual needs of the patients they serve, focusing on health promotion and disease prevention. Moreover, nursing content at the advanced practice level, in addition to the management of primary and behavioral health care conditions, includes content on population health and epidemiology to address the health care needs of the larger society.

In 2019, the California Future Health Workforce Commission released a deep dive into emerging workforce demand and developed a series of recommendations to assure that all Californians have access to high quality care. The Commission recognized health inequities in many communities, both in racial/ethnic diversity and in geographic disadvantage along with the looming shortage of primary care and behavioral health providers to meet the needs of these communities. Further, the Commission identified innovations using technology and team-based care as crucial in increasing capacity to meet the needs of the growing and diverse population of California. The Commission identified several strategies to build this workforce, building the pipeline for multi-cultural health practitioners and also modernizing regulations to allow nurse practitioners to practice to the full extent of their preparation.

The Legislation

A major outcome of the Commission work was Assembly Bill 890, sponsored by Assemblyman Wood, one of the Commissioners. This bill increases the ability of NPs to deliver care and develop new models and opportunities where there is need. It eliminates administrative barriers to care delivery by removing physician contracts and excess paperwork, allowing health care providers to devote more time to consumers. By recognizing the preparation and capacity of NPs to delivery primary care, it will improve recruitment into the profession and enhance the ability of NPs to implement innovative solutions that fit the needs of the population.

A Solution: Nurse-Led Clinics

According to the National Nurse-Led Care Consortium, there are 150 nurse led-clinics nationwide.  AB 890 supports the innovative nurse-led care model of delivery as designed and implemented by the National University Nurse Managed Clinic, which utilizes an interprofessional healthcare team to deliver services onsite at designated locations throughout underserved communities, providing comprehensive direct primary and behavioral health care to patients served.  Remote biometric monitoring is used between onsite visits to follow clinical trends. In contrast to the existing system, which expects patients to travel to the healthcare facility, this nurse-led clinic shifts the paradigm by taking the interprofessional healthcare team to the community. Designed to reduce the morbidity and mortality rates of the patient population served residing in the Watts area of Los Angeles County in California, this nurse-led clinic cost effectively utilizes faculty-supervised nursing and health professional students, in collaboration with a full-time interprofessional healthcare team, community-based organizations (CBOs), and faith-based institutions, which included Salvation Army locations, drug rehabilitation centers and a Baptist Church. The Watts targeted patient population was selected because of its high rates of serious chronic and acute health problems with notable poor healthcare outcomes. The Project uniquely created public-private partnerships to improve access to care for at-risk populations.  This grant-funded initiative provided services at no out-of-pocket cost to the patients served. The impact of the Project has been well documented using a variety of measures to report demographic data, reduction in loss to follow up, and decreased cost of care.

To address the complex needs of the patients served, a bi-lingual nurse-led clinic team consists of a project director, advanced practice nurses, medical social worker, project manager, project coordinator, medical director, evaluator, and an office secretary.   The full-time clinic team works in collaboration with an Advisory Board, CBOs and the faculty and students in the departments of nursing, community health and health sciences. The nurse-led clinic is located at the National University Los Angeles Campus, serving as the home office location.

Business Model

Currently this nurse-led clinic is a grant-funded initiative awarded to National University.  The University is cognizant of the fact that federal support is designed to act as a catalyst for the initiating of programs such as this, and has committed resources for in-kind contributions to the project. Funds to continue support for this program will come from reallocating existing resources, as well as revenues from grants and contracts obtained by the Project Director to operate the nurse managed clinic.  AB 890 will facilitate the ability of the NPs to directly bill for services and maintain a revenue stream.  Complicating the current reimbursement structure is the need for a collaborating physician who oversees the NP practice. This current expensive method of reimbursement is cost prohibitive, as it requires the services of a physician and undermines the autonomous practice of the NP.  Further, some third party payers stipulate an incident to payment model, which requires that the physician must perform subsequent services that reflect his/her continued active participation in and management of the patient’s care. With the advent of telehealth care technologies and virtual healthcare delivery models, the use of the incident to reimbursement methodology becomes problematic, as the physician may not ever have provided onsite direct care for the patient. Additionally, when NPs bill under their own Medicare number, the reimbursement is at 85 percent of the physician fee schedule. This Medicare number can be used for billing both in the outpatient and inpatient settings. However, when NPs bill incident to, they are reimbursed at 100 percent of the physician fee schedule, however a collaborating physician is still required.

The utilization of telehealth care technologies has grown exponentially with the advent of the COVID-19 pandemic, as the need for social distancing, face mask coverings, and absence of symptoms have significantly limited the onsite office visit.  Further the ability to remotely monitor biometric data improves access to care, as blood pressure, oxygen saturation, temperature, pulse respirations and body weight can be accessed and stored in the cloud without need for the patient to leave home.

AB 890 is the catalyst that will facilitate the autonomous practice of the NP, leading the way for the development of entrepreneurial models of care delivery led by teams of NPs improving access to care.

Further Action Required

AB 890 is an incremental improvement to the status quo, but more work is needed to fully optimize the contributions of nurse practitioners to the health of communities across the state.  Unlike more progressive states, California will require a transition to practice period of 4,600 hours of additional oversight prior to full practice authority for nurse practitioners. AB 890 also exempts correctional facilities and state run hospitals, posing barriers for vulnerable populations. The implementation of the transition to practice provisions will be developed by an advisory committee to the Board of Nursing Regulation.  It will be important to assure that these provisions enhance preparation and do not pose further barriers, particularly as this transition period is not funded by a traditional Graduate Medical Education model, such as a paid residency. Finally, the legislation does not reflect the national framework for Advance Practice Registered Nurses, embracing nurse practitioners, clinical nurse specialists, certified nurse midwives and certified registered nurse anesthetists as vital providers unified by their expertise and ability to deliver advanced care.

This is a culture change — to actualize the vision of a well-prepared, highly motivated and respected NP workforce, diverse stakeholders must participate and advance the opportunities for innovative, person and family centered practice. Academic colleagues can engage in preparing NPs for the future and in replicating successful nurse-led clinic models. Together, we can advance the vision for every member of our communities to receive culturally appropriate, accessible, equitable high quality care.

Heather M. Young is professor and founding dean emerita, Betty Irene Moore School of Nursing; national director, Betty Irene Moore Nurse Fellows in Leadership and Innovation Program, University of California Davis; commissioner, California Future Health Workforce Commission. She is also a member of the Strategic Advisory Committee of the Future of Nursing: Campaign for Action, an initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation.

Gloria J. McNeal is associate vice president, Community Affairs in Health, National University. She was a 2018 AARP Well-Being Champion.

Susan C. Reinhard is senior vice president and director, AARP Public Policy Institute and chief strategist for the Center to Champion Nursing in America, an initiative of AARP Foundation, AARP and the RWJF, which runs the Campaign for Action.

The post Implications for Nurse-Led Clinics appeared first on Campaign for Action.

Sacramento California outside capital building

California’s 39 million residents will have significantly improved access to care from advanced practice registered nurses (APRNs), thanks to legislation signed into law Sept. 29 by Gov. Gavin Newsom (D-CA).

AB 890, as the bill was known when it passed the California Assembly on Aug. 31, authorizes employed nurse practitioners (NPs) in defined healthcare settings to practice to the full extent of their education and training without physician supervision, after a three-year or 4,600-hour transition to practice. The majority of California’s 27,700 active NPs have at least three years practice experience, according to the California Board of Registered Nursing.

“California has been successful expanding health care coverage to many more people – and that’s absolutely what we should be doing – and we are faced with not having enough providers to care for this population,” said Assemblymember Jim Wood (D-CA), who authored the bill.

Though the law does not take effect until 2023, the pandemic might well have been on lawmakers’ minds. In California, the most populous state in the country, there are presently more than 807,000 positive COVID-19 cases and nearly 16,000 deaths due to COVID-19, according to the California Department of Public Health.

The Future of Nursing: Campaign for Action, an initiative of AARP Foundation, AARP, and the Robert Wood Johnson Foundation, as well as the California AARP State Office, plus their allies, contributed to the passage of the bill.

“California needs AB 890 now more than ever when we are experiencing a healthcare workforce shortage due to the COVID-19 pandemic,” said Nancy McPherson, state director of AARP California.

AB 890 offers consumers benefits that include:

• Helping patients find quality clinicians when and where they need one and potentially reducing travel or waiting time for health care appointments;
• Providing a pathway to eliminate administrative paperwork which could increase the amount of time NPs can spend with patients and their families;
• Eliminating unnecessary regulations to consumer access, which will help increase the supply of health care providers, increase competition, and lower patient costs;
• Expanding access to APRN care in underserved rural and urban communities hit hard by physician shortages, thanks to a provision that provides opportunities for NP entrepreneurs to open their own individual and group practices.

Campaign advisor Heather Young, PhD, RN, FAAN, professor and founding dean emerita, Betty Irene Moore School of Nursing, University of California, Davis, said, the legislation means not only better access for consumers, but improved health equity for Californians.

“As a commissioner on the California Future Health Care Workforce Commission, I came to appreciate that California is a large and diverse state, with both a shortage of primary care providers and a maldistribution of expertise, amplifying racial/ethnic and geographic disparities,” said Young, a member of the Campaign’s Strategic Advisory Committee. “Nurse practitioners are an important solution for assuring access and equity at the community level. California is known for many progressive innovations across sectors, yet, in health care we have lagged the nation in modernizing the nurse practice act to enable the highest and best contribution of nurse practitioners to the health of the population.”

Under the transition period outlined in the legislation, NPs who meet education, experience, national certification requirements can practice to the defined NP scope of practice in clinics, certain health facilities, medical group practices, home health agencies and hospice facilities. NPs practicing in their own nurse-run clinics or private practices will have full practice authority after an additional three years, though the Board of Nursing Regulation can reduce this time for those with a Doctor of Nursing Practice.

“The provisions set forth in this new law seek to recognize NPs as equal and valued members of the healthcare delivery team, and provide public transparency by codifying their legal scope of practice. Consumers have continuously called for improved access to qualified primary and specialty healthcare providers, in addition to choice of the type of healthcare provider delivering their care. AB 890 answers this call,” said Dr. Susanne J. Phillips, DNP, APRN, FNP-BC, associate dean, Clinical Affairs, University of California at Irvine, Sue and Bill Gross, School of Nursing, a lead champion of the bill.

The legislation includes a few barriers to full practice authority, such as site specific restrictions and the creation of a new Nurse Practitioner Advisory Board which requires the inclusion, but not the oversight, of physicians.

Since the Campaign began in 2010, to date nine states have fully removed statutory barriers that restrict nurse practitioners from providing more care, which in turn has increased consumers access to care. An additional eight states, including California, have made substantial improvements to increase consumers’ access to care. In 22 states and the District of Columbia, nurse practitioners are allowed to provide full care. In response to the COVID-19 pandemic, seven states (Kansas, Louisiana, Massachusetts, New Jersey, New York, Virginia and Wisconsin) have temporarily provided full practice authority to nurse practitioners. The Campaign will continue to support efforts to modernize and remove any existing these barriers to care in the future.

The post New Law to Improve Californians Access to Care appeared first on Campaign for Action.

The post How Closely Do California’s RN Graduates Reflect the State’s Diversity? appeared first on Campaign for Action.

Photo credit: yacobchuk

Patients—not nurses—are the story when it comes to state legislative battles to modernize advanced practice registered nurse (APRN) scope of practice laws.

Explain to someone how states regulate nurses, and their eyes might glaze over.

Tell them about the child who struggled with autism and homelessness whose opportunity to receive care was delayed by layers of laws, and people might want to know more.

That was my experience after recently meeting with a group of California-based APRNs.  In the course of my conversation, I heard about a myriad of unnecessary state government regulations with one thing in common: the red tape made it harder for patients to access quality health care in their own communities. The range of arcane regulations ranged from requirements on who could sit for certain licensing exams to  paper work required to order basic services to who is permitted sign various health forms.

While we know these are common burdensome issues in nursing, they do not even begin to tell the full story. Each restriction on nursing is, in fact, a limitation on patients and families.

That stark realization hit me when a clinical nurse specialist (CNS) told me about the paperwork requirements that ultimately ended with her chasing after a physician signature to authorize in-home supportive services for her patients.

I probed further, and the CNS continued.

For example, she said, there was a young girl named Katie.* Recently diagnosed on the autism spectrum, Katie had a complicated family life. She had been in and out of homelessness and struggled with poverty. Hope lay in the fact that the state provides in-home supportive services for personal care and domestic services to help children with autism. These services would be a godsend for Katie, helping her control outbursts and live safely in the community. They would also give her parents the respite they needed to get their life on track, secure, stable housing, and jobs.

The problem—it would take several weeks for a physician to formally sign on the dotted line to make Katie and her family eligible. Weeks of delay to access critical health care services because of a signature!

Unfortunately, this experience was not unique to Katie. In another case, a certified registered nurse anesthetist (CRNA) shared obstacles she experienced in providing care to a veteran who had disabilities and was in pain. Although nearby CRNAs could have provided the pain management to make him comfortable and allow him to live independently at home, this veteran had to travel hours on a bus, in excruciating pain, to get the care he needed. The CRNA was pained too—she had the training to deliver the services, and was upset on his behalf that the state law didn’t allow it. In his time of greatest need, this veteran faced outdated laws that stood in the way of his care.

This Fight, Is Our Fight

I am not a nurse, and neither was that veteran or the little girl diagnosed on the autism spectrum. But the fight to ensure patients have the choice to directly access nurse-led care belongs to all of us.

Behind the unnecessary obstacles and barriers that make it harder for nurses to do their jobs are the stories of human struggle and suffering that demand action.

*The name of the child has been changed for HIPAA privacy protections.  

Claudio W. Gualtieri, JD, is an adviser for the Center to Champion Nursing in America, an initiative of AARP Foundation, AARP, and the Robert Wood Johnson Foundation. He is responsible for stakeholder engagement and advocacy for the Future of Nursing: Campaign for Action, an initiative of those same organizations.

The post The Fight for Accessible Health Care Belongs to Us All appeared first on Campaign for Action.

Mary Dickow in her first year at USCF, in the Controller’s Office.

Nursing Journeys is a profile series featuring Action Coalition leaders discussing their career paths and reflecting on the lessons they’ve learned.

Mary Dickow, MPA, FAAN, is statewide director of the California Action Coalition and a national voice in leadership development for nurses and on leadership in health care. Dickow also serves as a program director with HealthImpact, California’s nursing workforce center, and as director of strategic initiatives at the Organization for Associate Degree Nursing. She has a long history working with the University of California, San Francisco including 15 years with Healthforce Center at UCSF, where she served as the deputy director for the Robert Wood Johnson Foundation Executive Nurse Fellows program.

You are a staunch advocate of the nursing profession. Why did you decide to become involved in the field?

My path, to say the least, was indirect. I can’t even say it’s because my mother was a nurse, though she was my first nurse. But truly, my sense of curiosity is what led to where I am today. I have been extremely lucky in meeting people who became mentors who saw potential in me, simply because I ask questions.

Dickow several years ago with Janis Bellack, PhD, RN, FAAN. Bellack, says Dickow, has been a steadfast mentor since they first met.

In short: I was at the University of California in San Francisco, at jobs that initially offered great benefits but were unrelated to nursing. At one point, one of my UCSF jobs had me talking with health researchers who had earned grants. I was fascinated enough by reading their findings, and asking them questions, that I was hired to assist on behalf of the researchers themselves.

In 1997, I had the good fortune of being recruited to work with the Robert Wood Johnson Executive Nurse Fellows Program. Over the course of that program, I learned so much about the profession through engagement with nurse leaders from across the country. I was fortunate to have been mentored by senior nurse leaders who inspired me to do more.

Describe the journey you took to get from that decision to where you are today.

I would not be where I am today, at HealthImpact and the Organization for Associate Degree Nursing, if not for those incredible nurses. They encouraged me to further my education and provided constant feedback. As I learned more about them and the profession, I had a greater understanding of the value of my role as a non-nurse advocate.

What impact did the Institute of Medicine’s Future of Nursing report have on you?

In 2011, I took a leap of faith and left a 27-year position at the University of California, San Francisco to be part of the California Action Coalition. It was the most frightening and rewarding thing I have ever done. Armed with the recommendations from the report, I was inspired to lead efforts to build our Coalition and develop partnerships across the state and nation.

How have you been involved with the Campaign for Action?

From the launch meeting in 2010 until today, I have been actively working with the Campaign for Action. I have served as the statewide director for the California Action Coalition and on a variety of committees at the national level.

Of all you have accomplished, what are you most proud of?

Mary Dickow, MPA, FAAN, program director of HealthImpact, in 2018, with Susan Hassmiller, PhD, RN, FAAN and Garrett Chan, PhD, APRN, FAEN.

I am most proud of my role as a champion for the profession. It is not always easy, but I am certainly passionate about nurses and the roles they play in the health of our nation. In 2014, I was inducted as an honorary fellow in the American Academy of Nursing for my advocacy. As one of two non-nurses to be inducted that year, I still feel honored to have been recognized by my nursing peers.

What is the most important action that nurses can take to lead the way to improve health and health care in America?

Nursing needs to step up and be present at every decision-making table. It will take strong leaders to change health care in this country and nurses are uniquely qualified to lead that charge. The nursing voice is critical in creating healthier communities and ensuring equitable access to care.

What advice do you have for the next generation?

As I tell students, and as my own unorthodox start in this tremendous profession shows, each of us has a path, and reasons for wanting or doing something that may or may not get in the way of our jobs, families, whatever. But for everyone, my advice is to get involved. Join your professional organizations and serve where you can. Find a mentor and dare to lead. We need all of you. Understand that we all have a responsibility to those that we serve to use our voices to ensure they live healthier and more productive lives. Nursing makes that difference!

The post Nurse Leaders Inspired Her to Be a Nurse Champion appeared first on Campaign for Action.

This is the 13th in a series of profiles of 

Melissa Pinto, PhD, RN, FAAN, is associate professor of nursing at the University of California, Irvine’s Sue & Bill Gross School of Nursing, where her research focuses on mood disorders in adolescents and young adults. Her expertise is in the area of adolescent and young adult behavioral health, self-management, psychosocial barriers to mental health treatment for adolescents, and technology and adolescent health risk behaviors.

Why did you decide to become a nurse?

I wanted a fulfilling career that aligned with my core values. While there are many different career options that aim to help others, I chose nursing because it offers tremendous flexibility in how you can promote health, both in the traditional acute care setting and into the community.

Can you describe your philosophical evolution from making that decision to where you are today?

My view of nursing has broadened over time. Patients, colleagues, mentors, and students have been my teachers and provided me with the opportunity to grow professionally and personally. I have been afforded the opportunity to engage with individuals from different parts of the health care sector. These experiences have shown me the potential nurses have to not only shape the delivery of care in their institutions, but also on a national and international scale.

Of all that you have accomplished, what are you most proud of? 

I cannot point to a single accomplishment, however I can point to moments I feel the most proud. I am most proud when the general public and those in formal positions of influence, like policymakers, are interested in my research because it is an indicator I am achieving my goal—to improve the health of patients and communities.

If you could change the profession in any one way, what would you change and why?

I would like to see the profession better capitalize on our strengths—like the delivery of care in different settings and understanding how patients care for themselves when they are at home. I would love to see nursing take this knowledge, convene and lead multidisciplinary teams to more rapidly develop creative solutions to some of our most pressing health problems like mental health, chronic disease, and violence. Nurses are well-positioned to promote the health populations of people around the globe.

What is the most important action that nurses can take to lead the way to improve health and health care in America?

Nurses should not wait to be invited to the table; instead ask for a seat. This is true for nurses working in all areas— acute care, academia, and in the community.

The general public, and even colleagues in health professions, often hold a traditional view of nursing and do not completely understand the role of nurses and their skills set. Being both vocal and visible about what we do that improves the health of Americans will position us well to lead important initiatives and be involved in critical decisions that influence the health and well-being of people on a large scale.

What role do you see for yourself in building a healthier America?

My contribution is to promote the mental health of adolescents and underserved populations through science, education, and leadership. I do not see the same attention paid to mental health as physical health; this is surprising given that mental health, particularly in youth, is a foundation for good physical and mental health long-term. Mental health is underfunded in research and in practice. There are considerable barriers to care, and mental health care is not well-integrated with physical health.  To address some of these needs, I see myself working with colleagues in various areas of the health sector to influence change and lead new initiatives at the population level. In my research, I will aim to improve the lives of children at risk for mental health problems by bolstering their resilience, developing new interventions, in an environment of severely limited healthcare expended for psychiatric disease and prevention.

The post Nursing Professor Aims to Improve Lives of Teens, Young Adults with Mood Disorders appeared first on Campaign for Action.

“One-nine-one-two-three,” she says, “and that is a ZIP code you didn’t want to come from.”

It may not have been her (or anyone’s) neighborhood of choice, but ultimately that gritty Philadelphia locale of her youth is what set McNeal on her life’s path. Fast-forward years later, and digits no longer identify McNeal; instead numbers are replaced by letters—as in, PhD, MSN, ACNS-BC (adult clinical nurse specialist—board certified), and FAAN (Fellow of the American Academy of Nursing).

From an early age in Philadelphia, McNeal saw firsthand that where you live, learn, work, and play determine not just your life course, but your very health. This fundamental understanding motivated her to first become a nurse, and then to do her part to change the trajectory for people from neighborhoods like hers.

McNeal knew that to help those in such neighborhoods, she needed to bring health care to the residents. Her early work in this area included mobile health van initiatives in hometown Philadelphia as well as Newark, NJ.

As is so often the case, with a solution came further challenges. While the van approach was effective, barriers remained. “We had to coax people to come into the van,” McNeal says. “They didn’t trust us right away.”

More specifically, with that “drive by” strategy come issues related to the service not being a part of the community. Ideally, a service would provide care in the community, in places clients already frequent.

Eventually McNeal moved to Los Angeles, home to many of the same urban health problems she knew so well. In the city’s Watts neighborhood, the average life expectancy is significantly lower than that of neighboring areas. When she learned of Watts’ health conditions and lack of health care options for residents, she built on what she’d already learned in seeking ways to improve on the mobile health clinic concept.

McNeal found an affordable solution in going straight to community institutions and finding partners. Reaching out to local churches, community centers, and the Salvation Army, she arranged to set up a nurse-managed clinic at those locations on different days. Later she incorporated telehealth, bringing even greater ease and efficiency to provider–patient interaction. With that added service and the community partner-provided space, nurse practitioners either showed up in person at the clinic or interacted remotely with clients via telehealth channels.

How does McNeal staff the clinic? Once again, with creativity. As part of their nursing curriculum, nursing students from L.A.’s National University work on-site at the community locations. In addition, a multidisciplinary team of health professionals—including those in informatics, public health, and other allied health professions—contribute to the design and implementation of the initiative. Aside from the hard work of McNeal and others, the health care delivery innovation was made possible by a $1.5 million federal grant from the Health Resources & Services Administration to provide health care for those currently underserved and uninsured.

Ultimately, McNeal hopes to show that the delivery-of-care model results in her patients leading healthier lives. She also intends to demonstrate the cost savings that come through the partnership of community organizations, a diverse health care team, and the use of telehealth. The model is both scalable and replicable.

“The mobile clinic was great when we started 20 years ago, but it was time to improve on the model and disrupt the way care was delivered,” says McNeal. “By creatively engaging new partners, health professionals and employing technologies that hadn’t existed years ago, we are able to serve some of those hardest to serve, in particular uninsured men.”

As McNeal speaks, you can sense her drive to continue pursuing her dream to improve the lives of those in communities similar to where she came from. Who knows what health care delivery breakthrough she’ll think up next.

A version of this story appeared on AARP.org. McNeal was recently recognized for her work by the AARP Public Policy Institute’s Culture of Health initiative. 

The post From One Coast to Another, Nurse Brings Health to Neighborhoods In Need appeared first on Campaign for Action.