Nurses, using this 40-foot mobile medical clinic, go into the community to to promote access to care, reduce food insecurity, and improve health outcomes in two nearby underserved communities. Photo credit: OSF Saint Francis Medical Center.

It is well known that nurses offer diagnoses, treatments, compassion, and care where they work and where they live. What is less known is that, increasingly, nurses are creating and participating in large-scale, systemic efforts to take on health equity by addressing needs before they become illnesses.

In this Q&A, Jo Garrison, DNP, RN, NEA-BC and Susie Smith, MSN, RN, of OSF HealthCare, St. Francis Medical Center, in Peoria, Illinois describe such an approach. OSF Saint Francis received the 2019 American Nurses Credentialing Center (ANCC) Magnet Prize for its novel, multifaceted initiative to reduce food insecurity and improve health outcomes in the community.

Please describe or give an overview of your project.

OSF HealthCare Saint Francis Medical Center created a six-part program that goes beyond the traditional bricks and mortar of a hospital, and is designed to improve social determinants of health—specifically, to promote access to care, reduce food insecurity, and improve health outcomes in two nearby underserved communities.

To do this, we have combined faith community nursing; a mobile free clinic; community gardening; assessments of food insecurity; and the education of nurses and children. These efforts together let us meet patients where they live and transform the health of their communities.

Each of the six components of the program was designed based on research of community needs:

Faith Community Nursing

The faith community nurses partnered with more than 35 churches in two ZIP codes to be an advocate, liaison, and resource for residents while focusing on the intentional care of the spirit. An affiliation with the local faith-based organizations was important because our prior efforts to engage this population had been unsuccessful. Residents had been seeking out their churches for assistance, which allowed our nurses to perform needs assessments, provide education, advanced care planning, and one-on-one consultations to individuals.

 These partnerships bridge the gap between the community and our health system by building trusting relationships.

OSF CARE-A-VAN

Our nurses provide free care up to three times a week at different drop-in sites in our CARE-A-VAN. This 40-foot mobile medical clinic, outfitted with clinic rooms, offers people at local community agencies and churches access to providers, as well as dentists and financial counselors. Partnerships with University of Illinois College of Medicine and other local colleges have helped to expand the number of clinics in recent years.

Community Surveys

We surveyed the community for levels of food insecurity and the use of the Supplemental Nutrition Assistance Program. Using the two-question Hunger Vital Sign, drawn from USDA’s food security scale, we found a prevalence of food insecurity. Despite having governmental assistance for food, 85% of the respondents of reported there was a time in the last year their food ran out and they were unable to buy more.

Educating Nurses

We sought to determine what ambulatory nurses knew about food insecurity, its impact on overall health, and the prevalence in our own community. The nurses surveyed had limited knowledge of how to assess for food insecurity. This presented the opportunity to educate nurses on the importance of identifying social determinants of health.

A Community Garden

Over two acres of city lots have been transformed into gardens.

This community had a lack of access to fresh fruits and vegetables. OSF St Francis hired a gardener and, through partnerships with the city of Peoria; the park district; local schools; and other community agencies, over two acres of city lots have been transformed into gardens and produce is being distributed directly to residents and to local community agencies. Volunteers from OSF, local colleges, schools, and churches volunteer their time to tend to the garden. Our mission partners—fellow employees at OSF St Francis—have also taken an active role in fundraising for this initiative.

Educating Children

To encourage healthy behaviors, we developed a four-part educational series to educate children on gardening skills, health and wellness, and stress management techniques. We are partnering with local schools to include this education as a yearly field trip.

Why did you decide to take your health care efforts on the road?

When it comes to access to health care, emergency department data showed a great disparity between well-off communities and people living within two local ZIP codes. When we dove deeper into the data, we identified 10 out of the top 12 reasons for emergency department visits were for primary care diagnoses, not emergency care needs—and that these visits also were losing revenue for our organization.

While there was a lack of grocery stores and medical facilities in these communities, our surveys also identified multiple churches and faith-based organizations in the area. This made us look at how we could go into the neighborhoods where people work, live, pray, and play. We decided to restructure an existing Faith Community Nurse Program to target those ZIP codes.

What made you realize that your community needed a public garden?

Despite obvious reasons of no grocery stores and lack of fresh fruits and vegetables at community agencies, the data in the literature spoke to us. In 2017, 40 million Americans experienced food insecurity—including more than 12 million children. The overall national rate was 12.5%. While Illinois was lower than the national average overall, the state was 5 percent higher for children than the national average at 17 percent. That’s roughly a half a million children in Illinois who lacked consistent access to food in 2017.

More concerning was that in Peoria County we exceeded both the national and state rates for food insecurity both overall and for children. Our overall rate was 14.3 percent, and for children it was 17.7 percent—that’s 7,860 children in Peoria County who lacked consistent access to food.

The garden is more than a community garden. It is a partnership with many local community agencies, churches, universities, and governmental entities such as the local health department and city of Peoria along with community members. It is a garden where local community events are held to promote wellness and provide school and dental physicals and education to the community. This past year, over 10,500 pounds of fresh fruits and vegetables were distributed to the community and local senior agencies. Over 1,100 volunteer hours were reported.

We hope to continue to grow this initiative this next year, with a large focus on beautifying the neighborhood; promoting behavior change; educating children and adults; and improving overall health outcomes.

Describe the journey you took to get from those decisions to where you are today.

The word journey is an excellent word to describe this project. We started with the revamping of the Faith Community Nurse Program and the CARE-A-Van in 2016. When we look back, it is amazing what has been accomplished in a relatively short period. When we started, we had a vision of taking care of patients in their own neighborhoods, providing access to care, and demonstrating care and compassion to an area that had a clear disparity compared with other neighborhoods. With the help of many outside of our local health care system, we have been able to deliver a comprehensive program far exceeding our first expectations.

Each year, the CARE-A-VAN visits grow, simply by parking the van in various areas within the neighborhood. Trusting relationships have been built and partnerships continue to grow. We have also seen a reduction in emergency department visits from these two ZIP codes. More important, people are getting care in these areas and we are excited that this work is positively impacting social determinants of health.

How did you feel when you heard that OSF Saint Francis was going to be the 2019 winners of the ANCC Magnet Prize?

Amazed. Excited. Proud. Those are the top three adjectives that come to mind. It was an incredible honor and privilege to be acknowledged with the ANCC Magnet, and receive the Cerner award. Being an OSF SFMC employee, we recognize the benefit of working at OSF for a variety of reasons but most important, its strong mission that never changes. This project is an example of Mother Frances Krasse’s words, “Serve the poor with the greatest care and love, and God’s blessings will be with you.” This prestigious award exemplifies this blessing and we are thrilled to have received it.

What impact has winning this award had on your project?

The impact has been tremendous.

Our hope the awareness of winning the award will encourage others to replicate the project and help the underserved populations in our country.

Since winning, we have been contacted by several organizations for benchmark information.

Within our own community, it brought awareness to more people who would like to participate, assisting us in a stronger sustainability plan. The money won from the grand prize will provide the funding for a greenhouse, a shelter in the garden, and the implementation of the SMART Meals program. In addition, the recognition provided validation to continue to do what is good and right, and follow the OSF mission as our guide. This demonstrated that working collaboratively together, we can make a huge difference in the community and the lives served.

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

We are very proud to be part of an organization that cares so much about the community and the people served. Most important, we are proud to see we are making changes for the good, affecting—every day—the lives of those served and those volunteering. It is my hope this has renewed a sense of purpose, care, compassion, and faith in our country to continue to work together to improve overall health.

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

Get involved! If you do not get involved, change will not occur. Realize you CAN make a difference. You can make a bigger difference if you recognize the importance of collaboration with other entities and people from other disciplines.

And we need to openly acknowledge the disparity among people in our country when it comes to the social determinants of health. If we do not address the social determinants of health, we are fighting an uphill battle to improve overall health.

Nurses are caregivers and have an innate quality wanting to help people. It is part of who we are. Nurses have always led by example in their actions of demonstrating care and compassion. Get your families involved. Call on your community. Be the change to replicate. Make a difference! The rewards and blessings are well worth your journey!

The post Hospital Bridges the Gap by Going Into the Community—Strategically appeared first on Campaign for Action.

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

Tracey Smith, DNP, PHCNS-BC, MS, is associate professor of family and community medicine and director of population health and community outreach at Southern Illinois University School of Medicine. She is vice president of the Carlinville, Ill., school board. Photo credit: Carrie Harris Photography.

When nurse Tracey Smith, DNP, MS, PHCNS-BC, began thinking about board service, it didn’t occur to her that the local school board could use her talents. But while serving on the board of the Carlinville Area Hospital in Illinois, she began collaborating with her city’s superintendent of schools to address student health. The school board president recognized the value of Smith’s nursing perspective, and in 2015, invited her to apply for an open board position. By then, she realized that having a nurse serve on a school board made perfect sense.

Since joining that Carlinville school board, Smith has found no shortage of ways to contribute. In conversations about how schools should handle student anxiety and medication, she has helped board members step back to consider what schools should look for when hiring a school nurse. In debates about recess, she has advocated that students with anxiety and attention deficit hyperactivity disorder should not be denied the opportunity to be active or outside.

“I bring the conversation back to the science,” says Smith, associate professor of family and community medicine at Southern Illinois University School of Medicine. Smith explains that her research-based perspective can ground conversations when personal opinions conflict.

In addition to understanding the science, nurses are particularly suited for addressing the health challenges schools face, Smith believes, because they take a systems approach. “Nurses are required to study the relationship between community and health,” Smith says, “so they bring a very important big picture mindset.”

Sometimes seeing the big picture actually requires focusing on a single objective. In debates about physical education, for example, Smith says the discussion can get bogged down in distracting issues such as the rules about what students should wear. “In a case like this,” says Smith, “my contribution is to remind everyone of the physical outcome we want. Kids need to be more active, so how can we make that happen at school?”

At other times, a systems approach requires stepping back to see all the moving parts. Smith says this approach is useful in dealing with the complex issue of trauma. “As a nurse, I know to look at the whole child and to include the family,” Smith says, “because in nursing, we take a holistic view of how family and community affect health.” For kids who have experienced trauma, Smith argues for bringing in the right mental health professionals and for training teachers and administrators in trauma-informed approaches to education. “These approaches should include having knowledge of families and a willingness to collaborate with them,” Smith adds.

Of her future plans as a school board member, Smith says she hopes to improve health care-related professional and vocational training in Carlinville schools. The effort could be a win-win for students and for a community in need of more health care personnel. To this end, she worked with the Carlinville Area Hospital to develop the High School to Health Care Club, which allows students to participate in training and shadow selected health care professionals.

This kind of planning, explains Smith, is an example of the value big picture thinking can bring to school boards, especially in rural areas. “We need people like me to help bridge these worlds,” she says, “because we don’t want to lose kids to the city, and no one wants to live in an area without health care.”

The post Nurse Brings Big Picture Mindset to School Board appeared first on Campaign for Action.

Problem Statement: A small group of Illinois nurses from public health, schools of nursing and the Illinois Healthcare Action Coalition identified the need to focus nursing practice on the health of populations, to improve health outcomes and advance the nursing profession.  A modified version of the Robert Wood Johnson Foundation nursing enumeration survey was sent to nursing faculty and local health departments in Illinois. We found that while public health nurses with a population focus were needed in practice, schools of nursing were struggling to find clinical sites offering a population focused experience. In 2015, the group unified around a vision to encourage academic-practice partnerships to build a better prepared nursing workforce through student projects promoting positive health outcomes for the populations served by health departments and community agencies; thus, empowering baccalaureate prepared nurses to practice population health in their chosen area of practice.

Approach: The American Association of Colleges of Nursing, Academic-Practice Partnership toolkit was used as guide to support five partnership pilot projects throughout the state during the 2016 fall and 2017 spring terms. With funding from the Robert Wood Johnson Foundation and Illinois Nurses Foundation, projects included improving immunization rates, preventing asthma episodes, reducing stress in the workplace and preventing sexually transmitted infections through education to providers and high school students.

Products/Outcome: The individual projects were reported as valuable by the students, faculty and community health departments and other project sites. They reported greater insight and understanding of population focused nursing experiences and enhanced progression of projects. A statewide conference is scheduled for October 20, 2017 and the Illinois Nurses Foundation refunded additional partnership projects during the spring term, 2018.

Implications: Academic-Practice Partnerships prepare our future nurses for population health management regardless of their chosen area of practice, and promote improved health in the communities they serve

The post Implementing Successful Public Health Nursing Academic-Practice Partnerships appeared first on Campaign for Action.

Consumers in Illinois will soon have better access to the care provided by advanced practice registered nurses (APRNs), thanks to a new bill signed into law on September 20 by Gov. Bruce Rauner. The law, which will go into effect on January 1, 2018, is expected to increase Illinoisans’ access to highly skilled nurses, particularly in rural and underserved areas.

The change enables APRNs who work outside of hospital settings and meet certain conditions to practice without a written agreement with a physician. However, APRN’s ability to prescribe certain medications will remain limited, making this change only a partial victory for consumers.

Beginning next year, APRNs who have completed 4,000 hours of clinical experience with a physician and 250 hours of continuing education will be able to practice without a written agreement with a physician. But they will still be required to have a written agreement with a physician in order to prescribe certain medications that have a high potential for abuse, such as opioids. The measure passed unanimously by the Illinois House and Senate before it was signed by the governor.

Ricki Loar, president of the Illinois Society for Advanced Practice Nursing, said in an interview with NPR Illinois that the newly signed measure will allow more people to get treatment they need. AARP Illinois was among the bill’s supporters.

With this step, Illinois joins the ranks of many other states that are making it easier for people to get the care they need from nurses.

“While more work still needs to be done to ensure that all Illinoisans have full access to the care provided by APRNs, the passage of this law is a big step in the right direction,” said Winifred V. Quinn, PhD, director of advocacy and consumer affairs at the Center to Champion Nursing in America.

The post Illinois Takes a Step Toward Better Health appeared first on Campaign for Action.

The post What Non-Nurses in Illinois Need to Know About the Importance of Nurses in Health Care appeared first on Campaign for Action.

Find the report that summarizes the findings below. Appendix A lists the questions asked in the survey.

The post Illinois Advanced Practiced Registered Nurses Workforce Survey appeared first on Campaign for Action.

It’s called The Surplus Project, and in 2016 alone, 6,000 pounds of food bound for landfills has been turned into 5,600 meals served at food pantries.

It started in spring 2015, when Grenier was director of telemetry at Rush Oak Park Hospital, overseeing the hospital’s use of specialized equipment to monitor patients. Equally important, she was part of a local leadership program that asked her to create a project that met a community need. Her partner in brainstorming was Beth Klein of the Oak Park River Forest Food Pantry. Grenier knew that a number of patients came to the hospital hungry. Thus was born The Surplus Project.

Grenier and Klein started with the kitchen at Rush Oak Park Hospital, where sandwiches, vegetables and lasagna were among uneaten edibles that were routinely tossed. Support from all quarters was strong and immediate: Giving time and money was none other than the hospital’s president and CEO, Bruce Elegant. Now, some 20 staff members certified to handle food are volunteers helping package the meals.

An unexpected bonus, says Grenier, is that it has brought staff members together; a nurse might exchange a high-five with, say, a dishwasher after they’ve spent time tucking cooked carrots and rice into boxes to be delivered to the food pantry.

Another unplanned benefit was how naturally The Surplus Project evolved so that nurses came to offer health screenings with the meals.

Grenier soon learned that those who are “food insecure” are not necessarily homeless or unemployed. For people who struggle to make ends meet, food goes on the list of what can be cut for the day. And those who eat what they can, when they can, are also at greater risk of developing health problems such as diabetes and hypertension.

That’s why nurses decided to start delivering, along with the meals, blood pressure screenings, nutritional assessments, and body-mass index calculations. When food is served, RNs on The Surplus Project team stand by, literally, to answer health care questions.

The Project Expands

Oak Park River Food Pantry executive director Michele Zurakowski has been involved from the start, and she, along with nurse-entrepreneur Grenier and Klein, this past February wangled the top prize of $50,000 at the Big Idea Pitch Party sponsored by Oak Park and River Forest Community Foundation.

Needless to say, the money joins the cycle of making good use of good resources. To waste less, feed more, Grenier and Klein had been eyeing other kitchens and other places serving meals. Eighteen months after the start of The Surplus Project, three others have joined the hospital as food donors (including a local grocery store and high school), providing meals to a total of five sites.

Grenier has been taking on more, as well. Six months ago, she became director of nursing rehab at Rush University Medical Center (which, she notes, has 15 kitchens—15 more opportunities to make use of food). A board member of the Illinois Organization of Nurse Leaders, Grenier was named a 40-Under-40 Emerging Nurse Leader by the Illinois Healthcare Action Coalition.  And, by the way, she is getting her doctorate degree, in system leadership.

Grenier considers this project to be a logical aspect of nursing and good health. “We make sure patients have their medications, their medical supplies, etc. But we never ask, ‘Do you have enough food in order to heal properly’?”

With The Surplus Project, Grenier and others in Chicago are providing needed answers.

The post Nurse Turns Surplus Into Better Health appeared first on Campaign for Action.

Continuing education units will be offered to all after requirements are met and are provided by the Illinois Nurses Foundation and ANA-Illinois.

Registration is open now. To learn more, visit the ANA-Illinois website: http://www.ana-illinois.org/

The post Leadership Webinar Features NOBC Head, 2 Emerging Leaders appeared first on Campaign for Action.

• Distribution of population by race/ethnicity
• Percentage of population living in rural versus urban areas
• Distribution of population by federal poverty level
• Areas in which there is a shortage of primary health professionals

These statistics can guide your Action Coalition’s work in shaping a nursing workforce to better meet local needs and overcoming health disparities in your state. As you integrate other Culture of Health aspects into your work, consider how demographics play a role in health equity and fostering cross-sector collaboration.

The post Demographic and Workforce Facts appeared first on Campaign for Action.