Nurse-managed Health Centers Research Articles

Toward a national nurse-managed health center data set: Findings and lessons learned over 3 years

Although primary care nurse-managed health centers (NMHCs) have gained increasing recognition, there are limited standardized clinical and financial data on these centers. The purpose of this paper is to present the process, benefits, and challenges in collecting standardized national data based on a consensus process from NMHCs over 3 consecutive years. The Institute for Nursing Centers (INC) NMHC Survey focuses on demographic, clinical, and financial data. A detailed codebook accompanied the INC NMHC Survey. A total of 42 NMHCs responded in at least 1 of the 3 years. Despite the challenges in collecting some of the data, especially for the first survey year, data quality improved remarkably when the INC NMHC Survey was repeated. Financial data seemed to be more easily reported than demographic or clinical data. NMHCs increase access to care, often for vulnerable populations, yet to date there are limited standardized clinical and financial data on these centers. The INC NHMC Survey and data described in this paper begins to address that gap.

Insurers' Contracting Policies on Nurse Practitioners as Primary Care Providers

A national survey showed that nearly half of all major managed care organizations in the United States refuse to credential nurse practitioners as primary care providers. In nurse-managed health centers throughout the country, nurse practitioners provide primary care to underserved populations with similar outcomes to primary care physicians. Insurers' prohibitive credentialing and reimbursement policies reduce these centers' capacity for growth and, in turn, threaten the long-term sustainability of a key component of the health care safety net. Two years after conducting a national survey of insurers' credentialing and reimbursement policies regarding primary care nurse practitioners, researchers returned to the subject matter and found that many of the same financial barriers to nurse-managed health center sustainability still exist. Although some progress had been made since 2005, this progress did not appear to be attributable to regulatory changes or renewed enforcement of existing laws.

Evaluation of a Telephone Advice Nurse in a Nursing Faculty Managed Pediatric Community Clinic

Introduction Nurse-managed health centers face increasing obstacles to financial viability. Efficient use of clinic resources and timely and appropriate patient care are necessary for sustainability. A registered nurse with adequate education and support can provide high-quality triage and advice in community-based practice sites. The purpose of this program evaluation was to examine the effect of a telephone advice nurse service on parent/caregiver satisfaction and access to care. Methods A quasi-experimental separate pre-post sample design study investigated parent/caregiver satisfaction with a telephone advice nurse in an urban pediatric nurse-managed health center. The clinic medical information system was used to retrieve client visit data prior to the service and in the first year of the program. Results Statistically significant differences were found on two items from the satisfaction with the advice nurse survey: the reason for calling ( P < .05), and the importance of being involved in decision making ( P < .05). Discussion A telephone advice nurse may increase both parent/caregiver and provider satisfaction and access to care.

A 10-Year Review of Four Academic Nurse-Managed Centers: Challenges and Survival Strategies

Since 1985, there has been rapid growth in nurse-managed health centers (NMHCs). Many were established by academic schools of nursing, and several have closed. The Independence Foundation undertook this study to identify the challenges and survival strategies employed by four academic nurse-managed center grantees during a 10-year period. Data from Foundation records, interviews with directors and staff from the centers and the National Nursing Centers Consortium, a focus group with center founders, and field notes were analyzed for themes related to the centers' challenges and survival strategies. Although the centers faced many challenges from the sociopolitical environment, the community, and their parent organizations, the most difficult challenge was achieving financial sustainability, which was attainable only by obtaining cost-based reimbursement. Because of existing health policies, that was possible only through organizational restructuring and affiliation with an existing federally qualified health center. The future of nursing centers depends upon favorable health policies, data documenting centers' effectiveness, and adequate preparation of the next generation of nursing center directors and practitioners.

Insurers’ Contracting Policies on Nurse Practitioners as Primary Care Providers: The Current Landscape and What Needs to Change

A national survey showed that most insurance companies refuse to credential nurse practitioners as primary care providers in nurse-managed health centers. These prohibitive policies, along with weak federal and state laws, threaten the long-term sustainability of nurse-managed health centers as safety-net health care providers and limit the ability for nurse practitioners to become an accepted primary health care source in the United States. Interviews with national managed care organizations revealed that these companies' current business practice and policies are unlikely to change without regulatory change at state and/or federal levels.

National consensus on data elements for nurse managed health centers

This report presents a summary of the findings from the National Network for Nurse Managed Health Centers Data Consensus Conference. Nationally, nurse-managed health centers are increasingly offering communities another option for access to high-quality primary care. The lack of agreed upon, standardized data elements for these centers has limited the ability to present clear information about their contributions as well as to inform policy related to their support and development. Fifty-three national invitees came to consensus in Washington, DC on the critical data elements for a national database for nurse-managed health centers. This database includes both clinical and financial/business practices elements. Consensus was not reached around some clinical areas. These areas are briefly discussed as well as the plans for next stages of data collection.

Nurse Managed Health Centers: Strengthening the Healthcare Safety Net

Nurse Managed Health Centers: Strengthening the Healthcare Safety Net

Nurse-Managed Health Centers

F or more than a century nurses have been at the forefront of providing health care to populations with limited access to care and of addressing unmet health care needs of communities. When health care needs are unmet, somewhere a nurse rises to the occasion and takes care of it. Such names as Florence Nightingale, Lillian Wald, and Margaret Sanger remind nurses of our roots in the community and in the care of underserved populations. Hanging on the wall of my office is a quote, given to me by a dear colleague as we embarked on the opening of our first nurse-managed health center (NMHC): ‘‘I look forward to the day when there are no nurses to the sick but only nurses to the well,’’ Florence Nightingale, 1893. It drives a personal practice philosophy that provides professional rewards each day when I leave our NMHC knowing that I have made a difference in the health of at least one client. Despite the wealth that exists in the United States, disparity in health exists with regard to socioeconomic status. Health care is big business and is not a ‘‘right’’ of each individual. This disparity exists across the lifespan, but it is particularly evident for the working poor: men who are considered ablebodied, who work every day, but at jobs that offer no access to health insurance and barely enough money to care for their family’s basic needs; women who as head of households lead lives so chaotic that they often are forced to chose between coming for health care or providing food on the table for dinner; and countless other disenfranchised groups.

The Nurse-Managed Health Center Safety Net: a Policy Solution to Reducing Health Disparities

Nurse-managed health centers are critical safety net providers. Increasing support of these centers is a promising strategy for the federal government to reduce health disparities. To continue as safety net providers, nurse-managed health centers need to receive equal compensation as other federally funded providers. Ultimately, the long-term sustainability of nurse-managed centers rests on prospective payments or similar federally mandated funding mechanisms.

Ethical Considerations for Nurse-Managed Health Centers

Ethical issues are commonplace in the health care delivery system. Nurse practitioners (NPs) working in nurse-managed health centers (NMHCs) frequently care for patients who are vulnerable and marginalized as a result of their culture, language, low income, or lack of insurance. Because a nurse's commitment is to care for patients without considerations of social or economic status, personal attributes, or the nature of health problems, the distress that occurs while advocating for patients through and around existing barriers to health care access needs to be anticipated and addressed.

Strengthening an academic nursing center through partnership

Nurse-managed health centers offer holistic health care and patient-centered health promotion and disease prevention. These goals are particularly well suited to the needs of children and their families. Few reports in the literature, however, have described such practices. The purpose of this paper is to describe one practice, Valencia Health Services (VHS), a nurse-managed, academic health center providing primary care to pediatric and adolescent patients. Valencia Health Services offers interdisciplinary, comprehensive health services to ethnically diverse children and their families through an inter-university partnership and provides clinical experiences and research opportunities, under the supervision of expert faculty-clinicians, to students of nursing (advanced practice, public health, and case management), social work and psychology. Valencia Health Services is the rare nurse-managed academic health center that provides comprehensive health care to children and adolescents. The multifaceted demands of such a health center, however, present both unique opportunities for quality care and service and considerable ongoing challenges.

The Alternatives for Wellness Centers: Drown in Data or Develop a Reasonable Electronic Documentation System

Measuring and quantifying the outcomes of care are becoming essential activities for the ongoing operation of nurse-managed health centers. Centers need a data collection system to collect meaningful data that assist with the development of programs and services, measure clinical outcomes, and promote health policy. Accomplishing these objectives is especially difficult in a health and wellness setting designed for an aging population. When tracking the care process over time, it is possible to drown in the data, especially qualitative data. This article describes the experiences of advanced practice nurses as they explored alternatives and devised a system to collect and manage qualitative and quantitative data using the Omaha System in a health and wellness setting for older adults. To be successful, nurse managed health centers and all providers must systematically evaluate their data and information needs as well as available systems and then implement an action plan.

The Quest for Sustainability Gets Closer: CMS Funds Nurse-Managed Health Center Congressional Demonstration

In July 2002, the National Nursing Centers Consortium (NNCC) received a demonstration grant from the Centers for Medicaid and Medicare Services (CMS) to create a descriptive profile and conduct an evaluation of selected health services at 15 nurse-managed health centers. This demonstration project will begin to assess the potential of nurse-managed health centers to serve as an alternative safety net model of community-based primary health care and health promotion. A final report is due in Fall 2003.

The Quest for Self-Sustainability: Nurse-Managed Health Centers Meeting the Policy Challenge

This article describes an evolving nurse-managed health center model that works, outlines challenges to this model, and recognizes the necessity of activism and public policy change to move this model forward in the 21st century.