Practice Makes Perfect: Nursing Students, Faculty Partner with Free Clinic

Posted: April 18, 2011 at 1:01 am, Last Updated: April 15, 2011 at 4:48 pm

By Leah Kerkman Fogarty

Meagan Ulrich, executive director of the Jeanie Schmidt Free Clinic; Brigid Corcoran, CHHS nursing student; and PATH program director Kathy Dickman work together at the clinic’s Herndon location. Photo by Laura Sikes

In this economy, millions of people in the United States are living on the edges of poverty, forgoing doctor’s visits in order to buy groceries.

Take one patient of the Jeanie Schmidt Free Clinic (JSFC) in Herndon, Va. She sends the majority of her paychecks from her three restaurant jobs back to her family in Thailand.

She was doing fine until one of her employers cut her hours and dropped her health insurance. She was recently diagnosed with cancer, but with the help of her health care providers at the clinic, her prognosis is good.

For this patient — and the thousands of others who lack health insurance in Fairfax County, Va. — the no-cost health care from free clinics such as the nurse-run JSFC are godsends. But in a declining economy, these clinics have seen a dramatic increase in the need for their services.

That’s where Mason’s School of Nursing comes in. With a $1.6 million grant from the U.S. Health Services and Resources Administration, the College of Health and Human Services established the Mason Partners for Access to Health Care (PATH) program last fall.

Mason PATH is a faculty practice plan that includes nurse practitioners providing primary and mental health care, nurse educators providing patient education and nurse researchers evaluating clinical and behavioral outcomes. In addition, the five-year grant offers graduate and undergraduate nursing students opportunities for service-learning experiences.

Through this one-of-a-kind partnership, Mason faculty members provide services to JSFC patients every Friday, functioning as a clinic-within-a-clinic.

“I think this collaboration is fairly unique,” says Meagan Ulrich, executive director of the clinic. “I haven’t heard of any other university–free clinic partnerships like this before.”

Says Robin Remsburg, director of the School of Nursing and associate dean in CHHS, “It provides a wonderful way for faculty to maintain their clinical expertise and a super learning experience for students, but it also provides much needed services for our community.”

Helping Those in Need

Mason student Brigid Corcoran cares for one of the clinic’s adult patients, who must have diabetes or hypertension to qualify for care. Photo by Laura Sikes

In 2002, the JSFC began solely for children who weren’t going to school because their parents couldn’t afford to pay for the mandatory physicals. In 2005, the clinic opened its doors to adult patients. Last year, the clinic moved to its present location in Herndon and served 1,146 patients.

The PATH program expands the reach of the clinic, with the goal of seeing an additional 100 patients in its first year. Ultimately, the program hopes to reach an additional 300 patients a year, increasing the clinic’s capacity by 25 percent.

At the JSFC, adult patients must be uninsured, have a household income of 200 percent below the national poverty level and have diabetes, hypertension, or both. Unfortunately, there are many individuals — especially in the Herndon area, which is considered a “hot spot” for poverty — who qualify for care.

Approximately 35,000 to 40,000 residents of Fairfax County earn 250 percent below the federal poverty level and lack health care insurance. County services alone only have the capacity to serve about half of the individuals eligible for care, making free clinics like JSFC in high demand.

“I saw the resources and expertise that Mason has and the needs that the clinic had,” explains Kathy Dickman, assistant professor of nursing at Mason and director of the PATH program.

“The clinic couldn’t stay open five days a week because it lacked the manpower, and Mason nursing faculty members were looking for a place to practice. This partnership just made sense.”

Providing Hands-On Learning

“I can teach students about diabetes, but when I tell the story of the patient I saw last week with diabetes and how we managed the patient’s care, that brings a richness to the classroom,” says Dickman, who has been providing patient care at the clinic nearly since its inception.

The grant provides funding for two primary care nurse practitioners and one behavioral mental health nurse practitioner from Mason. This arrangement allows for the expertise of the faculty member to be applied in a clinical setting; at the same time, those clinicians will be able to bring back real-world examples to their students at Mason.

More than 40 students will be involved during the first year of the PATH program, with that number likely to increase in future years. Nurse practitioner graduate students and undergraduate nursing students will complete clinical rotations; nursing education graduate students will prepare programs for patient education and self-managed care; and doctoral students will be evaluating programs.

“The clinic is a good opportunity for students to learn a lot about health care,” says Ulrich, noting that the clinic’s patients oftentimes have complex diagnoses, several medications and require multiple follow-up visits — all of which result in robust learning opportunities for student nurses.

Students will also treat patients who come from a wide variety of cultural backgrounds and will be better able to provide culturally sensitive care to future patients, Dickman says. In addition, the clinic will provide ample opportunities for faculty research in the future, she says.

Treating the Whole Patient

Kathy Dickman, PATH program director and assistant professor in the School of Nursing, meets with the clinic’s team of staff members and volunteers. Photo by Laura Sikes

Ulrich says the comprehensive nature of the PATH program is what really sold her on the partnership.

“They have a psych nurse practitioner working alongside the other nurse practitioners, and there’s a patient education component,” she explains. “It really is comprehensive health care.”

One built-in “best practice” for the PATH program is a mental health screening for every patient. Studies show that those with chronic conditions are at a higher risk for mental health issues, such as depression or anxiety. On top of that, patients who suffer from mental health problems are less able to manage their own care and stay healthy.

To address this vicious cycle, Dickman and her team wrote the mental health component into the grant proposal. Lora Peppard, a clinical assistant professor at CHHS who is a psychiatric nurse practitioner and engages in faculty practice two days a week at the Community Service Board, helped develop the guidelines for the behavioral health portion of the PATH program.

Patients who come up “hot” on the depression screening will immediately be given a behavioral health appointment, she says.

“What’s unique about this and what makes it an integrated care model is that behavioral health is not only co-located, but there’s a shared treatment plan,” says Peppard, explaining that the psychiatric nurse practitioner works closely with the primary care nurse practitioner.

The PATH program will also provide individual and group education programs for patients on topics such as dental care, nutrition, women’s health care and healthy living. These programs will help patients better manage their own conditions and stay healthy.

“One of the keys of quality care is that you see the same practitioner over and over,” says Remsburg.

This idea is built into the PATH program: The students working at the clinic will be supervised by their own professors and will see the same patients throughout their clinical rotation.

Perhaps the best thing about the program is that it could be easily replicated by other nursing schools.

“My hope is that Mason PATH can be a model for other nursing faculty practices partnering with community clinics,” says Dickman.

This article originally appeared in the College of Health and Human Services publication, Dimensions, vol. 17, 2011.

 

Write to mediarel at gazette@gmu.edu