Teaming up to serve the underserved

Nursing partnership benefits urban residents.

By Carrie Stetler

​Cindy Sickora, DNP, RN, makes sure that every weekday, the Rutgers School of Nursing’s health care van is there to help the people who need it. Its patients, mostly from Newark, New Jersey, USA, are elderly residents in buildings without elevators, gunshot victims in need of follow-up care, and children booked for vaccines in a city with one of the lowest vaccination rates in the United States.   Many are public housing residents with no health insurance or primary care doctor. Although the traveling clinic treats more than 1,500 patients a year, the city’s need for affordable, accessible health care is overwhelming.    Sickora, an associate professor at Rutgers School of Nursing, part of the former University of Medicine and Dentistry of New Jersey, was searching for a way to reach more people. She found it when she met Suzanne Willard, PhD, RN, APNC, FAAN. Both are members of the Honor Society of Nursing, Sigma Theta Tau International (STTI).   Willard had opened FOCUS Wellness Center last year on the other side of Newark. The wellness center is part of the Rutgers College of Nursing, which was founded at the university in 1955. By joining forces, Willard and Sickora hope to accomplish a shared mission: transforming urban health care.   The pair began working together as Rutgers was preparing to integrate with most of the schools, centers, and institutes that made up the former University of Medicine and Dentistry of New Jersey. Their new partnership allows the facilities to share resources and serve patients far better than they could on their own. For instance, the center has a social worker on staff for patients with mental health needs. The mobile clinic, which has no social worker, can now refer patients to the center.     “We have the potential to help a whole lot of people,” says Sickora, who directs the School of Nursing’s community health program. “Our mobile clinic can make inroads in educating people to use FOCUS, which could be a health care hub, especially for areas of the city we don’t cover.”     Nurses have a reputation for cutting through red tape and getting things done, says Willard, associate dean of Rutgers College of Nursing’s advanced practice program. “There is a solidarity among nurses.”   The center’s first patient was a referral from Sickora. The mobile clinic staff, which couldn’t provide gynecological exams at the time, sent her to FOCUS. “Cindy said, ‘I’ve got someone who’s had problems accessing services, and your center would be perfect,’” Willard recalls. Days after the visit, mobile care nurses checked in on her at home to make sure her symptoms had subsided.    Newark has one of the most underserved populations for basic health care in the United States. Many residents lack reliable transportation and must take multiple buses to see a primary care doctor, if they have one at all. Some wait days, even weeks, for appointments. Others are prescribed expensive medication they can’t afford.   Studies show that nurse-managed care can be just as effective as physician-administered care, according to Willard and Sickora. Nurse-managed care is especially successful at providing treatment continuity—as well as a personal touch—at a much lower cost. “Our approach is more holistic,” Willard says. “Nurses look at patients and think of their overall ability to improve health outcomes; that’s how we’re wired. We ask, ‘What do I need to do to help them take care of themselves when they leave?’ We want to keep them out of the emergency room.”   The FOCUS Wellness Center, funded with federal and local grants, is designed to meet the multifaceted needs of patients who are often grappling with mental health issues and neighborhoods filled with violence. These issues aggravate conditions such as diabetes, hypertension, and asthma that are common throughout inner cities.   Willard recalls one patient who said her father had been murdered when she was 7. “I thought, ‘How can you just treat the physical symptoms with a patient whose father was killed in front of her when she was that young?’ We have a lot of case histories like that,” Willard says.   The nursing school’s mobile clinic is part of a larger network, based on a pioneering health care model, in which residents work closely with nurses, Sickora says. The nerve center of the program is Rutgers’ Jordan and Harris Community Health Center, headquartered at the Hyatt Court public housing complex in Newark. It’s staffed by two nurses who make house calls to shut-ins and serve as liaisons between patients and outside health care providers.   Community health workers in Sickora’s program are trained to pinpoint residents in need, schedule appointments, and coordinate follow-up care. “They knock on doors. They’ll say, ‘We need to make sure the babies get their measles vaccine.’ They’re the reason we’re able to see so many patients,” Sickora says.   She and her staff, which includes nursing students, have worked hard to form relationships with residents, many of whom rely on them to treat chronic conditions.    During a recent physical exam, Andrew Jackson was diagnosed with high blood pressure. Since his Medicaid was cut off last year, he’s made weekly visits for checkups and advice. “They tell me to go slow on the salt,” says Jackson, 42.   No other mobile health care program in the nation, according to Sickora, uses the community health worker model, which she believes can be a valuable source of data for researchers. Two nurse scientists are already involved in evaluating programs.    Says Sickora, “We’re really asking the question: Can we change health care for underserved populations?” RNL   Video   Published 9/19/2013, Vol. 39, No. 3