Three nurses. Three health centers. One conversation. Lasts week’s CHI@Home session celebrating the Year of the Nurse 2020 featured three seasoned Community Health Center nursing leaders. Together, these nurses explained how nurses should be viewed as central to the management of chronic disease, to helping patients overcome social and economic barriers to good health and the benefits of putting nurses in leadership positions.
Mary Blankson, APRN, DNP, FNP-C, Chief Nursing Officer (CNO) for Community Health Center, Inc., oversees diverse nursing and medical assistant services across the CHC Inc., network in the Middletown, CT area. As CNO, she ensures the quality and expansion of nursing and medical assistant (MA)services, the development of nursing and MA policy, and continuing nurse and MA education. Dr. Blankson spoke about her pathway to nursing and workforce innovations.
Anthony Fortenberry, RN, is the CNO at Callen-Lorde Community Health Center in New York City, which provides New York City’s LGBTQ+ community with comprehensive clinical services. Fortenberry, who was recently featured in the New York Times Magazine, oversees the nursing, care coordination, and quality programming and highlighted the steps Callen-Lorde has taken to improve metrics for reporting, especially for patients who are transgender, and to address disparities in their evaluation of quality metrics.
Nathaniel Pena, MSN, RN, CNL, Registered Nurse Care Manager at Esperanza Health Center in Chicago, IL, discussed the RN-lead insulin titration program Esperanza created to reduce barriers that patients faced related to their diabetes care.
Three overarching themes emerged:
Utilizing Nurses is an Effective Strategy
In the case of Esperanza’s nurse-led insulin titration program, nurses were able to adjust medicines and address the social and economic barriers that impact the health of patients living with diabetes. Weekly meetings provide ongoing, patient-centered health education and counseling to address barriers to healthy eating and exercise. For example, nurses were able to adjust medicines and help address transportation issues. Patients were also given a prescription for free fitness membership for three months. The result: patients that had nurse intervention vs. just saw the doctor showed the most progress in managing blood sugar levels.
Similarly, following the ECHO model from the CHC Weitzman Institute helps nurses learn more about chronic diseases to be better able to manage complex cases. “Nurses are the crux of care management,” Blankson said.
The Importance of Innovation
CHC Inc. is building nursing skills through a special curriculum for primary care and community health nursing. For example, nurses gain the leadership competencies they need to be able to reach out to external organizations as the face of the health center. Trainings also include learning about successful models of care and the roles all practitioners can play. They are also collaborating with universities in Connecticut to bring 50-60 students on site. They are keeping their eyes open for their future workforce.
For their part, Callen-Lorde ensures routine competency so that nurses stay engaged and up to date on best practices. They offer in-house educational opportunities that help build trust and allow nursing staff to take a larger role in health education. Learning about cultural humility has also helped Callen-Lorde’s nurses create a safe space for people in crisis or for patients who had traumatic experiences before in a health care setting.
COVID-19 provided an opportunity for nurses country-wide to take on new roles and functions to respond to patient care needs. Telephonic-triage alongside care management is one of the emerging nurse roles reported by these three leaders, but also throughout other community health centers. Many are looking at keeping this role in place, as it enhances care between provider visits and provides an extra access point for patients.
Organizations Need Nurses as Leaders
Leadership structures set the stage for the culture of the organization. Often it is seen that organizations that don’t have nurses as leaders don’t understand how to use nurses at the top of their scope. Organizations that have nurses in leadership roles report that it improves staff morale and fosters a collaborative work climate that is less hierarchal and more patient-centered. Nurses provide key skills in teaching and quality improvement/assurance, to name a few. It’s important that community health centers identify key ways that nurses can play a role in leading care.
NACHC is continuing to celebrate the “Year of the Nurse.” We need your help to identify nurses at health centers that we can highlight. If you would like to nominate a nurse, please do so by completing this form.