Financially viable nurse-managed centers

Nurse managed centers play an important role in the health service delivery system; often serving those in greatest need, while struggling to remain financially viable. This article discusses the role of a Financial Advisory Committee (FAC) and the process of financial peer review in academic nurse-managed centers to improve financial outcomes. Advanced practice nurses may find the identified strategies for financial sustainability useful in their own practices.     

Academic nurse-managed centers: approaches to evaluation

A comprehensive evaluation plan was developed to assess the outcomes of a multiuniversity project to support the development of academic nurse-managed centers (ANMCs). The evaluation included measuring ANMC impact on the clients and communities served, on students, and on the sponsoring faculties and universities. This article includes a discussion of the processes used in evaluation plan development, the variables measured, the tools developed to measure selected variables, and a summary of evaluation findings. Recommendations for use of selected evaluation components across ANMCs are presented.     

Academic-based nurse-managed centers: six key questions

A school of nursing that is planning an academic-based nurse-managed center must consider the many implications of this action. It requires a long-term commitment to the community and to the individual clients served, and time, energy, and consistent funding will be needed to maintain viability. Six key questions that must be answered are explored.     

Patient satisfaction outcomes in nurse-managed centers

Patient satisfaction remains one of the critical benchmarks of primary care delivery. Although much of the research reporting outcomes related to nurse-managed centers (NMC) has included patient satisfaction, most of the reports have been limited to individual clinical settings. This study collected satisfaction data from 7 NMCs operated by 4 different academic institutions. Results demonstrated 3 components of patient satisfaction: patient perceptions of care, phone contact, and the patient's willingness to return to or recommend the clinic. Consistent with previous research, professional responsiveness and respect and courtesy from nurse practitioners were rated high on the composite satisfaction levels from a heterogeneous sample of consumers.     

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.     

Impact of academic nurse-managed centers on communities served

PURPOSE: This paper presents findings from six community focus groups that addressed the impact of academic nurse-managed centers (ANMCs) on the overall community being served as well as the quality of care provided in the centers. DATA SOURCES: Experts in focus group methodology from a public health institute conducted the six focus groups at ANMCs from four universities in the Midwest. Discussions were guided by nine questions presented to each group. All groups were tape-recorded and transcribed. A total of 37 participants were recruited from the ANMCs and included patients and families, advisory board members, and local community organizations. CONCLUSIONS: Four themes were identified across the six focus groups: valuing patient-centered care, which included two subthemes-continuous specific provider and specific aspects of care; quality of care; increasing access to care/addressing the safety net; and evidence of outreach. IMPLICATIONS FOR PRACTICE: Findings from these focus groups verify that community members do "get it" in terms of the unique aspects of ANMCs. Participants were able to articulate the differences between nurse-managed care and other types of ambulatory primary care. The unique strengths of nurse practitioners were repeatedly articulated as well as the centers' outreach into the community.     

Education of nurse practitioners in academic nurse-managed centers: student perspectives

Clinical experiences for advanced practice nurses are increasingly a challenge. Finding settings that demonstrate primary care nursing practice in its finest form can be difficult. This article reports on nurse practitioner (NP) student feedback on clinical placements in the academic nurse-managed centers (ANMCs) associated with four Michigan schools or colleges of nursing. Student feedback was solicited over three years through site and preceptor evaluation tools and focus groups. Students were overwhelmingly satisfied with their experience in ANMCs. Being mentored by an NP preceptor in an ANMC was a valuable experience for students. They valued the role modeling of the NP and the quality of their preceptors' instruction. Students stated that the nursing model of care to which they were exposed was congruent with classroom learning. They reported learning to apply an understanding of their patients' economic, social, and cultural situations to treatment decisions and patient-education efforts and learning to understand the role of community-based care. One limitation of ANMCs from the students' perspective was a relatively low volume of patients, particularly in the initial years. However, the benefit of having time to spend with clients and to reflect on clinical practice was also articulated.     

Characteristics of schools of nursing operating academic nurse-managed centers

Academic nurse-managed centers (ANMCs) can be important sites for addressing the tripartite mission of the academy. Yet, limited information about numbers of ANMCs and the schools sponsoring them is available. This paper presents an update on schools of nursing (SONs) operating ANMCs. A survey was sent to 683 deans and directors of baccalaureate and higher-degree SONs, with 565 responding (response rate: 83%). Ninety-two SONs indicated they had one or more ANMCs. The largest percentage of the SONs with ANMCs were classified as doctoral/research-intensive or extensive universities, a proportion much higher than the national percent of SONs in this category. Schools of Nursing were financially supporting centers at a lower percentage of actual costs than was reported in earlier studies, although grants continue to be a major source of funding. Academic nurse-managed centers are likely to be supported by SONs with substantial research, practice, faculty, and student resources. Overall, the national number of ANMCs seems stationary over the past two decades.     

Providing and funding breast health services in urban nurse-managed health centers

Nurse-managed health centers (NMHCs) are an innovative health care delivery model that serves as an important point of health care access for populations at risk for disparities in health outcomes. This article describes the process and outcomes of clinical breast health services in two NMHCs located in a large Midwestern city. Findings indicate that client's knowledge about breast health was increased after they received breast health services from NMHC nurses. Significant positive changes in behavior related to the early detection of breast cancer were found in the study. NMHCs, identified for expansion in the Patient Protection and Affordable Care Act, offer a unique health care services delivery model that promotes access to care and early identification of breast cancer in very low-income and uninsured women.     

The Omaha System and quality measurement in academic nurse-managed centers: ten steps for implementation

Measuring and describing client problems, nursing interventions, and outcomes is a challenge in nursing care. This study reviews the literature about the use of the Omaha System and describes the steps used to introduce and implement the Omaha System as a documentation and outcome measurement system in academic nurse-managed centers. The goal of the article is to provide a guide for nurse educators to develop and implement a quality measurement system that can be used in clinical settings by undergraduate students. The Omaha System is a strategy to introduce and incorporate evidence-based practice in the undergraduate nursing clinical experience.     

The experiences of migrant health nurses employed in seasonal satellite nurse-managed centers: a qualitative study

This research study describes the unique experiences of nurses who are employed in migrant health seasonal satellite nurse-managed centers in the upper Midwest. Data were generated through semistructured interviews with 10 seasonal nurses. Phenomenology served as the research method. Four themes were identified including seeking seasonal employment, establishing migrant seasonal satellite nurse-managed centers, learning the culture of Hispanic migrant farmworkers, and referring Hispanic migrant farmworkers for medical care. During their seasonal employment, nurses learned to establish and operate satellite nurse-managed centers. Due to the migrant health nurses' daily contact with their clients, they were able to establish rapport that led to a trusting relationship. This enabled them to provide culturally sensitive and lifestyle appropriate care to the migrant farmworker population.     

Survival and cost analysis of fatalities of the kobe earthquake in Japan

Objectives

The authors investigated the dying patterns, and cause and preventability of deaths in a major earthquake disaster, and estimated the cost needed to enhance emergency medical services (EMS) response to prevent “unnecessary” deaths.

Methods

The authors reviewed autopsy data in the Hanshin-Awaji (Kobe) earthquake of 1995. A survival analysis was performed to determine the time course and pattern of dying of these deaths. A cost analysis to estimate acceptable cost for EMS to reduce fatalities was also performed. Potentially salvageable life-years based on expected life-years among fatalities were calculated and used to simulate an acceptable cost for an enhanced EMS disaster response.

Results

The authors analyzed 5,411 fatalities. More than 80% of these patients died within three hours. There were statistically significant differences in survival/dying patterns among causes of death. Thirteen percent of victims experienced a protracted death, which could have been prevented with earlier medical or surgical intervention. The monetary cost of these lost lives was estimated at approximately $600 million US.

Conclusions

Survival analysis revealed a significant population of potentially salvageable patients if more timely and appropriate medical intervention had been available immediately after the earthquake. Based on our cost analysis, and assuming a 1% annual probability of an earthquake and a 30% enhanced lifesaving capability of the EMS effort, approximately $2 million annually could be a reasonable expenditure to achieve the goal of reducing preventable deaths in disasters.