The Changing Seasons
To every thing there is a season...
By the time you read this, we will have a new President-elect of the United States. At this time of year, many of us are preparing for a new legislative season not only in Congress but also in our state legislatures. As a DNP, I believe this is a perfect time to leverage our position as leaders in healthcare. We now have 21 states plus DC with full practice authority for NPs. But all nurses have potential barriers to practicing to the full extent of our education and training. As we seek to change healthcare through innovation and high-quality, cost-effective care, DNPs (APRNs and nurse executives) have the knowledge, skills, and ability to design, implement, and evaluate interventions that directly affect patient outcomes.
One of the most important ways we can create change is through partnerships, specifically through academic-community partnerships that leverage the resources of all partners. For example, colleges and universities have students who need projects and need to complete hours toward DNP degree Essentials or other degrees. Universities also have IRBs to review and approve proposed research as well as multiple departments that could provide valuable support for statistics, mapping, and intra-disciplinary collaboration. Community partners can provide healthcare settings for students and may have projects or studies that need to be completed for grant funding.
Here are some examples of how this is working in my free clinic. I work part-time in a free clinic and work part-time for a large university. I currently have two DNP students completing their DNP projects at the clinic. One is doing a diabetes outcomes project, and the other is doing a cultural competency project. I should tell you that my free clinic serves a largely immigrant population from northern Africa and the middle-east. But, we care for anyone who lives <200% FPL and has no health insurance and is without residency restrictions. Therefore, these projects are essential to providing improved care for this population and will hopefully demonstrate improved patient outcomes.
I have another DNP student who is helping to get our telehealth program up and running. I have two MSW (social work) students who provide care navigation, SBIRT, and psychosocial screening for our patients. The goal is to be able to target the patients who are at higher risk for poor outcomes. We will do this through a "hot spot" model. The identified patients will be offered home visits with telehealth support during these visits. The community health team (FNP and MSW students) will take the telehealth enabled tablet or computer into patients' homes and complete the appropriate screenings, review current medications, assess for psychosocial needs, and then utilize telehealth for a visit with the primary care provider for medication management and education.
Through academic-community partnerships, my patients have access to high-quality, cost-effective care that should improve outcomes (based on the current literatures). The target patients are part of the 5% who use 50% of the healthcare dollars. Simple high-touch interventions are able to reduce high-cost utilization of emergency rooms and adverse events related to uncontrolled chronic diseases, such as diabetes, hypertension, and hyperlipidemia. Our next step will be to complete a study to see if our interventions are successful. If so, we will approach our local hospital systems about providing affordable labs and radiology for our patients as we will be reducing high-cost ED visits our patients could not afford to pay for anyway.
Another idea is to write prescriptions for food, housing, or clothing assistance for patients who need these resources. An agreement with local social service resources would streamline the social service access for our patients through a universal screening system. For example, if a patient qualifies for our clinic, they would be qualified for the social services referral if needed. This would reduce the barriers of language and literacy challenges our patients face in accessing these services.
I realize many of these projects seem overwhelming and possibly unrealistic. However, they are working in my clinic and in many other communities around the country. When we create navigable community partnerships that focus on the patient and reduce the silos we have worked in for so long, our patients will have better outcomes, improved financial stability, be productive workforce participants, and cost our healthcare system less money.
As you read this blog, I urge you to consider the barriers to education, care, and cost in your workplace that you could change. Use this seaon of change to create partnerships and address barriers in your career. The DNP Essentials prepare us to be healthcare leaders. How will you lead?