When I recently told a female cardiologist that I was a nurse practitioner (NP) and the director of a nurse managed health center (NMHC), she responded, "Great!! I think that's where we are going to see all primary care in the future." I was not prepared for her subsequent remarks acknowledging the expertise and value of NPs, and our capability to manage a practice. Her immediate response (she didn't even take time to think about her words) was affirming to me and what I do. She was one less foe in the battle for greater equity in practice!!
I have only worked in college health as an NP. My first position in a physician-run center that actually functioned as a self-insured health maintenance organization was strenuous. Working long hours and seeing what seemed like hundreds of patients a day, I thought I was practicing independently because most of the time, the physicians were not present. What an eye opener when I changed positions and moved to Pace University and its NMHC!! I did not realize just how restricted my practice had been until I observed NPs at Pace making clinical and business decisions, advocating for greater autonomy from physician supervision, and executing changes in the healthcare system.
Flexing Our Muscles
In 2002, after Drexel University opened a large $3.3 million nurse-run facility, the Philadelphia Business Journal1 reported, "Nurses are flexing their medicinal and managerial muscles these days. In the process, they're changing the healthcare landscape. [They] enable highly trained, educated, and licensed nurses to transcend traditional nursing responsibilities and examine, diagnose, counsel, and prescribe medication for patients, often in low-income communities." The writer admonished readers to not always ask for a doctor but to instead ask, 'Is there a nurse in the house'?
In 2005, the Senate Committee on Appropriates (Bill H.R. 3010) reported, "The Committee recognizes that NMHCs serve a dual function in strengthening the healthcare safety net by providing healthcare to populations in underserved areas and by providing the clinical experiences to nursing students that are mandatory for professional development. Recognizing that NMHCs are frequently the only source of healthcare to their patients[horizontal ellipsis]the Committee encourages Health Resources and Services Administration to research the effectiveness of nurse managed health centers as a national model to reduce health disparities."
We Must Persevere
These are powerful testimonials to the important role NMHCs play in providing care to the nation's people, especially poor, underserved, and at-risk populations. However, because many NMHCs were and are started through grant funding, the eternal struggle to generate sufficient revenues to ensure financial viability and long-term sustainability remains.
Nurse practitioners must be innovative in finding ways to continue practices in areas of high need.
Nurse practitioners must be innovative and entrepreneurial in finding ways to continue these practices in areas of high need. Organizations such as the National Nursing Centers Consortium and the Institute for Nursing Centers (formerly the National Network of Nurse Managed Health Care Centers) are demonstrating the power of speaking a common language when NPs and NMHCs unite. Write, e-mail, phone, or visit your lawmakers to request adequate and fair funding amounts for NMHCs and community health centers. Access to quality healthcare cannot become a privilege to a limited few in America.
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