By Susan Davis
For Patricia Dennehy, RN, MS, FNP, the recent news that the US Department of Health and Human Services had given nurse-managed Glide Health Services a $1.5 million grant was nothing short of “fabulous.”
It means that “the federal government is finally recognizing that nurse-managed care can provide people with access to high-quality care,” she says. “That’s huge for nurses.”
A fully licensed community clinic located in San Francisco’s Tenderloin District, Glide Health Services sees 3,000 patients every year, 60 percent of whom are homeless. The others are often indigent or low-income and from populations that suffer from the greatest health care disparities.
Cecil Williams, founder and minister at Glide Memorial United Methodist Church where the clinic is located, says the grant is good news amid a national recession.
“What a great time for this award to come for those who are hurting and many times forgotten,” Williams says. “We know so many people who need to line up each day for our many programs, but this grant will help Glide Health Services increase access to health care by expanding services.”
Dennehy, who is the director of Glide Health Services, as well as an assistant clinical professor in the UCSF School of Nursing’s Department of Community Health Systems, has seen funding for community health services decline over the last several years. In fact, Glide has twice closed to new patients this year alone and its pediatric clinic on Valencia Street in San Francisco’s Mission District closed due to lack of funding last year.
In partnership with Catholic Healthcare West, Saint Francis Memorial Hospital, and UCSF School of Nursing, Glide Health Services is funded though grants from the HRSA Division of Nursing and the Bureau of Primary Healthcare. It is a member of the San Francisco Community Clinic Consortium, the California Primary Care Association, the National Association of Community Health Centers and the National Nursing Centers
With the new grant, Dennehy notes, the clinic will be able to sustain what it’s doing already, specializing in the training of advanced practice nurses, and other health professionals, plus add more clinicians and expand evening hours for its diverse patient population.
“We want to be able to provide more behavioral health services and substance abuse treatments,” she says, “as well as provide services to people in the community who have just started working again. Our evening hours let us do that.”
Strengthening the Primary Care Workforce
UCSF received the biggest amount of federal grant money in the UC system. In addition to the $1.5 million for nurse-managed care, UCSF received $3.84 million for its primary care residency.
The grant will enable the UCSF residency to fund two more residents per entering residency class in the UCSF Family Medicine residency program at San Francisco General Hospital (SFGH) and two more residents per year in the UCSF Primary Care Medicine residency at SFGH for a total of 20 additional residents trained overall between the two programs over the five-year grant period, according to Kevin Grumbach, MD, professor and chair of the UCSF Department of Family and Community Medicine and chief of Family and Community Medicine at SFGH.
“Both programs have an excellent track record in training primary care physicians who tend to work in community clinic settings serving underserved populations after graduating,” Grumbach says. “The $1.5 million will enhance the nurse-run primary care clinic at Glide, which is staffed by UCSF School of Nursing nurse practitioners and nurse practitioner students.”
The grant to Glide Health Services is just one of 10 grants given to nurse-managed clinics across the country. Under the Patient Protection and Affordable Care Act, a federal statute that was signed into law by President Barack Obama in March, some $320 million in US Department of Health and Human Services (HHS) grants are aimed at strengthening the primary care workforce. These measures include:
- expanding training opportunities for physician assistants, advanced nurses, including nurse practitioners and nurse midwives, and personal and home care aides;
- offering education, training and support for low-income people who want to go into health care professions; and
- developing health care workforces across the country.
“Chronic diseases, most of which are preventable, are one of the main reasons health care costs have soared over the past several decades,” HHS Secretary Katherine Sebelius said last week. “Investing in our primary care workforce will strengthen the role that wellness and prevention play in our health care system. With these grants, Americans from all backgrounds will have new opportunities to enter the health care workforce.”
In related news, Katherine Flores, MD, a family physician and director of the UCSF Fresno Latino Center for Medical Education and Research, was recently named to the new National Health Care Workforce Commission. That commission is responsible for advising policymakers on ways to improve the health care workforce to ensure the health and safety of the American people.
A New Era for Nursing
The timing of the grant coincided with Nurse-Managed Health Clinic Week when Dennehy went to Washington, DC, to give testimony to Congress on the importance of funding nurse-managed center clinics. According to the National Nursing Centers Consortium (of which Dennehy is a board member), some 250 nurse-managed health clinics currently exist in this country and they provide crucial access to health care in areas with populations who are currently underserved, including those who underinsured, uninsured, impoverished or members of racial and ethnic minority groups.
Just this week, the Institute of Medicine also released its “Future of Nursing” report, which was based on a two-year investigation of how the nursing profession needs to be assessed and transformed. Co-sponsored by the Robert Wood Johnson Foundation, the report concluded that the nation’s three million nurses can “play a vital role in helping realize the objectives set forth in the 2010 Affordable Care Act,” but that a number of barriers currently “prevent nurses from being able to respond effectively to rapidly changing health care settings and an evolving health care system.”
In response, the report concludes, a number of reforms need to be initiated, including allowing nurses to get higher levels of education, practice to the full extent of their education and training, and to be full partners “in redesigning health care in the United States.”
As founder and minister at Glide, Williams appreciates what nurses have to offer. “The nurses work on a mutual basis of being concerned and sensitive about the people who come for health care,” he says. “They seem to take more time to humanize the situation, therefore empowering the people they are working with. I am sure that the people of the Tenderloin and the nurses that are in training at our clinic will find that the future will bring many creative and enduring experiences. It is really a program for the 21st Century.”
Opportunities for Nursing Students
Currently, all nurse-managed health clinics or NMHCs are affiliated with a college or university department of nursing, a federally qualified health center, or a non-profit health or social services agency. All of the NMHCs that received HHS grant money recently, however, were affiliated with a school of nursing. Dennehy says the Glide Health Services grant will very definitely benefit students in the century-old nursing school.
“Our students will be able to focus on health education, managing chronic diseases, getting a better sense of what it takes to educate patients in the Tenderloin than in, say, the suburbs,” Dennehy says. “It gives our students a much broader opportunity to see how patients struggle to maintain their health in the face of poverty and health disparities.”
In fact, UCSF’s School of Nursing concentrates its efforts on preparing a masters-educated nursing workforce to work with populations who are least able to access health care,” says Sally Rankin, RN, PhD, FAAN, interim dean of the School of Nursing. Those populations include “chronically ill adults who are frequently homeless, mentally ill, or suffer from HIV and AIDS.”
Over the last 12 years, more than 150 students have completed more than 200 clinical rotations at Glide Health Services, Rankin says. “This grant will allow for growth of this excellent program and student exposure to the service and caring embodied by Glide Memorial United Methodist Church, a long time advocate for the needs and rights of the indigent population of San Francisco’s Tenderloin District.
Photos by Elisabeth Fall/fallfoto.com
“The Future of Nursing: Leading Change, Advancing Health,” Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine
The National Academies Press