Frenn, Marilyn

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Marquette Universitye-Publications@MarquetteCollege of Nursing Faculty Research andPublications Nursing, College of1-1-1997Prism: Special Issue on Nursing CentersMarilyn FrennMarquette University College of Nursing, marilyn.frenn@marquette.eduPublished version. Prism: The NLN Research & Policy Quarterly, Vol. 4, No. 4 (1997): 1,7. Publisherlink. © 1997 National League for Nursing. Used with permission.--"',i!/r1Vol. 4, No. 4Today's nursing centers shine in thegalaxy of health care providers. Howcan we ensure their survival, fostertheir growth, and establish them askey players in today's for-profit, man-aged-care environment?Nursing centers are a variedbunch. Also known as nurse-managedcenters, clinics, wellness centers, andthe like, they are organized and man-aged by nurses within the scope oftheir professional practice and statelaw. These centers have been provid-ing high quality, cost-effective ser-vices since the late 1970's. Theyaddress the needs of all persons butespecially the medically underserved,the underinsured.-minority groups.HIV/AIDS patients, migrant work-ers, the homeless, adolescents, andthe very young and very old (Higgs,1988). Services are provided in urbanand rural areas using a variety ofmodels and operating in a variety ofsettings: mobile vans, churches,homeless shelters, retirement com-munities, rescue missions, strip malls,and even "traditional" sites such ashospitals and colleges. A recent NLNsurvey found staffing that varied from1 to 115 nurses, and budgets rangingfrom $1500 to $40,000,000 per year(A Promising Trend, 1993).Nursing centers provide direct ac-cess to professional nurses who focuson keeping their clientswell and limit-ing complications or disabilities whenthey are i11. Nurses practice both au-tonomously and in collaboration withcolleagues from a wide range of disci-plines. These nurses serve as case man-agers, providers, and client advocates.urulvffiffi$tffi Lffiffi,effiY_SS# SFF:iru*FIffi "ff. fi,ff I :Tr&,qDOa A1r_'\.Today's Nursing Centers:State of the ServiceSandra B. Fielo, EdD, RN, CProfessor, State University of New York Health Science CenterCollege of Nursing, BrooklynIt's clear from widespread experiencethat nurses at nursing centers aretrusted sources of health care (Scottand Moneyham, 1995).The services provided at nursingcenters vary and reflect communityneeds as well as the expertise, interest,and creativity of the nursing staff. Ac-tivities include, but are not limited to,performing physical, functional, andenvironmental assessments; teachingindividuals and groups: screening toidentify unrecognized illnesses andmodify high risk practices; treating es-tablished disorders; counseling; andreferrals. Primary care is a major focus.Many centers routinely provide immu-nizations, Pap smears, and lab work. Insome centers, nurses make home vis-its and provide outreach and case-finding in their communities.It is estimated that there are about250 nursing centers in the UnitedStates. The exact number is difficultto pinpoint, because centers are notobligated to report their operation toany central agency, and there is noestablished national registry for thispurpose. While the NLN collects in-formation from members of its Coun-cil for Nursing Centers and fromnursing schools on an annual basis, lo-cating and obtaining informationfrom centers with no connection tothe NLN Council or to state-ap-proved schools of nursing is more dif-l-icult. In addition. some agencies maynot consider themselves nursing cen-ters, even though they meet the crite-ria for inclusion (nurses controllingtheir own practice, providing clients(continued on page 6)*LA -C^I ITqWFCT RAPTIST UNIVERSITY IlI._3April 1997PRISM: Speciallssue on NursingCentersMailyn D. Frenn, PhD, RNChair, NLN Council for NursingCentersNursing centers are ambulatory careorganizations, based on a nursingmodel, through which clients can ac-cess nursing and other health careservices directly. The centers are ananswer to many of the health care di-lemmas confronting policy makersand consumers today.Care provided in nursing centers isorganized in a way that supports clientsin learning to care for themselves. Avisit to a health care provider does notguarantee that people will take the ac-tions needed to prevent illness or man-age chronic conditions. Helpingpeople to care more effectively forthemselves requires a paradigm shift inthe way care is delivered, and nurses atnursing cenLers are experts in an ap-proach that is both more holistic andmore anticipatory than traditionalhealth care.(continued on page 7)IN THIS ISSUEDetroit Nursing Center . page 2Financing NursingCenters page 3Developments in Clientlnformation Systems . page 4Accreditation forCommunity NursingCenters page 5v Financing Centers(continued from page 3)program initiatives. However, allgrants are time-limited and not in-tended for ongoing operational sup-port. Long term survivability dependsupon the establishment of a morestable and reliable financial base.Reimbursement through managed-care and other organizations is onesource of fiscal support, especially if itcovers the actual costs ofcare. Servicecontracts with several different organi-zations are important to increase thepotential pool of clients as well as toavoid over-reliance on one source ofrevenue. At present, regulatory andadministrative barriers in some statesmay serve to frustrate full realizationof this funding stream (Olmstead andWilliams, 1996). More importantly, re-imbursement rates rarely cover admin-istrative costs, often restrict paymentto a narrow set ofservices, and do notcover all the costs of care.Arichmix of foundation grants forvarious aspects of center activities canhelp provide supplemental support.Single or significant reliance on anyone foundation, managed-care organi-zation, or other single source of rev-enue places the center's fiscal solvencyin the hands of others. Should any oneof those revenue sources be inter-rupted, diminished or eliminated, acenter's very existence would be seri-ously jeopardized. Thus, a pluralisticapproach provides for greater stability,as well as for continued growth and de-velopment in the future. Today, mostprivate, corporate, community, andgovernment sources of funding are in-terested in funding collaborations, andthey are looking for ways to work to-getherwith other philanthropic groups.Volunteer DevelopmentVolunteer deveiopment is essential intoday's health care climate. Volun-teers can contribute creative energy,time and direct financial support.They often have access to key re-sources. Given the inherent limita-tions in grant support and currentreimbursement mcchanisms, volun-teers may prove to be crucial for manynursing centers. However,volunteerism must be actively fos-tered and supported in order to beeffective and useful rather than adrain on the center.Administrative time and resourcesmust be invested in recruitment ef-forts, training programs, coordinationof schedules, oversight of activities andrecognition of individual volunteers. Inorder to do this, nursing center staffmay need to acquire new knowledgeand skills in community organizing, so-cial marketing techniques, volunteerdevelopment, accounting procedure,and tax law. If handled well,volunteerism has the potential to gen-erate sufficient new income to justifuits administrative costs. These volun-teer-generated funds are undesignatedfunds that can be used to offset generaloperating costs that other fundingsources don't cover.ConclusionNursing centers' immediate survivaland long term sustainability dependupon a strong and stable financialfoundation. Current services and pro-grams, organizational administrationand plans for the future depend upona diverse mix of financial resources,careful strategic planning, and sup-port from clients. the community.other health and human service orga-nizations, and policymakers.As nursing center directors be-come more familiarwith "micro" and"macro" health sector economics, fi-nancial management and strategicplanning, information management,community and inter-organizationalcollaboration, public policy and regu-latory development, and public rela-tions, the long-term sustainability ofnursing centers will be assured.ReferencesBrown, N.D. (1990). Costs and revenuesources for nursing centers. In B.Murphy's Nursing Centers: The Time isNow. New York: The National Leaguefor Nursing.Hangley, B. (1996). Wefare DevolLttion inPhiladelphia. Philadelphia: The 21srCentury League.Mackey, T. And McNiel, N. (1997). Ne-gotiating private sector partnershipswith academic nursing centers. AttrsingEconomics. Jan.-Feb., pp. 52-55.Olmstead, D. L. And Witliams, M.I.(1996). Billing for CRNP services. Penn-sylvania Mediclne. December, pp. 26-29.Starfield, B. (1995). Comment: Healthsystems' effects on health status-Fi-nancing vs. the organization of services.American Journal of Public Health, Oc-tober, pp. 1350-1351.Special Issue(continued from page 1)In a nursing center, clients may besuiprised to be asked about theirhealth practices and the ways theyhave managed illness as well as abouttheir medical history. Each visit is fo-cused on determining not only whatmay be wrong, but also in helping cli-ents understand what is happening.Follow-up care is arranged as needed,just as in other settings. But at nurs-ing centers, "follow up" involvesmore than simply future appoint-ments. Staff are quick to provide writ-ten materials to help clients learnmore about their particular healthconcerns. Classes are offered on top-ics such as parenting, coping with ill-ness, planning for retirement, andother "lifestyle" areas. Services suchas weight control programs and stressmanagement are also available. Eachnursing center develops programsbased on an assessment of communityneeds.The NLN Council for NursingCenters brings together practitionersfrom nursing centers and otherpeople who are interested in develop-ing this resource. The Council hostsan annual meeting where nursesshare their experiences and work to-gether to help set a national healthcare agenda that incorporates nursingcenters and their concerns. Videos,books, and a consultation networkalso are avaiiable through the Coun-cil. For more information, contact Dr.Lynda Crawford at the NLN at 800-669-9656, x404.This issue of PRISM addressesseveral topics of concern to the nurs-ing center movement and the peoplethey serve. What are nursing centersail about? How can information sys-tems be developed to meet eachcenter's needs as weil as foster theestablishment of a national databaseon nursing centers? How are the cen-ters best financed? What are the ben-efits of accreditation to nursingcenters? The growth and develop-ment of one nursing center in Detroithighlights some of these issues andshares the excitement of theirprogress.The future awaits us. We inviteyou to ioin usl

Prism: Special Issue on Nursing Centers

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