Nurses for America: Public health nursing collaborative model for health improvement through increased access for vulnerable populations

Access to care for vulnerable populations continues to plague the nation. Local health departments, community health centers and other safety net providers struggle to recruit and retain professional nurses ready for the challenge of caring for the most at-risk populations, as budget shortfalls complicate organizational survival. Nurses for America (NFA), a national program initiated in 2004 by the Georgetown University School of Nursing and Health Studies (GU-NHS) and partially funded by AmeriCorps was designed to increase access to nursing care for underserved, vulnerable populations and improve the quality of health care services delivered by community health centers and state and local public health agencies. The paper describes the planning activities, including recruiting and selecting the nurse members and their clinic sites; the design and conduct of the two-week intensive training; the roles and responsibilities of the nurse members, their mentors and preceptors; and the methods and findings of the intensive, mixed-method evaluation research component. The 18 nurse members received intensive training prior to being assigned to 14 health centers, faith-based neighborhood clinics, and public health departments in six states and Washington, D.C. Nurse members, who are employees of the health programs in which they work, received ongoing mentoring from GU-NHS or other faculty, and support from a preceptor at their clinic site as they provided urgently needed outreach, primary care and public health services to at-risk populations. Retention in the two-year program was high; by the conclusion of the program, most of the original members remained in the program and in the sites to which they had been assigned. The findings demonstrated extensive contributions by the nurses related to public health, primary care, civic engagement, and other activities. The nurse members by far exceeded the anticipated number of individuals to whom they provided public health services and at program completion they indicated their intention to continue to practice with vulnerable populations. Lessons learned from the program relate to funding mandates requiring significant economic and organizational resources for both the university and under-funded health facilities.