Nurse-managed centers bring health care to the people

nurse-managedTamara McKinnon knows that visiting a doctor’s office is a poor facsimile of real life.

“There are some things you just can’t see there,” says McKinnon, affirming the crazed detachment from reality provided by a 15-minute drive-by interaction.

McKinnon is part of a unique San Jose State University program that injects student nurses into largely low-income areas to provide healthcare advocacy for patients on the fringe of the healthcare system.

“These folks would otherwise not be seen,” says McKinnon.

Called Nurse Managed Centers, six of the sites dot San Jose and the surrounding area where student nurses help patients — frequently the elderly — with health education, medication counseling and case management that includes connecting them with social services or needed doctor appointments.

“Our focus is on the health of the community,” says McKinnon.

The centers have become a win-win situation for the host sites, which get onsite health support, and nursing students who receive much needed hands-on experience.

One Santa Cruz Latina, a 55 year-old kidney transplant recipient who is now legally blind in the wake of diabetes, receives weekly visits from two San Jose State nursing students. On this day in July, she complains of hair loss, stress and boredom as the students take her blood pressure then discuss nutrition and prescription drug delivery with daughter Marlen Rodriguez — her primary caregiver.

The visit quickly embraces Rodriguez herself and her elderly grandmother, who suffered a fall in May.

One home visit, three generations of care.

Another elder Latina living near the Santa Cruz Boardwalk in Beach Flats — a food desert — has no income save for the bottles and cans stacked high in her apartment. Suffering from diabetes, hypertension and poor vision from sun exposure, she discusses with the students her application for disability; they suggest applying a second time since her first was rejected.

Both patients are typical of a Nurse Managed Centers visit since the women are both on the outskirts of traditional healthcare; others may be undocumented, lack mobility, have transportation woes, or simply fear the healthcare world.

“To be able to bring it to their front door eliminates all those barriers,” says Shashi Jivan, director of family services for Mercy Housing California, which operates over 100 properties statewide; the four located in Santa Cruz are all visited by San Jose State nursing students.

“They’re taking the time to explain,” echoes Jose Ibarra, resident services coordinator and manager for Mercy in Santa Cruz. “They’re there to break down the message that the doctors give them.”

Most intriguing about the centers is that they provide a microscopic focus inside a global context. Seeing nursing through an international lens underpins the program’s larger public health mission.

Students explore the harrowing effects of disease, famine and other natural disasters ranging from hailstorms to cyclones, tornadoes, floods, earthquakes, water contamination, even bombs and hate crimes — all of which affect at-risk individuals more than the wealthy.

A highlight of the two-year program within the School of Nursing is a trip to the Caribbean island of Grenada, where students spend three weeks exploring the island’s public health system. This year’s unexpected and contradictory health lessons: Grenadians have a relatively long lifespan despite poor healthcare, with a healthy diet featuring few processed foods, and a surprising lack of protein in a country surrounded by water.

At a July meeting with student nurses in Santa Cruz, McKinnon holds up a local newspaper report about the Zika virus, which was first recognized in 1947 in the Zika Forest of Uganda and has now become a global scourge.

The lessons of such stories?

“Realizing that the world is a very small place and that our community is just around the corner,” says former student Maureen Tapir, now a cardiac nurse at Dominican Hospital in Santa Cruz.

“Within nursing as a profession we talk a lot about creating global citizens,” says McKinnon. “We’re the only public school of nursing in the nation doing [overseas trips].”

Current students are now in Dublin, Ireland, where they will spend three weeks working with the elderly in community living sites, sharing information with local public health nurses, and visiting Ireland’s Houses of Parliament.

They prepared for the trip by studying Irish history, especially this year’s centennial of the fight for independence — the 1916 Easter Rising.

“History is just a visceral part of who the Irish are,” says McKinnon.

While treating the underserved, McKinnon, her students, and graduates of the program cite a critical yet often overlooked skill: Listening.

“Just the idea to sit back and listen was a new concept and something I had to learn a whole lot more about,” says student Valli Barrioz.

“You’re really engaging the client in asking open-ended conversations so that the client is directing their care,” agrees student Brianna Figueira.

In the States, bout 500 older adults are seen weekly, scattered in various facilities: mostly low-income housing, but also at independent living sites, community centers, behavioral health facilities and a rehabilitation center. The nursing students assist about 2,500 unique patients annually.

The Nurse Managed Centers sprung from San Jose State’s nursing program 35 years ago, pioneered by long-time San Jose health expert Bobbye Gorenberg, who helped create the first “wellness center” at a retirement facility in nearby Los Gatos. From there, the centers spread, always with nurses (originally called “district nurses”) working independent of physician oversight.

While many of today’s students have an associate’s degree from a community college, the additional two years for their baccalaureate degree offers them the opportunity for higher-paying jobs or a path to graduate work, says Toby Adelman, a gerontology expert who oversees the centers for San Jose State.

Up to 100 students begin the nursing program each semester — twice yearly.

“They are much better poised to get a job,” says Adelman, an associate professor at the School of Nursing.

Last year, Mercy Housing honored the program with a community partnership award for its long-term support.

Adelman says the Nurse Managed Centers model has proven successful for nearly four decades because it’s a real world response to challenging public health problems.

“It’s our classroom outside the classroom.”

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