The University at Buffalo School of Nursing has expanded its clinical sites for students, improved nursing services to local Native Americans and other underserved populations, and enhanced its curriculum, thanks to $3.4 million in grants from the Health Resources and Services Administration (HRSA).
“Because of the student’s clinical experiences and didactic education, our students have a better understanding of what they are going to face in practice within rural and underserved settings,” says Linda Paine Hughes, clinical assistant professor and program director for the two HRSA grants.
Some of the programs are works in progress, Paine Hughes notes. And a key component of the grant work’s success is the ability to adjust the plan if roadblocks occur, a process called rapid cycle quality improvements through PDSA cycles. Being able to change direction quickly – rather than having to wait months – was essential for meeting the grant’s objectives, she says.
“PDSA cycles made it possible for us to be overwhelmingly successful with the HRSA grants, nearly 100%,” she says. “The students benefitted, the School of Nursing benefitted, and our community partners benefitted.”
The HRSA funding was actually two grants, Paine Hughes explains. The first, an advanced education nursing, or ANE grant, ended in December. The second, an advanced nursing education workforce grant, or ANEW, will be extended to June.
The two grants led to significant improvements in addressing nursing shortages, both in reaching underserved populations and allowing the School of Nursing to educate more Doctor of Nursing practice students.
Amanda Adams, an ANEW scholar and alumna of the DNP family nurse practitioner program, says that, besides paying for part of her education, the grant also exposed her to different underserved populations, as well as paid for technology such as telehealth – most notably at the Tuscarora Nation Health Center in Lewiston.
“It can be very difficult, especially at the Nation, for patients to utilize health care facilities,” Adams says. “We often don’t think about things like access to heat, water or food when we’re dealing with primary care issues; but when you consider whether or not a patient has the ability to access even the basic of necessities, it changes the way you build your patient plan of care to better suit the needs of the person in front of you.”
The HRSA program gave her the experience of caring for these types of populations, Adams says. The telehealth program funded through HRSA expanded that access to patient care by bringing in additional clinical preceptors and students to see more patients.
Adams is now a full-time nurse practitioner at the Tuscarora Nation Health Center, “serving the patients I cared for during my time as a student at UB.”
“To say that I am grateful for the experience is an understatement,” she says. “The grant allowed me to see patients and understand underserved populations better than I would have ever imagined. Not only did it allow the patients access to quality health care, but it also allowed me the opportunity to learn and grow as a provider seeing patients that truly need care the most.”
Results and outcomes from the HRSA grant include:
•Increased community partnerships & more services for underserved
The HRSA grants enabled the School of Nursing to expand its presence in the community and establish new clinical sites for students
In the past four years, 36 students completed clinical rotations in rural underserved settings, such as the Tuscarora Nation Health Center, Salamanca, Warsaw and Niagara Falls.
The grants funded two part-time primary care nurse practitioners through the Niagara Falls Memorial Medical Center clinics: a part-time psychiatric nurse practitioner and a cultural expert who served as a liaison between the School of Nursing and the Tuscarora Health Center.
Tuscarora Nation leaders cited the need for traditional medicine services at their health center, Paine Hughes says, and School of Nursing faculty identified this request as an important result of the grants. Trust was established between the Native elders and the School of Nursing through these grants. Now, team members will work together to better understand and implement traditional medicine care as an option for this population.
“If you have people seeking traditional medicine treatment, but their Western medicine provider does not understand the concepts of traditional medicine, patient care may suffer,” Paine Hughes says. “Our goal is to provide personalized health care, which is culturally sensitive, safe and effective.
“That is our goal. It’s a journey. As trusted team members, we will help improve access to health care for rural and underserved populations in Western New York and beyond.”
Paine Hughes says the grant also addressed the need for increased access to mental health services in Western New York, specifically integrating mental health into primary health.
At this time, two nurse practitioners at the Tuscarora Nation Health Center are graduates of UB programs, providing insight for other UB graduates who plan to work in similar settings.
•Integrating telehealth into rural settings
Unlike traditional clinical encounters where the health care professional is on site, the telehealth model provides a means for high-quality health care provided through live-stream video with the provider at a distance from the clinic. ANEW scholars have experience in providing telehealth care, as they are present with their patient in the clinic and the preceptor or supervisor is off site, but present through telehealth technology. Other uses of telehealth implemented at the School of Nursing include remote site visits, interprofessional consultations and educational sessions.
•Nursing school symposiums
A supplementary ANEW grant was awarded to the School of Nursing in 2018, enabling it to offer a series of symposiums. Students, faculty, preceptors and community partners attended symposiums on substance abuse, mental health and telehealth in the past 12 months, with attendees from Mexico, California, Texas and rural regions attending via live-stream telehealth format.
ANEW scholars receive up to $20,000 a year in tuition and stipends. The students are required to complete at least 15 hours of volunteer service each semester in rural or underserved communities, as well as a longitudinal clinical placement in such settings.
“With increased exposure to these settings, students frequently choose to return to work in one of these settings upon graduation,” Paine Hughes says. “That’s been proven with Amanda.”