Title : The essential role of the nurse when treating patients with complex medical conditions at community health centers
Abstract:
Community health centers serve the most underserved populations worldwide. Staffed with general practitioners and medical assistants, millions of people receive care from community health centers. Many of the individuals have complex co-morbid conditions such as diabetes, hypertension, obesity, depression, asthmas, substance abuse, and communicable and infectious diseases. These health centers are located within rural and inner cities communities with no direct access to primary care and enabling services. The social determinants of health greatly impact underserved individuals including poverty, education, housing, transportation, environmental issues, and employment.
Numerous studies and articles have been released that describe with both urgency and alarm, the shortage of health care professionals and the overall impact on individual and world health outcomes. This shortage greatly impacts the ability of community health centers to recruit and retain physicians. After all, when compared to other health care jobs, community health centers are often unable to compete with salaries and benefits offered by hospital systems; the health centers may not be located in the most desirable neighborhoods; patient volume is exorbitant; and resources may be lacking.
In an attempt to address the provider shortages, many health centers have expanded the role of nurses to accommodate patient needs. Nurses are being asked to take roles that require increased independence and engagement with patients. For example, in many states and health care settings, Advanced Practiced Registered Nurses (APRN) often serve as primary care providers and treat patients independently without physician oversight. Licensed Practical Nurses (LPN) and Registered Nurses (RN) have responsibility for operating diabetes and medication adherence clinics. Likewise, in some states, health centers are able to bill for the independent services that RNs provide to patients. The ability to bill for the services provided by nurses greatly impacts the bottom line for many organizations and improves access to care for individuals who have trouble locating a primary care physician, thereby decreasing hospital emergency room utilization and improving community health outcomes. If the health industry is going to actually successfully improve health outcomes, nurses must be more widely utilized and they must be given autonomy to provide treatment to patients. For the most part, they have the most contact with patients and due to their training, are better positioned to assess patient need than most physicians. They are therefore, essential to treating patients with chronic co-morbid conditions who require more time to thoroughly evaluate and provide patient education around treatment, medication adherence, and other support necessary to achieve optimal health.
