Here, There and Everywhere: Splitting a Nurse's Time Between a School and a Community Health Clinic Helps Coordinate Care

Linking a community-based primary health care clinic to neighborhood schools

A partnership in Madison, Wis., established a formal link between the South Madison Health and Family Center and area neighborhood schools to test a model of health care delivery.

In the model, the same pediatric nurse practitioner provides care in the neighborhood's schools and in a community-based primary care clinic in order to better serve the complex needs of low-income children and their families.

The partnership, started in the 1970s, included the Madison Metropolitan School District, Madison, Wis., the South Madison Health and Family Center, and the University of Wisconsin-Madison, School of Nursing.

Key Results

  • The pediatric nurse practitioner provided primary health care services, including:
    • Health maintenance visits.
    • Immunizations.
    • Treatment of minor injuries and health conditions.
    • Management of chronic illness.
    • Referral to specialists.
  • From June 1997 through June 1998, 98 children ages 5 to 19 from approximately 24 different schools (out of 45 in the district) were seen by the pediatric nurse practitioner.
    • Some 67 percent of these children were uninsured and without a regular source for health care.
  • Of the care provided, 54 percent of the visits were for acute illnesses and 36 percent for well-child care.
  • Immunizations were updated for 28 percent of the patients.
  • Some 40 referrals to specialists or recommendations for follow-up at the clinic were made.
  • Twenty-six percent of the patients seen needed coordination with their school in some capacity.
  • In addition to the school-age children, from August 1997 to April 1998, the pediatric nurse practitioner saw 197 infants and 86 preschool children.

Project Management and Operations

The University of Wisconsin-Madison School of Nursing oversaw the project.

The pediatric nurse practitioner, a master's-degree-level nurse from the School of Nursing and employed by the Madison Metropolitan School District, spent 50 percent of the time in the schools and 50 percent at the Madison Community Health Center, a clinic housed within the Center.

The shared pediatric nurse practitioner position created a link not only between the nursing school and the community clinic but also between the nursing school and other school nurses within the school district.

Funding

The Robert Wood Johnson Foundation (RWJF) supported the second year of the partnership project with a grant of $39,966 between September 1997 and August 1998.

The District provided funds to reallocate 10 percent of the school nurse's time to be available at the health center, and the School of Nursing contributed 20 percent of the time of two pediatric nurse practitioner faculty members to the health center.

After the Grant

As of early 2000, the pediatric nurse practitioner was no longer available to spend 50 percent of the time at the Center's clinic. But she spent one morning a week there.

This would enable the link between nursing school and the clinic to continue. In addition, a link was being developed with the Head Start program housed at the health center.