RWJF Grantee Fights to Free Nurses to Practice to Full Extent of Their Abilities

    • July 14, 2010

Problem: Primary health care provided by physicians is expensive and often difficult to obtain for low-income and other vulnerable people. Nurse practitioners can provide more affordable, more accessible preventive and primary care—but they face legal and policy barriers in many states to practicing to the full extent of their abilities.

Background: Tine Hansen-Turton discovered the power of nurses in an unlikely place: inner-city public housing developments in Philadelphia.

Nearly two decades ago, Hansen-Turton, then a recent immigrant to the United States from Denmark and a new graduate of the Fels Institute of Government at the University of Pennsylvania, landed a job as a special assistant to the CEO of the Philadelphia Housing Authority and began working to help improve the lives of the hundreds of thousands of residents of the poorest neighborhoods in Philadelphia.

One of the first things she noticed in her new job was the poor health of many residents. Chronic disease was rampant, and low-birthweight babies were common. Few residents sought preventive or primary care at local medical facilities, even though they were located just blocks away from the housing complexes. And when health problems grew severe, residents fled to the nearest emergency department.

“The lack of adequate health care stuck out like a sore thumb,” recalls Hansen-Turton, M.G.A., J.D., , an advocate for nurse-led health care who is also an Edge Runner with Raise the Voice, a campaign of the American Academy of Nursing (AAN) that is supported by the Robert Wood Johnson Foundation (RWJF). “People just didn’t seek care.”

At the time, Hansen-Turton and her colleagues in the public housing and health fields stumbled upon a golden opportunity: A nurse leader, Susan Sherman, had recently taken over as the head of the Independence Foundation, a charitable organization in Philadelphia, and was seeking ways to promote nurses as primary care providers for vulnerable populations in the Philadelphia area.

Hansen-Turton and her colleagues at the Philadelphia Housing Authority got permission from the U.S. Department of Housing and Urban Development to provide free space for nurses so they could serve the residents of the city’s public housing complexes, and a new model of care delivery—the nurse-managed care center—was born. The Independence Foundation and the Philadelphia Housing Authority built nurse-managed centers in four public-housing complexes in Philadelphia. They were among the first such nurse-led care centers in the country. An experiment in nurse-led care had begun.

Just one year later, the evidence was in: All of the babies born to mothers at the Abbottsford Homes public housing development were healthy—a dramatic reversal from the prior year, when most babies had been born underweight. The difference? Nurses had provided the complex’s mothers with prenatal care during their pregnancies.

“I was sold on the power of nurses to improve health,” Hansen-Turton says.

Hansen-Turton eventually became CEO of the National Nursing Centers Consortium (NNCC), a nonprofit organization that advocates for nurse practitioners as providers of primary health care, and continues to work to promote the growth of nurse-led care. She also serves as the executive director of the Convenient Care Association (CCA), a trade association for retail-based “convenient care” health clinics, which are located in discount stores, supermarkets and pharmacies and are primarily staffed by nurse practitioners.

Solution: Today, there are 25 nurse-managed health centers in Pennsylvania and 41 convenient care clinics. Nationwide, there are roughly 250 nurse-managed health centers and more than 1,150 convenient care clinics, and these numbers are expected to grow thanks to new federal government support. Together, nurse-led and convenient care centers serve some 20 million people.

Unlike other non-emergency care settings, convenient care centers are often open in the evenings and on weekends. They offer quick, comprehensive and affordable quality primary care services. And no appointments are needed.

As CEO of the NNCC and executive director of the Convenient Care Association, Hansen-Turton works to foster the growth of nurse-led centers and retail clinics. She and her allies have already overcome considerable legal and policy barriers to nurse-led care, including reversing dozens of state laws and regulations barring nurses from practicing to the fullest extent of their abilities.

Hansen-Turton and her colleagues now have their sights on reforming insurance reimbursement regulations. Only about half the nation’s insurance companies will compensate a patient who sees a nurse practitioner for primary care services, she says. That means many people cannot see a nurse practitioner for care unless they pay out-of-pocket for their services.

But change is on the horizon. Aetna, a major health insurance company, recently announced it would reimburse consumers for primary care provided by nurses. This move could spur similar policy changes among smaller insurance providers, Hansen-Turton says.

Also, in June, the U.S. Department of Health and Human Services announced it would invest $15 million to support the operation of nurse-practitioner led health clinics. And the new health reform law passed earlier this year authorizes $50 million to support innovative safety-net providers such as nurse-led health clinics.

These are just the first few rays in a new dawn of nurse-led care, says Hansen-Turton.

“The nurse-managed model is really going to be the future of primary care in this country. We don’t have enough family physicians, and I don’t think we ever will. But nurses can ably fill that void.”

RWJF Perspective: For her work, Hansen-Turton has been named an Edge Runner by the American Academy of Nursing (AAN). The Edge Runner program is a part of Raise the Voice, an initiative funded by the Robert Wood Johnson Foundation (RWJF) and directed by AAN to recognize innovators in health care. Edge Runners have developed care models and interventions that have been proven to be effective.