1. Building Opportunities for Your Nurse-Directed Health Center Presented by Shari Shapleigh, BSN, RN, MS, FNP

2. Welcome!

3. Goals for the Day Understand the challenges that most nurse-directed health centers have in common Discuss the sources of these challenges Identify tactics to address these challenges

4. Isolation Lack of resources Compliance issues Conflict

5. Sources of challenges Challenges Isolation

6. Due to resources  Day to day operations occupy all resources  Difficult to make time to network and build bridges Due to location  Rural settings physically isolated  Often fewer local providers and other health care resources in area  Physical isolation on campus Isolation

7. Population served: uninsured or underinsured student 28.1% of students age 18-24 are uninsured Minorities and older students even more likely to be uninsured HSACCC survey found 36% of 25-29 year old community college students were uninsured Many more students are underinsured Often not able to refer to outside providers Pressure to perform more services in-house, stretching resources further Isolation

8. Challenges Isolation Lack of Resources

9. Manpower  Often services begin with just one nurse provider  Limited monies for staff, esp. if budget solely from student health fees Lack of Resources

10. Monetary ◦rising health care costs ◦budget cuts ◦small student base Lack of Resources

11. Challenges Isolation Lack of Resources Compliance Issues

12. Immunization Compliance: Another facet of resource shortages ◦too time consuming for small staff ◦health center doesn’t have budget to automate No administrative support Compliance Issues

13. Isolation Challenges Compliance Issues Lack of Resources Conflict

14. Scope of Practice ◦defined by State law ◦advanced practice or nursing only? Services Provided ◦primary care or referral? ◦dispensary or OTC? ◦CLIA waived labs? Conflict

15. For whom? ◦Faculty/staff ◦students only? Conflict

16. Other challenges?

17. Isolation Challenges Compliance Issues Lack of Resources Conflict Finding Solutions

19. Develop a Support Network

20. Support Networks: Professional ◦Regional College Health Association ◦Nurse directors’ group ◦Student Health Center listserv ◦Local professional group Finding Solutions

21. The National Nursing Centers Consortium (NNCC) “….are health centers managed by nurses in partnership with the communities they serve. They provide direct access to nurses and high quality health services, which may include comprehensive primary health care, health promotion, education and health protection and disease prevention.”

22. Finding Solutions Support Network: Campus Students Academic Departments Athletics Admissions Public Safety

23. Support Network: Local Entities -Department of Health -Hospitals/Walk-in Clinics -Planned Parenthood -Nearby Colleges -Educational Resources Finding Solutions

24. Isolation Challenges Compliance Issues Lack of Resources Conflict Finding Solutions Support Network Secure Extra Resources

25. Secure Extra Resources: Human Students ◦nursing ◦business administration ◦public health Interns ◦nurse practitioner ◦nursing ◦health education ◦massage therapy Finding Solutions

28. Secure extra resources: Human Contractual agreements with local providers Finding Solutions

29. Secure Extra Resources Finding Solutions

30. Secure extra resources: Time Benchmarking Automate Finding Solutions

31. Isolation Challenges Compliance Issues Lack of Resources Conflict Finding Solutions Support Network Secure Extra Resources Human Time Strategize and Advertise

32. Strategies to Increase Opportunities Finding Solutions

33. Promote your health center on campus – build its profile:  peer educators promotion  work with Public Relations department on campus for inclusion in campus newsletter/on Web site  guest lecture in specific classes  present to Board of Trustees Finding Solutions

34. Promote your health center on campus: Value points: ◦your services help the under-served ◦more cost effective than traditional models ◦nurses spend more time educating students Finding Solutions

35. Isolation Challenges Compliance Issues Lack of Resources Conflict Finding Solutions Support Network Secure Extra Resources Human Time Strategize and Advertise Create a Business Case

36. Identify exactly what you want Get an audience with decision makers Speak their language and make a good pitch! ◦include return on investment (ROI), profit margin, quality assurance and operating costs in your analysis ◦include figures from benchmarking to back up your argument Finding Solutions

37. CollegeDirectorClericalPhysicianNP/PARNPopulation OnondagaCC1100110,000* LaGuardiaCC1003FT/2PT10,000 Hudson ValleyCC+ 1/1clinical coordinator 211FT/1PT212,000 FingerlakesCC 1/1Immunization coordinator 115,100 BroomeCC+1(NP)11(PT)16,000 CayugaCC1(RN)1,000 SullivanCCC1(RN)11,400** MonroeCC1201(?)517,500

38. Isolation Challenges Compliance Issues Lack of Resources Conflict Finding Solutions Support Network Secure Extra Resources Human Time Strategize and Advertise Create a Business Case Money

39. Where’s the money? Grants Doing it all by yourself is difficult ◦find out about grants through networking ◦research using Web sites such as grants.gov ◦partner with your grants research office within your institution, if you have one, so they actually write the grant Finding Solutions

41. Where’s the money? Refocus priorities so services aren’t so stretched Investigate student health insurance options Finding Solutions

42. Challenges and Opportunities Need to Balance Isolation Challenges Compliance Issues Lack of Resources Conflict Finding Solutions Support Network Secure Extra Resources Human Time Strategize and Advertise Create a Business Case Money

43. Questions?

44. References Atwater, Janet, Director of Health Services Hudson Valley Community College, Troy, NY. Personal interview, May 11, 2009. Dalton, Brenda Director of Health Services and Women’s Health Nurse Practitioner, Spelman College Atlanta, GA. Personal interview, January 2009. DeNavas-Walt, C.B. Proctor, and J. Smith. Income, Poverty, and Health Insurance Coverage in the United States: 2007. U.S. Census Bureau., August 2008. Health Services Association California Community Colleges Survey, spring 2007. http://www.hsaccc.org/NCHASpring2007_Overview.pdfhttp://www.hsaccc.org/NCHASpring2007_Overview.pdf Hurley, Janet. “The History and Practice of College Health.” University Press of Kentucky, 2002. pp 154-160. Perry, Jayne, College Nurse Jeffersen Community College, Watertown, NY. Personal interview, March 2009. Torrisi, D.L. and Hansen-Turton, T. “Community and Nurse Managed Health Centers: Getting Them Started and Keeping Them Going” National Nursing Centers Consortium Guide. Springer Publishing Company. New York, 2005.

45. Thank You! Shari T. Shapleigh, Director of Health Services Dryden, NY 13053 shaples@tc3.edu