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Introduction
Our communities need nurse practitioners (NPs) to serve as leaders in health promotion. Too often, the perspective of local government and business leaders, the news media, and the public at-large is that NPs are "midlevel providers," busy staffing clinics and outpatient services in lieu of physicians. Rarely are NPs perceived as leaders in fostering the overall health of communities. News media personnel searching for "expert" opinions or insights on community health issues, therefore, are much more likely to turn to hospital administrators, prominent physicians, and managed care industry leaders than community NPs. Given that NPs represent a growing, cost-effective, highly efficient sector of healthcare professionals in the United States who also have both an expertise in health promotion and a unique focus on holism, preparing NPs for community roles seems natural as well as important. Nursing textbooks on community health, used by today's NP students, proclaim the value of the advanced practice nurse in promoting community health. In Wisconsin, students are exposed to politics, policy development, and political action through the Wisconsin Nursing Association (WNA), their course work, and their clinical experiences. Once the courses are completed, however, and NPs are certified and actively practicing, they quickly become inundated with the daily requirements of their new positions and often ignore the larger community focus. Nursing educators, nursing students, and nurses in traditional practice settings rarely have opportunities to interact with nurses involved in "nontraditional" practice settings such as schools and geriatric facilities like assisted living institutions. One way to start addressing the lack of visibility of NPs in the community is to develop strategies for enhancing community involvement during the educational process. In Wisconsin, public and private funders and policymakers are beginning to push the development of community/university partnerships, as well as the use of these partnerships in regional economic planning.[1] Community-campus partnerships are emerging as one way to encourage community involvement among the campus as a whole. The creation of community-campus relationships have been accelerated by incentives from organizations such as the Corporation for National and Community Service, the US Department of Housing and Urban Development Office of University partnerships, and various foundation program initiatives requiring collaborative approaches.[2] Grants provided collaboratively among Blue Cross-Blue Shield of Wisconsin, the University of Wisconsin, and the Medical College of Wisconsin serve as an example of this type of an initiative to link academic organizations to the community through community health research and practice. Many times, these partnerships are developed and fostered through medical schools and colleges of business and public administration, however, with little input and participation from nursing faculty. Institutional barriers related to tenure and promotion sometimes prevent faculty from electing to participate in community-based participatory research (CBPR).[3] Nursing faculty involvement in community service is not valued as highly as teaching and scholarship in decisions related to tenure and promotion. In addition, the amount of time required for clinical
supervision, maintenance of clinical competency, and teaching load often preclude involvement in community service.
Service-Learning
Service-learning is the link between educational organizations and the community. It engages students and faculty in community-identified concerns, connecting their academic coursework and research to roles in community service and citizenship. NP faculty and students learn to understand their role as a health professional and a citizen in a larger societal context.[4] Service-learning is becoming more prominent in both medical and nursing training programs. The integration of service-learning in NP graduate programs to enhance community visibility and promote potential community leadership roles can be accomplished in a number of ways, such as:
Involving NP and master's level nursing students in community assessment processes; Encouraging the development of team projects that provide a tangible community service product; Revising coursework to include active involvement in community health initiatives and local political health issues; Developing collaborative programs with other disciplines that promote the development of strategic planning, organizational behavior, leadership, marketing, cultural diversity, and communication courses; Promoting active involvement in community-based health outcomes measurement; and Fostering involvement and leadership in worksite/campus health promotion.
Recognize community as a unit of identity; Discover the strengths and resources in a community; Facilitate collaboration; Address health issues from a variety of perspectives; and Commit to long-term involvement in community health promotion.
NP students can learn these principles through service-learning that is linked to community needs assessments. To accomplish this, nurse educators can contact organizations performing community needs assessment projects and offer to find students who might serve as representatives of the "college" community. Examples of organizations include the local United Way, Community Foundation, the Chamber of Commerce, or other "development" groups. Student participation in these community-based projects could be linked to research coursework. Students could also get involved by volunteering to serve on a local United Way allocations committee. Allocations discussions provide good insight into funding mechanisms for community
nonprofit organizations. As a byproduct of this activity, the student gains an appreciation of the scope of services available through the community's nonprofit agencies.
Be well-versed in the needs of the community; Be aware of the activities and needs of the local nonprofit agencies; and Have good working relationships with directors and funders of local nonprofit agencies.
appreciation for diversity, cultural implications of care, and the ability to communicate as effectively in the board room as in the exam room. Collaborative arrangements with other departments such as Business Administration, Public Policy Administration, and Epidemiology may enhance curriculum focused on community healthcare business skills. Diversity and cultural skill development could be enhanced by collaboration with a school for the Arts, Women's Studies, and multicultural groups within the educational organization and in the community. The key to collaborative education is systematically addressing the artificial "departmental" barriers that are inherent in educational organizations. Administration needs to provide the encouragement, time, and resources needed to promote collaborative approaches to advanced practice nursing and management education.
Commitment from administration to make this a priority; A committed team of professionals representing all facets of the organization; Willingness to try new ways of promoting health; Modeling of good health practices; and Strategies for outcome measurement that quantify the effectiveness of health promotion efforts.
Advanced practice nurses and nursing managers should embrace health promotion efforts by their organization as an excellent opportunity to showcase the value that NPs and nursing managers bring to that organization. NP students should also be encouraged to get involved in campus health promotion efforts and to serve as student leaders in these efforts; for example, they can help organize "fun runs/walks," health promotion fairs, and health screening services.