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A Caring Community: Nurse Practitioners Find Their Calling Working in Community Health Settings
BY LINDA CHILDERS
At the Sacramento Native American Health Center (SNAHC) in Sacramento, California, Julie Omishakin, MSN, FNP-C, greets her first patient of the day, a man recently diagnosed with hypertension. After ensuring he’s monitoring his blood pressure regularly and taking his prescribed medication, she reminds him that he’s also due for some cancer screening tests.
Omishakin is one of many nurse practitioners (NPs) across the country that provide primary care in a community health setting. These community health centers, also known as community clinics or Federally Qualified Health Centers (FQHCs), serve as a safety net to uninsured and underinsured patients. They provide medically underserved communities with affordable, comprehensive medical care and reduce barriers to care including language and travel distance.
With the Association of American Medical Colleges (AAMC) predicting a physician shortage of up to nearly 122,000 physicians by 2032, the American Association of Nurse Practitioners (AANP) believe that NPs are key to bridging the gap in health care. According to the AANP, there are currently more than 325,000 NPs practicing across the country, and 30,000 NPs entering the workforce each year. More than 85% of NPs are trained in primary care and one in four NPs practice in rural areas that lack access to health care.
For Omishakin, working at a FQHC means taking a holistic approach to patient care and treating the whole patient, not just a singular medical event. Twenty-six percent of the patients seen at the center are Native American, from both local and out-of-state Tribes. The center serves as a safety net in the Sacramento area, where changes to Medi-Cal (California’s Medicaid program) benefits have left many with limited access to health care.
A new study found that physicians run into more obstacles when trying to bill Medicaid than they do with other insurers. In addition, Medicaid reimbursement for doctors is lower than Medicare and private insurance coverage. As a result, many physicians are reluctant to accept Medicaid patients, making it difficult for these patients to find doctors who will treat them.
Clinics such as SNAHC improve health outcomes and reduce health disparities in marginalized communities by making health care accessible for all patients. In addition to primary care, SNAHC offers patients medical, dental, vision, and behavioral health services.
“Our care goes beyond the traditional 10-minute office visit,” Omishakin says. “We spend 15-30 minutes with each patient and automatically screen them for depression, as well as ensuring they’re up-todate on annual screenings.”
A nurse practitioner for the past eight years, Omishakin says she finds working in community health to be extremely rewarding.
“We’re providing care to people who are working hard to make ends meet and offering them health care options they might not have otherwise,” she says.
Providing Care for All Ages
In Riverside, California, Cynthia Jovanov, DNP, FNP, NP-BC, president elect for the California Association for Nurse Practitioners (CANP), works at a community clinic, with Dr. Luther Mangoba, providing primary care to patients who are largely on Medi-Cal.
Cynthia Jovanov, DNP, FNP, NP-BC
“We see patients ranging from pediatrics to geriatrics,” says Jovanov, who also works as an adjunct professor at California Baptist University and as a general surgery NP at Eisenhower Medical Center. “Recently we’ve seen a spike in college-aged students who either don’t have insurance or are uninsured after they’ve turning 26 and are no longer covered by their family’s health insurance.”
For Jovanov, who grew up in Riverside, caring for those in her community has allowed her to come full circle in her career. “We care for so many different people who hail from various walks of life,” she says. “I think the key is meeting patients where they are at that moment in their lives and understanding their vulnerability.”
Jovanov says one of the most critical issues NPs face today is being granted full practice authority (FPA). After a decade of working towards FPA, California Governor Gavin Newsom signed AB 890 legislation in 2020, expanding the existing scope of practice laws for NPs. It became law in January 2021, allowing NPs to practice independently after finishing a transitional oversight period.
Currently, there are 24 states plus Washington D.C., that have full practice authority for nurse practitioners. The remaining states have either reduced or restricted practice. This map shows an overview of NP licensure for all 50 states: https://www.aanp.org/advocacy/ state/state-practice-environment
“It’s impossible to meet the growing demand for primary care with just physicians, especially since so many don’t accept Medi-Cal/Medicaid,” Jovanov says.
Antoinette Barrett, NP, CPNP, with some patients
According to the University of California, 65 million Americans reside in federally designated health professional shortage areas (HPSAs) for primary care. These areas tend to be in remote rural towns and low-income areas, the same areas where a growing number of NPs provide care.
A Mobile Community Clinic
Antoinette Barrett, NP, CPNP, is clinical supervisor of Cedars Sinai Medical Center’s Community Outreach Assistance for Children’s Health (COACH) for Kids program in Los Angeles, California. As part of a mobile medical and case management program, Barrett and her colleagues provide primary and preventative health services to low-income and medically underserved children and their families in Los Angeles County.
Barrett, who previously worked in pediatrics in a hospital setting, says community work is an entirely different type of nursing than working at a patient’s bedside. The COACH program connects with local schools and also takes their services to shelters and public housing units, providing critical health services to families who live below the poverty line.
“Our mobile medical units regularly travel to areas of Los Angeles where families don’t have access to medical care,” she says. “We treat children with asthma, respiratory infections, diabetes—we’re a nurse-run primary care clinic on wheels.”
Barrett says many of the children seen in the COACH program have only received fragmented medical care in the past.
“They may have been seen at an urgent care clinic or emergency room when they became ill, but we find a lot of children who are behind in their immunizations or who have developmental delays that weren’t previously diagnosed,” she says.
At COACH, nurse practitioners work to connect families with a regular medical provider and also address any other barriers to care such as food insecurity and transportation issues.
“After learning that many of our families didn’t have a pharmacy in their neighborhoods, we began dispensing medications from our mobile clinics to make the process easier,” Barrett says.
Linda Childers is a freelance writer based in California.
