• Utilizing health in an emergency department was chosen by 19% of the at-risk population versus using a primary care clinic.
• Over 9% of the at-risk population does not seek medical attention when needed.
• Access to health services was impeded by the inability to afford co-payments or deductibles, no insurance, too long to wait for an appointment, and the inability to get to a provider.
• Sixty-four percent of the people in the county are overweight.
• Chlamydia and gonorrhea are on the rise.
• Fifty percent of 12^th graders are using alcohol and opioid use has seen dramatic increases.

To help eliminate these disparities, an RN workforce and educational model that enhances the core competencies and training of future and existing nurses to deliver primary health care in population and community-focused settings are critical. There are indications that one of the four challenges facing the nursing workforce is the need for RNs to have expertise in concepts of public health, care coordination, and community partnerships. This need is driven by existing RNs of services and in care management and coordination of roles. This preparation may be self-limiting and related to the parameters of existing practices in preparing our nursing workforce [7].

Methodology

Prior to enrolling students in the project, Methodist College faculty completed several tasks:

• Developed a pre-licensure and BSN CBPC academic certificate (PL/BSN CBPC). This certificate consisted of courses currently embedded in the BSN curriculum with the addition of two additional courses that were used to complete the program requirements. Courses included:

• Concepts of Health and Health Care, Enhancements
• Population Health in Nursing, Enhancements
• Public Health: Epidemiology
• Service Learning

Baccalaureate School of Nursing (BSN) students were recruited for the BSN CBPC certificates based on interest in providing care in medically underserved areas in primary care settings. The students recruited for this program were given the title of, Community-Based Care Externs, and received a stipend for tuition, fees, books, and residential housing.

Developed a module-based Registered Nurse CommunityBased Primary Care Certificate (RN CBPC) that provided foundational concepts related to epidemiology, health promotion, and prevention, and focused the learners to address specific health care disparities identified as critical to the community of interest health care needs.

Registered nurses were recruited from the Unity Point Health clinics, public health departments, and at large from the community. Nurses selected received funding to cover the continuing education certificate costs and were known as RN Community Based Specialists.

• Methodist College continued collaboration with Unity Point Health and the college’s Health Professions Advisory Committee. This collaboration helped in the evaluation performance of the health science degree programs.
• A new Greater Peoria Community-Based Nursing Consortium was developed to include individuals with pivotal roles and key stakeholders, such as the Human Service Center and the Public Health Department. This consortium participated in the development of a conference on community-based healthcare social determinants of health.

Student Recruitment Plan

We proposed to prepare 50 BSN Community-Based Externs, which is equivalent to approximately 10% of the BSN student population at our college. The recruitment plan began with an email containing information about the grant program. The email included frequently asked questions, the date when the application to apply for the grant program, and the link to the application. It was sent to all qualified students two weeks before the start of the fall, spring, and summer semesters. Two weeks after the email was sent, the grant coordinator scheduled classroom visits to discuss the program and answer student questions. The program was advertised throughout campus via fliers and televisions. The grant team reviewed all the applications. Students chosen to participate in the program were emailed a letter outlining the grant program requirements. The grant coordinator met with each student to review the letter. The student and grant coordinator then signed the letter, which was the contract for adhering to the grant requirements.

Program Activities

Students had the opportunity to engage in hands-on community-based primary healthcare with the Mobile Outreach Learning Lab for Integrative Education (MOLLIE). Our college had received a grant that allowed the purchase of a mobile van that was retrofitted to provide community-based educational services to Medically Underserved Communities (MUCs) and Medically Underserved Populations (MUPs). The MOLLIE underwent the following enhancements: enhancements: a redesigned interior, a generator for a continuous power source, Wi-Fi capabilities, three laptops for documentation, a printer, and supplies appropriate for use by nursing students. The specific purposes of this grant aligned seamlessly with the NEPQR-RNPC grant.

The MOLLIE initiative was used to promote a higherperforming public health system that strived for more equitable healthcare access, particularly focused on the most vulnerable members of our population. Innovative programming and resourcing collaborative work within the college and with community stakeholders was vital to delivering these mobile healthcare services. The collective efforts between the college and the community better connected the traditional healthcare sector in a teaching environment with supportive services that assisted in delivering critical services to the targeted population. MOLLIE provided educational opportunities and hands-on experience to nursing students. It also included interprofessional educational services on the mobile unit that incorporated students from other college disciplines, including social work and health and human services. With the MOLLIE initiative, students were able to fulfill their 150 clinical hours in primary care.

One of the benefits the students attained was that they became more engaged and gained a stronger connection with the community and participated in public health events, such as immunization clinics. This experience also promoted the learning of effective communication and the ability to disseminate targeted health information to diverse audiences. The students were able to conduct educational programs, such as on the importance of handwashing and education on diabetes. Emergency response plans were added to the environment module and included in the Population Health in Nursing Course. High-risk behaviors or developmental risk factors were highlighted, and students learned the appropriate Erickson’s stages of Development for each age range. Evaluation of this knowledge occurred through course exams.

Our college collaborated with a health system that has multiple clinics that are HPSA and/or rural designated clinics. Most of them are in MUAs. The students worked at the clinics where the nurse navigator was able to teach them how to:

• Oversee a caseload of patients across the care continuum to include pre and post-treatment management in collaboration with the care team
• Facilitate communication between the provider and the interprofessional team

Facilitate a quality treatment experience and outcome for the patient

• Work collaboratively with (a specialty) service staff to ensure ongoing program development and improvement with outcomes and satisfaction.
• Work collaboratively with (a specialty) service staff to ensure ongoing program development and improvement with outcomes and satisfaction.

The students were provided opportunities to engage with the client(s) and their families and/or caregivers. They engaged with the community to safely perform culturally sensitive and inclusive, patient-aligned care focused on health promotion and prevention.

Evaluation

The project evaluator conducted focus groups and the students kept journals. In their journals, the students did reflections on why they joined the program. One said the following:

• I believe community-based primary care is essential and makes a large difference in the health of a community. I believe it is an important field in nursing because when we see trends and needs in a community, we are able to advocate for our communities. They may not feel like they have a voice, or they can change anything, but we are able to empower them and give them a voice. We assess for common illnesses or health alterations, and we identify needs to meet within the community to improve the overall health of the populations we serve. Having community health nursing also reaches a population that may not otherwise seek or receive health care, and I think that is a very important aspect of nursing.

Students also described their experiences in the program and one stated:

• I have worked in a primary care physician’s office for over three years as a medical assistant now and it took me so long to catch on. Once I started to get the hang of my job,I realized how much I enjoy caring for patients and that is what led me to want to become a nurse. Now that I have been a nursing student and a medical assistant, I have gotten to piece together so much more than I ever thought. I believe the education I have gained through school has helped me become an outstanding leader and mentor.

Findings

The themes that developed were those vulnerable populations, particularly those who live in rural communities, need to have access to community-based primary care clinics, and these clinics need to have baccalaureate nurses advocate for the vulnerable populations in their care. Another theme was that students recognize their commitment to quality patient care and the need to involve the family or support system of the patient. The students acknowledged the necessity and importance of their professional growth in primary care.

Implications

This NEPQR project is well developed to be able to promote primary care in rural communities. Rural integrated primary care practice requires specific training, expertise, and adjustments to service delivery and intervention to best meet the needs of rural and underserved communities and this project has established this for future nurses. This project will prepare future nurses and existing nurses to provide population and community-based primary care with the knowledge to be culturally inclusive, advocate for social justice, and expand their role as professional nurses.

Conclusions

Methodist College is committed to promoting communitybased primary care, especially in the rural communities that lack this focus of care. We are committed to developing and enhancing educational practices related to community and population-focused health care that increase the abilities of future and existing RNs to provide the highest quality of care in their expanded role as professional nurses. The enhancements in identified program-specific curricular practices, both pre-licensure and RN to BSN, provision of a Population Health Certificate, and continuing education for community health care providers will positively impact the delivery of health and primary care services. Community/population-focused healthcare educational programs that promote cultural inclusivity and advocacy of social justice will expand the roles of healthcare providers, particularly RNs, and their core competencies in the health and primary care of the U. S. population.

Disclosure

Author Contributions

Project data, B.M., N.M.R.; References, B.M.; writing-original draft preparation, N.M.R., B.M.; writing-review and editing, N.M.R, B.M.

Acknowledgments

“This project was supported by the Health Resources and Human Services (HRSA) of the U.S. Department of Health and Human Services (HHS) under the Nurse, Education, Practice, Quality and Retention Registered Nurses in Primary Care. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.”

Ethical Guidelines

This project was approved by the Institutional Review Board at Methodist College. Informed consent was obtained from all project participants for data reporting, presentations, and publications.

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