The patient was distraught.聽She had been in a bicycle accident a few months earlier and, ever since, her menstrual period had been irregular and she had experienced abnormal bleeding.聽
鈥淪he was spiraling, thinking she had cancer, and nobody was listening to her,鈥� says Tamara Webster, M.S. 鈥�24, a D.N.P. student at the Connell School of Nursing (CSON) who cared for the woman last fall while on a clinical rotation at the Lynn Community Health Center.
Webster assured her that she would receive a thorough exam and review of her lab tests, and that the clinic would follow up with her.
鈥淚 learned that sometimes people just need you to sit with them and hear where they鈥檙e at in life,鈥� Webster says. 鈥淚 think that was very important to her. She definitely left much more at ease than when she came in.鈥�
CSON student and Ryan Sullivan see a patient at Lynn Community Health Center. Photo: Caitlin Cunningham
Webster鈥檚 encounter with the woman stemmed from a CSON initiative to boost nursing students鈥� clinical placements at community health centers. Known as CHCs, these nonprofit organizations offer primary care and other medical services to more than 30 million patients in the United States each year, regardless of whether they have health insurance or can pay for treatment. Primarily funded by federal grants, they are typically located in urban or rural areas where people have limited access to medical services. The first CHC in the United States opened in the Columbia Point section of Dorchester, Mass., in 1965.
DEFINITION: COMMUNITY HEALTH CENTERS (CHCs)
Nonprofits that offer primary care and other medical services to more than 30 million patients annually, regardless of insurance or ability to pay. They are typically located in urban or rural areas where people have limited access to medical services.
Ted Hannigan, assistant dean of clinical placement and community partnerships at CSON, says the school has worked with CHCs for a long time, but in the past, most placements have been what he calls 鈥渙ne-offs,鈥� which typically occurred when a CSON alumnus working at a CHC offered to serve as a preceptor to a student for a semester.
Ted Hannigan
鈥淲hat we鈥檙e trying to do now is formalize these partnerships so they鈥檙e sustainable, where we send students every semester,鈥� says Hannigan. 鈥淎s a school of nursing, it鈥檚 our responsibility to promote health equity. By partnering with community health centers, we鈥檙e providing students with an opportunity to work with underserved populations and care for the whole person.鈥�
He notes that the partnerships need to benefit both the school and the CHCs: 鈥淚t can鈥檛 be a one-way street where every semester we ask, 鈥楬ow many students are you going to take?鈥� We always want to be really mindful of what鈥檚 in it for the health center.鈥�
For two local centers, Lynn Community Health Center (LCHC) and South Boston Community Health Center (S海角社区HC), working with CSON is helping to address chronic staffing shortages and provide critical care to a population in need.
鈥淎s a school of nursing, it鈥檚 our responsibility to promote health equity. By partnering with community health centers, we鈥檙e providing students with an opportunity to work with underserved populations and care for the whole person.鈥�
鈥擳ed Hannigan
Assistant Dean,聽Clinical Placement and Community Partnerships
Lynn Community Health Center
Of the city of Lynn鈥檚 103,000 residents, about a third were born abroad, making it one of Massachusetts鈥� most diverse cities. 鈥淲e see patients from all over the world who are new to the United States. We have treated conditions that most clinicians will never see in their careers, such as malaria,鈥� says Ryan Sullivan, M.S. 鈥�15, chief financial officer at LCHC, who is also a nurse practitioner (NP).
Ryan Sullivan
About 90 percent of the people who come to LCHC have family incomes below the federal poverty line. 鈥淢any have problems paying for groceries and utilities. For some, even getting transportation to their medical appointments can be a challenge,鈥� says Sullivan. He estimates that English is not the primary language of 70 to 80 percent of the clinic鈥檚 patients, which adds to the challenge of coordinating their care.
In his role, Sullivan must ensure that the clinic receives adequate reimbursement for the care it delivers by providing insurers with accurate and complete diagnosis data for their patient population. 鈥淏ut the health center鈥檚 providers need to focus on direct clinical care, and this information is often not captured,鈥� says Sullivan. He needed help with that process, and he had another problem: records showed that more than 4,000 of their patients were overdue for cervical cancer screenings. So Sullivan, who had done a clinical rotation at the Lynn facility during his time at CSON, asked Hannigan if students from the school could help out.
Tamara Webster
As a result of this new partnership, Webster and four other CSON nurse practitioner students, plus two from other schools, helped conduct weekly wellness clinics at LCHC last fall, a program that continued this year. Over the course of a dozen sessions, 280 people came to the clinic for annual Medicare wellness visits and/or cervical cancer screenings.
During the wellness visits, the CSON students met with Medicare recipients to obtain basic health information, review diagnoses and medications, and discuss required screenings and other routine medical needs. Students also asked them about issues affecting their well-being, called social determinants of health, such as their ability to purchase healthy foods or pay rent. They referred people in need of assistance to a care coordinator.
A patient and a CSON student at Lynn Community Health Center Photo: Caitlin Cunningham
CSON students also assisted with a program for women who were overdue for screening for cervical cancer, which is responsible for about 4,300 deaths in the United States each year. Students received training and guidance in performing the Pap test, which identifies abnormal cells and flags people at increased risk for cervical cancer. During these sessions, 170 patients were screened; four had results indicating an increased risk for cervical cancer and required referrals to a gynecologist for additional evaluation. 鈥淯pward of 30 percent of those patients found to be at high risk could progress to cervical cancer at some point,鈥� says Sullivan. 鈥淭hat is a powerful clinical benefit that the students were able to help us achieve.鈥�
CHCs by the numbers
~15,000
# of community health center sites in the United States
~50
% of patients treated at CHCs who are on Medicaid
1 in 5
patients treated at CHCs have no health insurance
173
# of CSON clinical placements at 18 Massachusetts聽CHCs since 2023
South Boston Community Health Center
Alison Marshall
Assistant Professor of the Practice Alison Marshall has been a family nurse practitioner at South Boston CHC for 21 years. 鈥淭his was my first job out of graduate school. I had a great passion for community health, so I only applied to community health centers,鈥� she says.
Over the past two decades, Marshall has observed a few persistent staffing problems. 鈥淲e have a very robust practice that takes care of all types of people who have complex health care needs, and we couldn鈥檛 keep our nursing staff,鈥� says Marshall. 鈥淎nd we had a few new NPs who didn鈥檛 make it through their probationary period to stay on as providers. They weren鈥檛 ready to work in a very busy, fast-paced, complicated primary care practice.鈥�
Jocelyn Guggenheim
Jocelyn Guggenheim, S海角社区HC鈥檚 chief operating officer who is a nurse practitioner, discussed these concerns with Marshall. 鈥淭his is something that community health centers and other [providers] have dealt with for some time,鈥� says Marshall. Guggenheim came up with an idea to address the longevity problem: a hybrid training program for new NPs. She tasked Marshall with developing the curriculum for what became known as the APRN Transition to Practice Fellowship Program, which she adapted from the American Association of Colleges of Nursing Competency-Based Education framework.
鈥淥ur trainees come in and learn how to do the part of clinical care that happens outside of the office visit, such as triage, returning messages, arranging for hospice services, and dealing with insurance companies,鈥� says Marshall. 鈥淭hen, slowly, they also start seeing patients one-on-one with a preceptor.鈥� Fellows commit to staying on through the length of the program, a minimum of 18 months, though some remain for up to two years.鈥�
Christina Bibinski, D.N.P. 鈥�26, Kate Griffin, D.N.P. 鈥�24, and Assistant Professor of the Practice Alison Marshall at South Boston Community Health Center Photo: Matthew Healey
That鈥檚 an improvement from the rapid and unexpected turnovers that we had been experiencing for years,鈥� says Marshall, noting that the clinic can plan for the departure of a participant who completes the program and moves on to another job. For some fellows, the opportunity at S海角社区HC may become permanent if a position is available. Kate Griffin, D.N.P. 鈥�24, recently became the first fellow to be hired permanently. A second student, Christina Bibinski, D.N.P. 鈥�26, will join the fellow team in June.
S海角社区HC intentionally accepts new fellows on a rolling basis. 鈥淭hat way the more experienced fellows help to train the newer ones, keeping the institutional knowledge within the department,鈥� says Marshall. 鈥淭his program feels like it steadied our big ship.鈥� 鈼�
Who receives care? In the U.S., CHCs care for:
400,000
veterans
1.4M
people experiencing聽homelessness
3.6M
adults over age 65
8.8M
children