The Reporter: Dec 1994, Vol.5, No.4
Nursing School Opens Center for Advanced Practice

School of Nursing faculty are the first among the nation's nearly 100,000 advanced practice nurses to form a faculty group practice with full admitting privileges to a major teaching hospital. Through an unprecedented partnership with Presbyterian Hospital, faculty nurse practitioners will admit and follow patients seen initially at the School of Nursing's Center for Advanced Practice, a new clinic run by nurses in northern Manhattan.

"Our Center for Advanced Practice offers an innovative model for expanding the role of advanced practice nurses in a reformed health care system," says Dr. Mary O. Mundinger, dean of the School of Nursing. "Just as important, the center provides a new site for the delivery of high-quality care to the residents of Washington Heights-Inwood."

Located at 64 Nagle Avenue in northern Manhattan, the center is the newest addition to the Ambulatory Care Network Corporation of Presbyterian Hospital.

"Through the complementary activities of teaching, research, and practice at the Center for Advanced Practice, the School of Nursing enhances the mission and reach of this academic medical center," says Dr. Herbert S. Pardes, vice president for health sciences and dean of the faculty of medicine. The center will serve as a clinical education site for students in the School of Nursing's advanced practice programs.

Patrick Coonan, assistant dean for advanced practice at the School of Nursing, serves as director for project implementation and evaluation. Patricia Ruiz, assistant professor of nursing and a pediatric nurse practitioner, manages the clinic's daily operations.

Faculty nurse practitioners at the Center for Advanced Practice evaluate and treat patients of all ages for the full range of common health problems, including routine newborn and child care, diabetes, hypertension, and asthma. A complete network of specialists is available for referral of unique or complicated medical problems. When appropriate, such as in the case of a diabetic patient requiring regulation of blood sugar or a pediatric patient requiring stabilization of asthma symptoms, the faculty nurse practitioner will admit a patient to Presbyterian Hospital, manage the patient's treatment while hospitalized, and assure continuity of care when the patient returns home.

Researchers from the School of Nursing will work with the nurse practitioners to evaluate nurses' patterns of referral to specialists, their admitting practices, nurse management of hospital stays, and patients' adherence to health regimens under nurse direction. The researchers also will seek to determine the effect on patient outcomes of continuity of care provided by nurses with admitting privileges.

Washington Heights-Inwood, the community served by the Center for Advanced Practice, has a socially diverse population of 300,000, of whom 67 percent are Latino, 25 percent are Caucasian, and 12 percent are African-American. Since 1975, five hospitals in the area have closed, and it is estimated that the remaining health care facilities-including those at CPMC-meet only 50 percent of the community's primary care needs.

The Center for Advanced Practice has received overall funding from the Division of Nursing in the Department of Health and Human Services. In addition, the New York State Department of Health has provided salary support for nurse practitioners in the center as part of the Workforce Demonstration Project in collaboration with Presbyterian Hospital. The Fan Fox and Leslie R. Samuels Foundation has funded the evaluation study, and the center also has received support from the Walter H.D. Killough Trust.

The nation's 100,000 advanced practice nurses encompass nurse practitioners, who provide primary care in clinics, schools, and homes; nurse-midwives, who deliver babies in hospitals, birthing centers, and homes; nurse-anesthetists, who provide anesthesia for all types of surgical procedures; and clinical specialists, who provide complex care, such as chemotherapy for cancer patients, in hospitals. All advanced practice nurses hold a baccalaureate degree, with graduate training at the master's level or beyond in a clinical specialty, and they are nationally certified by professional associations. Advanced practice nurses have made steady gains in independent authority and scope of practice in recent years. Nurse practitioners have authority to write prescriptions in 48 states and are eligible for Medicaid reimbursement for their services in 49 states.