NURSES ROCK! Nurses champion children, education through clinics

School of Nursing faculty nurse practitioners lead an manage the clinics. They have the authority to write prescriptions, and are nationally certified in their specialities and licensed by the Texas Board of Nursing.

Having asthma can be scary, but when your child has it, it can be even more distressing. There are often multiple trips to a health care provider to get the breathing problems under control and establish a treatment plan. This was the case for Selma Hernandez, whose children, ages 2, 4, 7 and 11, have asthma.

“Sometimes getting an appointment with their primary-care provider was difficult. In order to take them to the doctor I would sometimes have to miss a full day of class or my husband would have to miss a full day of work,” said Hernandez, because the family had one car to take the children to day care and school, her husband to work and Hernandez to school for her medical assistant classes.

Fortunately, Hernandez was able to take all her children to the AVANCE Community Outreach Clinic at 2642 Castroville Road, where her two younger children were attending day care at the AVANCE Early Head Start Center.

“I am so thankful that the clinic at AVANCE is open to all of my children. They are able to see Mrs. Mary (Mary Maffei, M.S.N., RN, PNP) at a time that is convenient for my family,” Hernandez said. Maffei provides health care services at the clinic and is a clinical instructor in the School of Nursing’s Department of Family and Community Health Systems.

The nurse-led, nurse-managed clinic is one of seven operated by the School of Nursing’s clinical enterprise, which includes a number of pediatric clinics in partnership with community agencies, as well as the Employee Health and Wellness Clinic and Student Health Center on the UT Health Science Center’s Joe R. and Teresa Lozano Long campus.

Mary Maffei, M.S.N., RN, PNP, visits with Tabby

Tabitha Hernandez, 3, benefits from care provided by UT Health Science Center nurses at the AVANCE Community Outreach Clinic on San Antonio’s West Side. Mary Maffei, M.S.N., RN, PNP, is among the School of Nursing faculty who provide care at seven nurse-led, nurse-managed clinics throughout the city.

The pediatric clinics provide an accessible, high-quality, efficient and cost-effective system of care that establishes a “health home” for children enrolled in Early Head Start (birth to age 3) and Head Start (ages 3-5) programs offered through several AVANCE-San Antonio and Family Service Association locations. Health care services and education are also offered for pregnant teens, teen parents and their children through the Healy-Murphy Center, an alternative high school for at-risk students and its accompanying day care center.

“These clinics create learning, research and practice ‘collaboratories’ for faculty members and students in the School of Nursing and in other health care disciplines at the Health Science Center,” explained Julie Novak, D.N.Sc., RN, CPNP, FAANP, associate dean for practice and engagement in the School of Nursing.

Dr. Novak, who joined the School of Nursing in September of 2009, is director of the fast-growing School of Nursing clinical enterprise that provides care for more than 12,000 adults and children. More clinics are expected to open this year through partnerships with local agencies and school districts.

The clinics are led by nurse practitioners who work in collaboration with physicians. The physicians review 10 percent of the charts and are available for phone consultation per Texas state law. “We are fortunate to have two excellent collaborating physicians, Dr. Miguel Ramirez-Colon and Dr. Mark Nadeau,” Dr. Novak said, who are Health Science Center School of Medicine faculty members.

The clinical enterprise team works closely with the Long School of Medicine and the Dental School, referring patients for specialty care. A grant is under review that would create a collaborative school health model with the Division of Community Pediatrics, Department of Psychiatry, Dental School and other subspecialties.

All of the clinics offer preventive care, including immunizations and a variety of services tailored to the population served. For example, all of the children at the AVANCE Head Start and Early Head Start Child Development Centers have been immunized and receive health screenings mandated by the federal government, which provides funding for the AVANCE program. Well-child check-ups, treatment for common health issues and a dental sealant program are provided.

In December, Dr. Novak created a partnership with Family Service Association (FSA) at eight screening sites. School of Nursing team members have provided nearly 1,000 comprehensive assessments for FSA Head Start enrollees. In January, Dr. Novak opened a second AVANCE clinic site at Fenley Center at 934 Flanders in the Harlandale Independent School District.

In collaboration with the missions of the community partners, Dr. Novak is integrating the Brazelton Touchpoints Approach into the pediatric clinic practices. The approach involves educating and enhancing the competence of parents as their children move through developmental milestones, in order to build strong families.

Dr. Novak completed predoctoral work at the Brazelton Touchpoints Center associated with Harvard University and Children’s Hospital Boston with renowned pediatrician Dr. T. Berry Brazelton to learn more about this approach, which she integrated into the nurse-led clinical enterprise she directed at Purdue University. Dr. Novak was a faculty member at Purdue from 2000 through 2009, where she also served as professor, head of the School of Nursing, director of the Doctor of Nursing Practice program, and director of four nurse-managed clinics. Dr. Novak secured funding from the American Recovery and Reinvestment Act and Federally Qualified Health Clinic status for two of the clinics.

In March, Dr. Novak’s career achievements were acknowledged when she received the Henry K. Silver Memorial Award from the National Association of Pediatric Nurse Practitioners. The biannual award is presented to an individual who has contributed to the expansion or improvement of pediatric health care and the advancement of the profession of pediatric nurse practitioners at the national and/or international level.

“It is a tremendous honor to receive this award, especially now, while I am working to expand the School of Nursing clinical enterprise,” Dr. Novak said. “Dr. Silver’s focus on holistic approaches to the care and empowerment of children and families, and his wisdom in guiding the development of the nurse-practitioner movement set the stage for the critical role that advanced-practice nurses are playing in health care reform and the creation of patient and family-centered clinics.”

For Hernandez, whose children receive care at the AVANCE Community Outreach Clinic, the benefits of the School of Nursing clinical enterprise are obvious. In addition to having well children who spend more time in school, Hernandez herself was able to maintain a 4.0 grade point average while earning her medical assistant certificate. The family has just moved into a Habitat for Humanity home and she is seeking employment as a medical assistant.

“The staff at AVANCE and the AVANCE Clinic are awesome!” she said.