Publications » Essay Winner 2011

Essay Winner 2011


 2011 NSNA/Nursing Spectrum/NurseWeek Essay Contest Grand Prize Winner


Transforming Healthcare with Community Health Centers

By Jennifer Seegmiller
Jennifer Seegmiller (right), of Lewis-Clark State College, Lewiston, ID, pictured with NSNA® Imprint Editor and Image of Nursing chair, Kindra Scanlon, won the Essay Contest Grand Prize, presented at NSNA's 59th Annual Convention, April 6-10, 2011, in Salt Lake City, UT. Students were asked to respond to the question “If you could propose any change to healthcare, what would you change and how would the change impact the nursing profession?” Ms. Seegmiller won a $500 gift cheque, complimentary registration to the Convention and the winning essay published online at and
A mother rocks her son to comfort him. He’s been sick for three days, but there’s no money to pay a doctor’s bill. She tells herself that he will get better on his own. But as three days stretch into four, the child’s fever climbs to 103 and a rash appears. She takes him to the doctor knowing that this month will be a hungry one.
This is not a scene from a third-world country, it happened here in America. It happened to me. Health insurance was unavailable for dependents when my husband was a graduate student and his meager stipend was considered too affluent for Medicaid. Our town didn’t have a public health clinic and I couldn’t find a job at all, much less one with benefits. I literally had to choose between getting my son the care he needed and buying food. 
It’s a choice no parent in America should ever have to make.
If I could propose one change to healthcare, I would ensure that every county in America had at least one low-cost community health clinic to provide comprehensive primary and preventative health care for the economically disadvantaged. It is a telling oversight that in this land of prosperity, existing medical services are inadequate to meet this population’s great need. 
According to the Centers for Disease Control (CDC), 7% of the population did not seek medical care during 2009 because of inability to pay for services. This figure represents a significant increase from 2008, and reflects a trend of steady increase since 1997 when only 4.5% of the population couldn’t pay for care. When examined by income level, 44% of persons below poverty level, and 45% of persons between 100-199% of poverty level did not seek medical care due to inability to pay. This same study indicated that 40 million people in the U.S. lacked a usual place to go for medical treatment (CDC, 2009, 2010a, 2010b), which was an increase from 36 million people in 2004 (Hawkins & Proser, 2004).
The National Association of Community Health Centers (NACHC, 2011) report that over 8,000 community health centers across America provide medical, dental, mental health, and pharmacy services regardless of a patient’s ability to pay. Approximately 16 million patients visited community health centers in 2007 for a total of 63 million clinic visits (Hawkins & Proser, 2004; NACHC, 2011). However, with data indicating that 40 million Americans have insufficient access to health care, 59 million Americans are uninsured, and 1,500 U.S. counties lack a community health center, need is still outpacing availability (CDC, 2009, 2010b; Hawkins & Proser, 2004). 
The efficacy of community health centers in providing quality care and reducing costs has already been established. Between the years 2000-2007, there was a 56% increase in low income patients seen at community health centers, although the overall low income population only increased by 7% (Hawkins & Proser, 2004; NACHC, 2011). Medicaid recipients who utilized community health centers were 19% less likely to present to the emergency department for avoidable conditions and had lower hospital admission rates, shorter length of hospital stays, less costly admissions, and cost taxpayers 33% less in overall medical expenditures than Medicaid patients who sought care elsewhere (Falik, Needleman, Herbert, Wells, Politzer,Benedict, 2006; Falik, Needleman, Wells, & Korb, 2001). Patients who visited community health centers demonstrated improved clinical outcomes with management of diabetes, cardiovascular disease, asthma, depression, cancer, and HIV, with lower attendant costs. Furthermore, communities with health centers had a 40% lower infant mortality rate than communities without an open access health clinic (Hawkins & Proser, 2004; Falik et al., 2001; Falik et al., 2006; Institute of Medicine, 2002; NACHC, 2011).
It is the nurse’s ethical duty to promote wellness, restore health, and relieve suffering regardless of a patient’s race, socioeconomic status, or personal choices (American Nurses Association, 2010). With this mandate and as natural patient advocates, nurses are crucial to the success of community health initiatives both as providers of care and as voices calling for service expansion (Institute of Medicine, 2010a; U.S. Department of Health and Human Services, 2007). 
As providers of care, nurses are pivotal to the success of community health centers. In 2007, clinical staffing at community health centers utilized registered nurses (37%), nurse practitioners (11%), and certified nurse midwives (1.7%), but were 1,384 nurses short of full staffing (NACHC, 2011; U.S. Department of Health and Human Services, 2007). It is projected that by 2015, community health centers will provide medical services for an additional 30,000 patients, requiring an additional 12,000 nurses (NACHC, 2008).
So how will the expansion of community health centers impact the nursing profession? First and foremost, it will increase the demand for highly skilled registered and advance practice nurses.   Secondly, it will require nurses to attain higher levels of education to expand depth and breadth of knowledge and promote parity with other health professionals for true team-oriented collaborative care. And third, it will require visionary nurse leaders who will gather sufficient legislative support to shape laws, fund educational initiatives, and provide facilities to bring about meaningful results (Institute of Medicine, 2010a, 2010b). 
Change from within has incomparable power to transform. Our professional future will be shaped by how well we embrace recommendations to take leadership roles, promote interdisciplinary collaboration, facilitate effective planning and policy for workforce training, and refine educational systems that encourage higher levels of training with a seamless academic progression (Institute of Medicine, 2010a, 2010b). But if each member of the nursing community contributed by supporting educational innovations, promoting professional and patient advocacy, and enabling positive workplace and professional culture, we would be an overwhelming force for change. 
Nurses are expert problem solvers and as such, we are uniquely positioned to address our nation’s health care challenges. As we mobilize our knowledge, skill, humanity, and creativity to meet the health care needs of the economically disadvantaged, we will empower the disenfranchised and forge collaborative partnerships that will transform our nation’s healthscape to improve the quality of life for all Americans.