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“Nurses always have a real concern for preventive care,” Baumann said. “That’s right up their alley for nurses. And they’re good at leading change.”

They’re also trained in a team approach to care, she said, and that’s essential when trying to build prevention into a health practice.

Maribel Cifuentes, RN, serves as the deputy director of the Prescription for Health initiative. Many of the projects involve nurses because nurses help manage and run the family practices where the research is being carried out. That provides a natural role for nursing, but several projects are focusing on enhancing the role of nurses and using them as agents of change. That’s a good thing, according to Cifuentes.

“I’m personally biased because I am a nurse,” she said. “The people who go into nursing have certain qualities. They’re very good communicators. They have diverse backgrounds and the passion to do quality work. It strikes me that nurses are very well-suited for this.”

Arnold makes good use of those communication skills. Getting the practices on board requires flexibility and an open mind, she’s found. One of her biggest obstacles has been to convince clinic staffs that she isn’t going to take up too much of their time.

“They have lots of people coming in and auditing them and giving them flow sheets,” Arnold said. “They’re very busy. They just don’t have time to do one more thing.”

Arnold has to negotiate with the various clinics for time to make presentations. Three clinics dropped out of the project, and the research network had to recruit three replacement sites.

“I believe flexibility is key and keeping an open mind, and not being judgmental and trying to fit them into a model,” Arnold said.

Time crunch

In already time-constrained, busy family practices, finding the staff with time to address behavior changes with patients can be challenging.

Another Prescription for Health project is testing the role nurses should play in providing health education. The Hartford, Conn.-based New England Clinicians Forum is conducting its grant research in eight health centers spread out over Maine, Connecticut and Massachusetts. The sites are all federally qualified health centers serving disadvantaged populations.

The project links risky drinking and tobacco use and is looking at whether it makes a difference who provides the screening and intervention.

The project is testing three models. In three clinics, a physician or nurse practitioner handles the screening. In three other clinics, a medical assistant or nurse fills this role, and in two clinics, a health educator from outside the center works with the patients.