1. Tuttle, Jane PhD, APRN, FNP-BC, FAANP

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Fellowship in the American Association of Nurse Practitioners is an honor that recognizes the importance of leadership roles in, and stewardship of, the nurse practitioner profession. For me, as a fellow, those key functions are epitomized by opportunities that I have had to work with Health Resources and Services Administration (HRSA)-funded interprofessional education projects. These projects are administered by the Maternal and Child Health Bureau (MCHB) and are instrumental in increasing the capacity to care for underserved populations, in this case, adolescents and children with special health care needs. When our University of Rochester Leadership Education in Adolescent Health (LEAH) project was initially funded in 1997, I was invited to serve as the Nursing Discipline Coordinator, along with faculty colleagues from medicine, psychology, social work, and nutrition. The Rochester New York project continued for 15 years and provided excellent team education and clinical experience for fellows from each of our disciplines to develop leadership and clinical capability in providing care for adolescents and their families. Fellows are typically graduate students or postdoctoral fellows in each of the disciplines. The nursing fellow, typically a nurse practitioner student in the last year of their graduate education, has been an ideal collaborator in the experiential learning and leadership development opportunities. At the national level, LEAH has continued to be funded in six or seven sites every 5 years.


My involvement in LEAH led to an invitation to serve in the same role with the HRSA-funded Rochester Leadership Education in Neurodevelopmental and related Disabilities (LEND) project for several years. This project includes more than twice as many disciplines, including the abovementioned ones for LEAH, as well as education, advocacy, audiology, speech therapy, physical therapy, occupational therapy, and more recently self-advocacy. Selected LEND fellows in each of the disciplines follow an individualized plan of education and training to develop as leaders, clinicians, policymakers, and educators. Each five years, more than 30 LEND fellowships have been funded across the country, and the Rochester LEND program has had continuous funding for the past three decades. Graduates of both LEAH and LEND have gone on to lead federal agencies, teach, and establish clinical and research programs all over the country. One of our early nursing fellows in LEAH served as the deputy director of her county's health department and has had a leadership role in other state and regional programs. Another has been an innovator in the area of school-based health services.


Both LEAH and LEND are part of the Division of Maternal and Child Health (MCH) Workforce Development, with the goals of working collaboratively "with national, state, and local MCH organizations to develop and sustain MCH professionals prepared to provide leadership within Title V and other MCH programs"(Health Resources & Services Administration [HRSA], 2018a). In addition to didactic education and clinical experiences, fellows are socialized to the crucial leadership role of advocacy, both for services and policy at all levels. The Rochester LEND fellows become active participants in the Association of University Centers on Disabilities University Centers for Excellence in Developmental Disabilities and attend a policy seminar in Washington DC each spring. After learning about how the government works and key legislation, the fellows, led by LEND faculty, visit legislators on Capitol Hill.


During most of these years, I also served as National Health Service Corps (NHSC) Ambassador for the University of Rochester School of Nursing. The NHSC is also a part of the HRSA and has as its mission to support the development of primary care providers and their deployment to underserved areas (Health Resources & Services Administration [HRSA], 2018b). This was a good fit with my role as Family Nurse Practitioner program director. Two of our FNP students were able to benefit from the NHCS scholarship, whereas many others continue to benefit from the various loan repayment options. I am proud to say that nurse practitioners are a major force in filling the shortage of primary care providers. It has been wonderful to offer additional education and training in both adolescent health and working with individuals and families with disabilities from an interprofessional perspective.


Technical assistance is a key component of LEAH and LEND programs. For example, as a result of our LEAH program, then program director Richard Kreipe, MD, and I teamed up to procure a small grant from the MCHB to support the commonwealth of Puerto Rico in formulating and implementing a youth development curriculum. We worked with the Puerto Rican Department of Health to help them design culturally relevant programs to reach youth throughout the commonwealth using a strength-based approach to health promotion and prevention of health risk behaviors. This activity is consistent with the mission of LEAH and LEND in supporting regional, state, and national programs that benefit the target populations.


The nurse practitioner role is especially suited to participation as faculty in interprofessional learning opportunities. The interprofessional LEAH faculty shared the responsibility for didactic teaching and worked together in clinical supervision. Each week, we saw a new adolescent patient who had been referred by their primary care provider for consultation on a wide range of adolescent issues from eating disorders to school avoidance and family stress. This consultation clinic became a valuable community resource, serving as an excellent clinical education model. Other interprofessional activities such as research projects and community outreach provided authentic experiences for leadership development.


In the Rochester LEND program, the clinical experiences are more varied. Each year, the fellows team up for an interprofessional clinical experience with a volunteer family. The nurse practitioner student fellows bring a wealth of clinical experiences with underserved populations to inform the assessment and management of a range of health challenges. I participated in our LEND group research project focusing on the transition to adulthood for youth with special health care needs. Each year, small groups of interprofessional faculty and fellows collaborated to study various aspects of the needs of transition age youth. For example, fellows and faculty from education, nursing, occupational therapy, physical therapy, social work, and speech pathology teamed up to study the lived experiences of adolescents with disabilities and their parents in transition planning (Hetherington et al., 2010).


My interest in the transition to adulthood also led to my involvement in the planning for a regional center that provides comprehensive health services for adults with childhood-acquired conditions. That center opened its doors in March 2016 and serves a growing number of adults with childhood-acquired complex conditions such as sickle cell disease, cystic fibrosis, and various disabilities, who have aged out of the pediatric health care system. Primary care, dentistry, physical therapy, mental health services, and care coordination are all available at this center as are some of the specialty services.


In conclusion, the Health Services and Resources Administration and other government agencies provide opportunities for nurse practitioners to demonstrate their leadership in interprofessional education. The outcome of these initiatives includes a workforce that is well prepared to address environmental trends and factors that affect the health of vulnerable populations. Ultimately, having nurse practitioners involved allows us to fulfill our professional responsibilities and promote stewardship of the NP role.




Health Resources & Services Administration (HRSA). (2018a). Division of MCH workforce development. Retrieved from [Context Link]


Health Resources & Services Administration (HRSA). (2018b). National Health Service Corps Retrieved from [Context Link]


Hetherington S., Durant-Jones L., Johnson K., Nolan K. W., Smith E., Tuttle J. (2010). The lived experiences of adolescents with disabilities and their parents in transition planning. Focus on Autism and Other Developmental Disorders, 25, 163-172. [Context Link]