Closing the care gap

“When patients walk into UC Irvine’s federally qualified health centers in Anaheim and Santa Ana, they often arrive with symptoms complicated by personal circumstances. Many are uninsured or underinsured. Some have spent months waiting for specialty appointments they cannot afford. Others are managing chronic illnesses as they confront transportation barriers, limited health literacy or fear of seeking care altogether. At the same time, Orange County continues to face a growing shortage of primary and mental healthcare providers. For faculty at the UC Irvine Sue & Bill Gross School of Nursing, those challenges have become part of the classroom. Doctor of Nursing Practice faculty are serving patients directly through UC Irvine-affiliated FQHCs and the Student Health Center while simultaneously teaching and mentoring the next generation of nurse practitioners. The integrated faculty practice model allows nursing faculty to provide care in underserved communities as part of their academic appointments – a structure that remains uncommon in nursing education. The approach strengthens access to care for Orange County residents and gives students hands-on clinical training grounded in real community needs. “This is truly valuable to patients and to our learners,” says Candice Whealon, D.N.P., a family nurse practitioner, the director of clinical faculty practice at the Sue & Bill Gross School of Nursing and an associate clinical professor. “Our clinical competence is maintained through practice within UCI. It’s not the norm nationally, but it’s incredibly meaningful because students learn alongside faculty who are actively caring for these populations.” A different model for nursing education At many nursing schools, faculty members are expected to maintain their clinical skills independently, often working outside their teaching roles on evenings or weekends. At UC Irvine, faculty with clinical doctorates serve patients at community clinics and the Student Health Center and also supervise D.N.P.- F.N.P. students in real-time clinical environments. Their patient care counts toward their teaching responsibilities, linking classroom learning and practice. “It’s important that we show our students that we’re still practicing, that we’re clinically relevant,” says Tiffany Nielsen, D.N.P., senior director of D.N.P. programs and associate clinical professor. “We’re walking the walk, not just talking about it in class.” Currently, four nursing faculty members practice at the Student Health Center, and others serve at UC Irvine-affiliated FQHCs in Anaheim and Santa Ana. Two more faculty clinicians are in the onboarding process to expand the program further. The FQHCs serve some of Orange County’s most vulnerable populations. “These are the individuals the clinics were designed to care for,” Whealon says. “The needs of these communities often exceed the capacity of available providers, so the School of Nursing is helping bridge that gap.” The work also aligns closely with the school’s mission to prepare nurses who can serve disadvantaged communities and improve access to care. Training students in real-world care For UC Irvine’s D.N.P. students, the experience begins long before graduation. Students rotate through clinics with faculty mentors, taking patient histories, conducting physical exams, participating in procedures and helping manage patient care under direct supervision. At the Student Health Center, Nielsen’s background in emergency medicine gives students access to both primary and urgent care services. “We have X-ray on-site, lab on-site and urgent visit capabilities,” Nielsen says. “Students are seeing the full spectrum of patient care – from wellness visits to injuries and acute illnesses.” Depending on their training level, students can document visits, input orders, review lab results, assist with procedures and provide patient education. “As much as their knowledge and experience allows, they’re involved in the whole gamut of patient care,” Nielsen says. The integration of classroom instruction and clinical practice gives faculty a unique perspective on student development. “I know exactly where they are in the curriculum and what they’ve been taught,” Nielsen says. “There have been moments where I’ll tell a student, ‘We talked about this in class last week.’ It helps connect what they’re learning academically to real patient care.” Beginning this fall, students in the revised D.N.P. program will begin clinical rotations earlier, increasing consistency in hands-on experience throughout their education. Faculty say the approach strengthens both competence and confidence. “I think it solidifies learning,” Nielsen says. “Students are reading about concepts in class and then immediately seeing them in practice with real patients.” Caring for complex patient populations Faculty say one of the most important lessons students learn is how to care for patients with constrained resources. At FQHCs, providers must often navigate barriers that extend far beyond diagnosis and treatment. “When you’re caring for a patient with limited access to care, you have to be very mindful about where you refer them,” Whealon says. “It’s not helpful to refer someone to a clinic they can’t afford or where they may wait a year for an appointment.” That challenge often requires providers to manage more complex conditions directly within primary care settings. “For example, if a patient needs dermatology care, they may not be able to access a specialist quickly because of insurance limitations,” Whealon says. “So clinicians in these spaces need expanded expertise to manage more complex diseases.” Faculty believe exposing students to these realities early prepares them to work with underserved populations more effectively after graduation. “They gain knowledge not only about clinical care but about how to navigate the healthcare system for patients who face barriers,” Whealon says. “That helps them provide more holistic care.” A residency designed for community care The Sue & Bill Gross School of Nursing is also addressing primary care provider shortages through a family nurse practitioner residency program supported by a CalOptima Health Nurse-OC grant. Directed by Nisa Zacharias, D.N.P., assistant clinical professor, the program offers an additional year of structured clinical training for newly graduated nurse practitioners committed to serving vulnerable communities. “The idea is that we’re creating a pipeline of community nurse practitioners for Orange County,” Zacharias says. “The idea is that we’re creating a pipeline of community nurse practitioners for Orange County,” says Nisa Zacharias, D.N.P., UC Irvine assistant clinical professor and director of the family nurse practitioner residency program. Steve Zylius / UC Irvine Residents are fully licensed clinicians who spend part of their time independently caring for patients in community clinics and part of their time training alongside faculty mentors, partaking in observational specialty rotations and didactic learning. “They’re licensed and board-certified practicing providers, but it’s an additional training year,” Zacharias says. “It gives them extra support as they develop the skills needed to care for highly complex populations.” Zacharias, who has spent her entire career in community health settings, says the additional training is critical. “There’s a depth of complexity that comes with serving this population,” she says. “Patients often face financial barriers, language barriers and advanced disease processes. This extra year helps clinicians feel more prepared and confident in caring for them.” The residency program places clinicians at community sites including Camino Health Center San Juan Capistrano, and they mentor alongside faculty at UC Irvine-affiliated FQHCs. Faculty mentors guide residents through patient care while also helping them develop skills in health literacy, chronic disease management and culturally responsive communication. Building trust through patient care For Zacharias, some of the program’s most meaningful moments happen when students build trust with patients who may have spent years hesitant to seek care. She recalls one patient with uncontrolled diabetes who repeatedly showed abnormal test results but resisted further evaluation. A D.N.P. student developed rapport with the patient and emphasized the importance of follow-up care. Eventually, the patient agreed to closer examination. The care team discovered a complex gynecologic mass that was later diagnosed as cancer. “If the student hadn’t spent that extra time building trust and understanding the patient’s fears, we might not have gotten the information we needed,” Zacharias says. “That human connection made all the difference.” The experience reinforced what faculty say sets UC Irvine students apart. “So many of our students choose this program because they genuinely want to serve underserved communities,” Zacharias says. “You see them going the extra mile for patients.” Expanding access to care Faculty members say the impact of the integrated practice model extends beyond education. By embedding experienced nurse practitioners within community clinics, the Sue & Bill Gross School of Nursing is helping increase access to high-quality primary care throughout Orange County. “These patients often have complicated disease processes and limited access to specialty care,” Whealon says. “By utilizing faculty who are experts within their profession, we’re helping ensure patients receive high-quality care where it’s needed most.” The model also allows faculty and students to contribute directly to clinic improvement efforts. Many D.N.P. students complete quality improvement projects at the clinics, helping streamline workflows and enhance patient care processes. “We’re seeing positive changes within the clinics because our students are conducting these projects,” Nielsen says. “That’s another unique opportunity we’ve been able to establish.” As Orange County continues to confront provider shortages, faculty believe that the Sue & Bill Gross School of Nursing’s integrated approach is helping prepare clinicians who are not only clinically skilled but deeply connected to the communities they serve. “We’re seeing the real-time difference this training makes,” Zacharias says. “The more prepared our clinicians are, the better able they are to serve patients who often need the most support.”

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