This year, the Kentucky Racing Health Services Center (KRHSC) is celebrating 20 years of addressing the health care needs of this often-underserved population. A partnership between the UofL School of Nursing and the Kentucky Racing Health and Welfare Fund (KRHWF), the health services center provides care to backside workers and their families for a $10 co-pay. Access to primary health care remains a challenge for backside workers due to financial constraints, language barriers and demanding work schedules.

In May 2018, O, The Oprah Magazine featured the Kentucky Racing Health Services Center in its “Health Heroes” section, highlighting the clinic’s significant impact on the health and well-being of racetrack workers. This impact is the result of the continuity of care supported through careful mentoring and succession planning of center leadership, beginning with founding director and dean of the School of Nursing, Whitney Nash, and continuing to the center’s next director, Sara Robertson and now Dedra Hayden. This has proved to be an exemplar model of the school’s efforts to promote outstanding faculty and foster the professional development of nursing leadership. 

Open three days a week, KRHSC has six APRNs (Advanced Practice Registered Nurses) and certified specialists in adult geriatrics, women’s health and midwifery, family practice, and psychiatric mental health. Throughout the past two decades, the staff has engaged in more than 26,000 patient encounters, making a significant impact on the community.

UofL News spoke with Hayden about this major milestone.

UofL News: What was the vision for creating the KRHSC and how has it evolved?

Hayden: The original vision was to serve as a safety net for uninsured backside workers, primarily addressing minor illnesses and injuries. Over the past 20 years, the center has expanded its scope, integrating preventive care, specialty women’s health providers, mental health support, and chronic disease management into our services. We have expanded our interprofessional collaboration within UofL including Latin American and Latino Studies, the School of Dentistry and the Office of Community Engagement. Several pre-nursing, dental, and medical students have completed language internships with us.

UofL News: What kinds of health concerns can the KRHSC help address for backside workers?

Hayden: A typical patient at KRHSC is Hispanic, non-English speaking, and works in the Kentucky horse racing industry, often without health insurance. They come from countries where health care is not a priority because the priority is to survive. Therefore, we start from the beginning and ensure they are up to date on all preventive care services. Common health concerns include musculoskeletal injuries, respiratory conditions, diabetes, hypertension, and mental health challenges such as anxiety and depression.

UofL News: As director and a nurse practitioner for the center — what is the best part, what is the toughest part?

Hayden: The opportunity to provide accessible health care and advocate for patients who might otherwise struggle to receive care has been incredibly fulfilling. The best part of the job is patient success when you develop trust and goals of care are met. The toughest part is observing patients who experience unfairness outside of our clinic. We are quick to step in as an advocate.

UofL News: What does the clinic mean for the community?

Hayden: It’s an essential resource for the community because we are improving health outcomes and fostering a sense of security for backside workers. It takes a long time to gain trust in our community. Its presence reinforces the importance of equitable health care access for all, regardless of socioeconomic status.

UofL News: Are there particular patients who stay with you – who you remember because of their story?

Hayden: I have so many stories. I was treating a patient who came to the U.S. and was experiencing depression. I learned she had left her children in her home country to come to the U.S. to work and was sending all her earnings back home to them. That was a tough one. Another impactful story was when a cancer patient was refused lifesaving radiation treatments. I brought the patient in and cleared him for therapy and was quick to call the radiation center and advocate that this patient be seen as soon as possible.

UofL News: Any other thoughts you’d like to share?

Hayden: It is an honor to be the director at the center. Without the unwavering support from the School of Nursing administration, the university and the Kentucky Racing Health and Welfare Fund, we could never accomplish our mission. Even more importantly, the entire team of accomplished APRNs that I have the privilege to work with, who provide evidence-based care to every single patient, make our mission possible. Hats off to Krista Roach, Karen Turner, Sarah Carter, Sarah Cohron, and Courtney Albers. Thank you for helping make it all possible!

Nash is currently a professor and dean at Georgia Southern University’s Waters College of Health Professions. No stranger to UofL, Nash is a two-time alumna and has spent 17 years employed with the university. She earned a Master of Science in Nursing degree in 1997 and PhD in Nursing in 2010. From 1997 until 2022, she served as an instructor, assistant professor and associate professor at the School of Nursing. Nash also has held a number of leadership positions including: director of practice for international affairs, associate dean of practice and service, assistant vice president of inter-professional practice partnerships on the Health Sciences Center campus and as an executive team member of the .

In 2005, Nash was hired by UofL as the founding director of the , a clinical practice that provides free care to backside workers in the thoroughbred horse racing industry. The clinic offers a full range of primary care services, including mental health. In 2011, Nash developed and implemented the School of Nursing and advanced practice inter-professional education collaboration, which utilizes advanced practice nurse practitioners to guide students in obtaining consultations for medically compromised patients. Additionally, she founded UofL Care Partners, a nursing and dental clinic founded based on results of a needs assessment and in response to the lack of access to care for patients receiving dental care at the School of Dentistry.

She is a member of the American Academy of Nurse Practitioners and the National Organization of Nurse Practitioner Faculties. She has received dozens of accolades and awards including recognition as a Fellow of the American Academy of Nursing in 2021, Fellow of the American Association of Nurse Practitioners in 2017 and was a finalist for Business First’s Health Care Hero in 2016.

“We are delighted to bring an accomplished educator and leader back to UofL,” said Provost Gerry Bradley. “Dr. Nash will lead an outstanding School of Nursing to new levels of excellence in the years ahead.”

Nash says becoming dean of the UofL School of Nursing has always been her dream job. Originally from southern Indiana, she considers the Louisville area home, and says she’s had the honor of watching several of her previous students become faculty members and colleagues.

The new nursing dean says her vision for the School of Nursing is “to refine and accelerate every mission area, but with an initial focus on the research mission. I want to help the school really define its areas of distinction.”

“Again and again, Louisville took a chance on me. I was in the second cohort for the master’s degree and the first cohort for my PhD in nursing, and I feel like a pioneer in that way,” Nash said. “When I was hired to start the Kentucky Racing Health services program, they took a chance on someone who had not done something at that level. It means a lot to me that they had faith in my ability, and it’s come full circle now.”

Whitney Nash, PhD, APRN, FAANP, UofL School of Nursing associate dean of practice and service, has been appointed assistant vice president of interprofessional practice partnerships at the .

Nash will be responsible for expanding multidisciplinary practice at the academic health sciences center and forging partnerships with community organizations.

“The future is in interprofessional health education and practice,” Nash said. “Health care providers can no longer afford to practice in silos. Extensive research supports interprofessional education and practice as a mechanism to decrease medical errors and improve patient care.”

Nash will build upon UofL’s existing education and practice programs that incorporate interprofessional health care.

UofL Care Partners, a nurse practitioner-managed primary care clinic housed at the School of Dentistry, opened in 2018 to serve patients at the dental clinic and members of the community with immediate health needs and chronic issues.

The clinic is an outgrowth of an established relationship between the UofL Schools of Dentistry and Nursing, which in 2012 jointly received a $1.1 million federal grant that supported an educational initiative for nursing and dental students to enhance communication between the professions and develop best practices in patient assessment, consultation and management.

Another interprofessional practice site is the Kentucky Racing Health Services Center, a nonprofit clinic run by UofL School of Nursing faculty that has been nationally recognized as an innovative care model. Medical, nursing and dentistry students rotate at the clinic, which serves low-income backside workers of the thoroughbred racing industry.

UofL has translated interprofessional health research into curriculum changes as well.

Faculty members at the UofL School of Medicine developed a national training program to instruct educators at universities across the United States in teaching interprofessional palliative care for patients with cancer. Supported by the National Cancer Institute, the Interdisciplinary Curriculum in Oncology Palliative Care ����ֱ�� has trained thousands of students from social work, medicine, nursing and chaplaincy.

The Interprofessional Curriculum for the Care of Older Adults was funded by the Health Resources and Services Administration to develop and evaluate an interdisciplinary geriatric curriculum for medical, nursing, social work, pharmacy, dentistry and law students. The project aims to meet the needs of rural older adults by integrating geriatrics with primary care, maximizing patient and family engagement and transforming the rural health care system.

The Academy has named School of Nursing faculty members Whitney Nash, PhD, APRN, and Sara Robertson, DNP, APRN, for establishing and growing the clinic, which serves low-income thoroughbred racing industry workers and their families. The designation recognizes original evidence-based and nurse-designed care models that have shown significant clinical and financial outcomes.

Located a block from Churchill Downs, the clinic is a partnership between the School of Nursing and the that provides comprehensive health care to backside workers, including assistant trainers, grooms and hot walkers.

Most workers the clinic serves migrate from Latin America to work U.S. horse racing circuits. These low-paying jobs typically do not include health benefits. Before the clinic opened in 2005, many of its patients forwent health care or used the emergency room for primary care.

“It is a privilege to be recognized with such a prestigious designation,” said Nash, School of Nursing Associate Dean of Practice and Service and founding director of the clinic. “We are honored to serve one of the most vulnerable populations.”

Funded by uncashed parimutuel tickets at horse racing tracks throughout Kentucky, the clinic decreases health care barriers and has reduced medical costs by providing much of the workers’ health care in one place.

Workers can access the clinic for a $5 copay, which covers the patient visit and lab tests. Services include mental health treatment, physicals and women’s annual exams, care for acute illnesses, and maintenance treatment for chronic conditions such as asthma, diabetes and hypertension.

“The high level of comprehensive care and readily available appointments allow patients to understand and manage their unique health situation,” said Richard Riedel, director of the Kentucky Racing Health & Welfare Fund. “Because satisfaction levels are so high, patients often return for their care.”

The (NAMB), the domestic mission agency of the Southern Baptist Convention, brought the two mobile clinics – one for dental services and the other for basic medical screenings – to the on May 20 to treat its first patients. Faculty members from the UofL School of Dentistry and School of Nursing worked at the clinics for the day, seeing patients from the nonprofit center that serves the backside track workers at Churchill Downs.

NAMB wanted to gauge the efficiency of the clinics and get feedback from the health providers. The units will officially launch in St. Louis a week before the Southern Baptist Convention Annual Meeting June 14-15. Eventually, the clinics will travel across the United States to provide free health care for in-need populations and possibly as part of disaster relief efforts.

“This is a test run to make sure everything is where it needs to be and operational,” said Judy Cape, logistics specialist with NAMB. “We’re looking for suggestions on what we need to do to tweak the units and stock them any differently.”

Whitney A. Nash, PhD, APRN, UofL School of Nursing associate dean of practice and service, said the state-of-the-art units didn’t need much improvement.

The dental clinic has an X-ray machine and two operatory rooms and the medical clinic has two exam rooms, a bathroom and an intake area.

“They’re really great quite honestly,” Nash said. “Preparing for a particular disaster response would be critical because you couldn’t equip it for every contingency; there just isn’t enough space. Having the supplies ready so you could quickly mobilize would be key.”

The mobile units came to the racetrack clinic with help from David C. Jones, DMD, lecturer at the School of Dentistry. Jones is a member of the same congregation as David Melber, NAMB’s vice president of , which oversees the mobile clinics.

“I knew that NAMB was looking to test the units,” Jones said. “We’ve got all these track workers here, and I thought it would be great to have the mobile units treat them.”

Recently, the Kentucky Racing Health Services Center – an award-winning, nonprofit clinic run by University of Louisville School of Nursing faculty – began offering mental health services to grooms, hotwalkers, exercise riders and other backside racetrack workers.

Catherine Batscha, DNP MSN, UofL School of Nursing assistant professor and psychiatric-mental health nurse practitioner, provides counseling at the clinic to workers with anxiety and depression. A majority of the patients are from Latin America and speak limited English. Most also consistently travel across the United States throughout the year to work at other racetracks.

“It’s a hard life,” Batscha said. “When you look at the track, a lot of the people who work there have families that are far away. They miss their children. Some have been sexually abused, raped or have grown up in families with alcoholism and substance abuse.”

Previously, the clinic had to send patients to other facilities in the community for mental health treatment, which often took months for an appointment.

“If you’re in the middle of a crisis, you don’t want to wait the eight weeks it’s going to take to find a provider,” Batscha said. “If they have someone who needs to be seen today, I can see them today.”

Providing mental health treatment in-house has made it easier to coordinate care with other nurse practitioners at the clinic, which offers comprehensive services including physicals and women’s annual exams, treatment of minor illnesses and maintenance treatment for conditions such as diabetes, asthma and hypertension.

Founded 11 years ago, the clinic is a joint venture between UofL and the Kentucky Racing Health and Welfare Fund to provide free or low-cost health care to backside track workers and their families. Nursing students see patients under the supervision of faculty members. Students from the Latin American and Latino Studies program also gain experience by serving as translators.

Because most of her patients are transient, Batscha gives them ways to manage anxiety on the road.

Batscha created a SoundCloud relaxation audio in Spanish that patients can access through their smart phones. The audio walks users though progressive muscle relaxation techniques, useful for people who need help getting to sleep or calming their bodies and minds.

The clinic has eliminated barriers to care for the backside workers.

Maria Rinosa, a hotwalker at Churchill Downs and a native of Guatemala, sought mental health treatment for depression at the clinic after the death of her 1-year-old son due to a viral infection.

Without the clinic, Rinosa said she would have limited health care options.

“I don’t know where else I would go,” Rinosa said. “Without medical insurance, the cost is really expensive and the little we earn doesn’t stretch that far.”

Despite their hardships, the workers are incredibly dedicated to their jobs and take pride in their work, Batscha said.

“Everyone is up at 3 in the morning with their horses on the track,” Batscha said. “It’s just humbling to work with folks who have been through so much. They’re still on their feet and working to do a good job and make a difference for Kentucky.”

The clinic is located across from Churchill Downs at the Kentucky Racing Health & Welfare Fund office, 422 Heywood Ave. For more information, .