Expanding Rural Healthcare Access: Nursing Holds the Key

Expanding Rural Healthcare Access: Nursing Holds the Key

Urbanization and declining farm incomes are causing many rural communities to struggle, and the healthcare providers who serve those communities are facing major challenges attracting talent and sustainably treating a dwindling, aging population. This shortage of providers directly impacts access to care in rural communities. A recent NPR poll of rural Americans found that, despite 87 percent reporting having some form of health insurance, more than one quarter of respondents had not been able to access healthcare when they needed it at some point in the last few years.1 These troubling statistics are a call to action for healthcare leaders, and a call to reimagine and reinvent how we deliver care in rural areas. Undoubtedly, nursing will play a critical role.

The Growing Role of Telemedicine

The gap between rural healthcare needs and provider capacity is growing—literally, by miles. From 2013 to 2017, 67 rural hospitals closed, 23 of which were 20 or more miles away from the next closest hospital.2 As the distance between providers and patients increases in rural areas, telemedicine will play an important role in care delivery. For decades, nurses have counseled patients over the phone regarding health questions, but technological advancements are creating exciting new possibilities like enhanced remote patient monitoring and advanced telehealth apps. By improving the suite of telehealth resources available to rural area patients, they’ll have easier access to preventive and primary care in their own communities—often, from the comfort of their own homes.

However, there are many primary care services that must be delivered on site by a provider, and rural communities are suffering from an acute shortage of healthcare providers. According to the National Conference of State Legislators, 77 percent of rural counties are designated as health professional shortage areas.3 Compounding the existing shortage is the fact that rural primary care physicians are, on average, older than their urban counterparts, which will only worsen this troubling trend over time.

Filling the Care Gap with NPs and PAs

Addressing the supply shortage, the number of nurse practitioners (NPs)4 and physician assistants (PAs)5 who graduate each year is outpacing the number of medical doctors (MDs)6. In 2017, there were approximately 68 percent more new NPs and PAs than MDs. The numbers of NPs is projected to continue growing,7 and they must be empowered to meet primary care needs with a widened scope of practice, enabling them to treat patients more independently. Nurse practitioners can provide essential in-person care without a physician. Twenty-two states and the District of Columbia have pursued some expansion of scope of practice for NPs,8 including rural states like Nebraska, where 13 of 93 counties lack even one primary care physician.9 Additionally, other Advanced Practice Registered Nurses (APRNs), like certified nurse-midwives and clinical nurse specialists, can also address rural health needs when physicians cannot.

Nursing talent will play an essential role in expanding access to rural healthcare, but it will require a concerted effort to recruit, educate, train, and retain nurses in rural areas. First, healthcare leaders and nursing educators need to elevate this opportunity in our dialogue with students. Rural nursing is a high-need role for professionals excited to make a difference and pioneer innovative approaches to care. Healthcare providers have continuity in small towns, getting to know patients personally and addressing their needs.

Providing Healthcare to All Communities

As called for in the National Academies of Sciences, Engineering, and Medicine’s 2011 The Future of Nursing report, we must continue to encourage nurses to pursue advanced education, enabling them to take on advanced practice responsibilities.10 This can be done through innovative programs designed to increase access to education and prepare them without having to leave their communities. Educating nurses where they live may mean they’ll stay there longer, which is especially helpful in addressing the need.

In rural healthcare, the nursing profession has the opportunity to showcase the full range of its abilities and embrace the future of expanded nursing practice. Close collaboration between nursing educators, policymakers, regulators, and health systems will enable us to embrace these opportunities, making care more efficient, affordable and accessible for rural America. Working together, let’s reaffirm our commitment that all citizens, wherever they live, deserve a system equipped to meet them where they are and provide superior care. The nursing profession stands ready and eager to do our part.

Karen Cox, Ph.D., R.N., FACHE, FAAN, is President of Chamberlain University, which has the largest nursing school in the country, and Immediate Past President of the American Academy of Nursing.

Notes on sources:

  1. https://www.npr.org/sections/health-shots/2019/05/21/725059882/poll-many-rural-americans-struggle-with-financial-insecurity-access-to-health-ca
  2. http://medpac.gov/docs/default-source/reports/jun18_medpacreporttocongress_sec.pdf#page=69
  3. http://www.ncsl.org/research/health/closing-the-gaps-in-the-rural-primary-care-workfor.aspx
  4. American Academy of Certified Nurses Enrollments and Graduations 2017-2018
  5. Physician Assistants Education Association Program Report 33, 2017
  6. https://www.aamc.org/download/321532/data/factstableb2-2.pdf
  7. https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm (visited June 2019 ). Data reflects a projected percentage change in employment from 2016-2026 and may not reflect local economic conditions
  8. https://www.healthleadersmedia.com/clinical-care/more-states-pushing-autonomy-scope-practice-battle
  9. https://www.omaha.com/livewellnebraska/nebraska-counties-have-no-primary-care-doctor-here-s-what/article_f0911c82-70c8-5929-b983-045a0fc151d1.html

10. http://www.nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-      Change-Advancing-Health/Report-Brief-Education.aspx

Increasing Diversity in Nursing Begins with Our Institutions

Increasing Diversity in Nursing Begins with Our Institutions

There is much discussion about the need for diversity in nursing and the importance of educating a health care workforce that mirrors the population. Recently, Dr. Ernest Grant, president of the American Nurses Association wrote, “A diverse workforce allows us to use our varying cultural perspectives to ensure all patients and populations receive optimal and empathic care, which also may speed up their recovery and reduce the risk of preventable chronic conditions.”

Powerful words – “speed up their recovery and reduce the risk of preventable chronic conditions” – which are exactly the actions and goals we should be striving to achieve in an effort to increase the health of the population and eliminate health disparities. 

While contemplating diversity in nursing, a few key population statistics are worth considering. According to the U.S. Census Bureau, 49.2% of the American population are men, 41.5% of the American population are of a race other than Caucasian, and 21.3% of the American population speaks a language other than English at home.

However, according to the 2017 National Nursing Workforce Survey, just over 9% of working RNs are men, and only 19.2% are minorities. While reliable data about the number of nurses who speak a language other than English is scarce, based on the statistics demonstrated above, it’s unlikely this number mirrors the population.

In order to reduce health disparities by addressing inequalities and eliminating care gaps, it is critical to educate a vast and diverse health care workforce. The systems that educate and train nurses should place a focus on increasing the diversity of their nursing student population. Another key step is to make programs increasingly accessible through holistic admissions processes to admit a larger number of qualified nursing students.

Additionally, providing students with exposure to patients of all types of backgrounds and demographics during education and training, will help them achieve a better understanding of patient needs and how they can connect with them to provide quality care and improved experiences. Diversity in all its forms, from innate characteristics including age, race, and mental health to acquired characteristics like religion, education, and language skills, requires an awareness and respect for every person. This helps transition students from viewing their work through a cultural competence to a more inclusive lens of cultural humility.

Building cultural humility begins with a better understanding of the unique challenges every student faces and putting in steps and processes for helping them succeed while in their program. By teaching students that they are cared for, students are able to better focus on providing exceptional care for others. Putting each student at the forefront at each touchpoint and never letting them lose sight of their passion for health care, helps them become an extraordinary nurse who cares for others.

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