Counties across Oregon are suffering from a shortage of primary care Nurse Practitioners (PCNPs), according to a 2019 survey. A recent study from the Oregon Center for Nursing found that despite the promising national statistics reported by the American Association of Nurse Practitioners (AANP), which estimates that over 75% of NPs are practicing in primary care settings, the distribution of these NPs is severely lacking in Oregon.
As PCNPs are vitally needed to compensate for the shortage of physicians, their unavailability is severely felt in parts of Oregon, which is one of the 22 “full practice” states in the US. In contrast to the AANP’s national figures, a state-specific study of Oregon indicates that only one third of practicing NPs (35%) are working in primary care, with another 22% focusing on a combination of specialty and primary care. Of the 22% with combined practices, 62% spend less than half their time on primary care.
Surprisingly, the shortage of primary care NPs tends to be more evident in urban counties, whereas rural counties appear to be better served. Although there are fewer PCNPs by number in rural counties, the proportion of PCNPs is actually higher in rural areas when measured against per capita population figures.
The Oregon Center for Nursing makes three recommendations:
- Communities should promote incentives such as student loan repayment programs and grants to attract PCNPs to practice in their areas. In addition, incentives could be devised to encourage primary care physician groups to hire NPs and include them in their existing practices.
- The education system in Oregon should examine ways to increase the number of PCNP graduates. Currently, some 70% of the PCNPs practicing in Oregon received their degrees in out-of-state schools. This indicates that the facilities within Oregon are not able to meet present needs for the education of PCNPs, and until the state expands educational opportunities for PCNPs, it will be necessary to fill the gap with graduates from other states.
- Community leaders and health officials should explore the reasons that affect NP decisions to focus on primary care. In addition to considering the question of why PCNPs are being drawn more to rural areas in Oregon than urban counties, these officials should ask “Why do NPs choose to work in non-primary care roles? What incentives might change their minds? Once these underlying reasons are understood, communities can use this knowledge to attract NPs to provide primary care in their communities.”
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Nursing students, nursing schools, school nurses grounded after school closures, and retired nurses are all joining the fight against the rising pandemic.
Here are just a few
examples to be found across the United States:
Belhaven’s School of Nursing are performing community outreach and
educating the public on how to protect themselves and others from the
virus. Students are teaching infection-control techniques, discussed
sanitation practices with the college’s operations team, and have
posted instructions in campus dorms on maintaining safe hygiene.
Senior Rebecca Rylander tells Jackson’s WJTV,
“There is a desperate need for healthcare workers amidst this
pandemic, and I want to help fill that need.”
Long Island, New
At nursing and
medical programs in Long Island, students barred from immediate
contact with patients are playing an active role behind the scenes
and on the front lines. While medical students at the Renaissance
School of Medicine in Stonybrook are conducting online research and
serving patients via telehealth sessions, the Barbara H. Hagan School
of Nursing and Health Sciences tells Newsday
that they have “alumni, graduate students and faculty working in
emergency rooms and testing sites, and undergraduates are working or
volunteering as nursing assistants.”
School nurses have
volunteered at Darien High School’s COVID-19 testing station. Lisa
Grant, a school district nurse at Hindley School, said “We had been
asking our director what we can do to help so when Darien signed up
for a site, we volunteered.” Yvonne Dempsey, of Ox Ridge School was
also ready to help out. Dempsey told the Darien
Times, “As nurses, we put ourselves out there any way we can. I
figured that’s something I can do in my free time with the schools
closed.” She adds, “Testing is the key — testing and isolation
as much as possible is the only way to stop the spread.”
Massachusetts, Caldwell, New Jersey, and elsewhere
In response to calls
from the American Association of Colleges of Nursing, nursing faculty
at colleges, universities, and community colleges are rushing to
donate supplies of everything from masks to isolation gowns, to hand
sanitizer. “This is a time when we all need to come together as a
community and work cooperatively to fight this pandemic for the
health and safety of everyone,” MassBay Community College President
David Podell told the Framingham
Source. Jennifer Rhodes, DNP, a faculty member at Caldwell
University’s School of Nursing and Public Health, remarked,
“As a former emergency room nurse, I cannot imagine what they are
experiencing on the front lines right now.”
Retired nurses are
also answering individual states’ call for help. Nebraska
TV spoke to 61-year-old Mary Steiner, a former emergency response
nurse, has volunteered for the Central Nebraska Reserve Core. As she
waits to put to use her training in natural disaster and emergency
preparedness, Mary remarks, “If it’s something that becomes as
serious as what’s going on in New York City right now… They’re
wanting all hands on deck and so regardless of what my workplace
setting has been in the past I know they’re going to be able to use
This Nurse of the Week is preparing to practice nursing on a global scale. Graduate student Pam Martin has spent 20 years as a nurse in pediatric hospitals across the US, but she’s now on a mission that will take her far beyond her own national borders.
Pam’s stint as a medical volunteer in rural Haiti in 2017
expanded her horizons and inspired her to ply her skills around the world. First,
though, she has to work through a crowded agenda. While she works in an adult
Emergency Department, Pam is also studying for her Doctor of Nursing Practice
degree at Washington State University in Vancouver. At the same time, she’s
working toward a Graduate Certificate in Public Health (at the WSU College of
Nursing) and a Global Leadership Certificate from the WSU online program.
Pam is focusing on anthropology for her Global Leadership
Certificate, and she believes that this, along with the Graduate Certificate in
Public Health are essential to her plans: “I want to not only treat the person
sitting in front of me, but the population as a whole. In a refugee camp, for
example, if you have an outbreak of disease you need to get that under control
very quickly; if you have limited resources, how do you do that?”
What will Pam do after receiving her DNP and certificates? According
to the WSU
Insider, “After graduation she’ll work as a nurse practitioner to gain
experience in that role. Then her plan is to do humanitarian work, whether
that’s in refugee camps or with groups facing disease outbreaks or displacement
from a natural disaster.” As Pam says, “With an education as a doctoral
prepared DNP, with certificates in Public Health and Global Leadership, I hope
to apply my experience and knowledge to humanitarian work in health care.
Learning from those around the world allows us a better understanding of our
differences and our shared humanity.”
To learn more about Pam Martin, visit the WSU
series takes a look at the stories appearing in The Rebel Nurse Handbook, which
features inspiring nurses who push the boundaries of healthcare and the nursing
profession. This installment focuses on nurse, writer, public speaker, and acting
director of Show Me Your Stethoscope, Dr. Jalil Johnson.
Johnson found his career in nursing at what might have been the lowest point of
a hard life. After graduating from high school, the impoverished Tennessean was
struggling. Living from paycheck to paycheck, he ultimately found himself
working as a $7.00-an-hour dishwasher. Then came the night—at a time when he
had no more than $10 to his name—that Johnson found himself laid off.
relentless job hunt that followed, a newspaper ad for free Certified Nursing
Assistant (CNA) classes caught his eye. Johnson was intrigued, but in his
impoverished state, the cost of the course textbooks was beyond his means. As
he sat in front of the school planning his next move, he happened to encounter the
Dean of the program. The Dean was touched by Johnson’s situation and his astounding
resolve. With his encouragement and assistance, Johnson applied for financial
aid, enrolled in the CNA classes, and embarked upon a career in nursing.
training, and later the job itself, changed his life. After getting his CNA,
Johnson decided to continue his nursing education. What inspired this decision?
Johnson says, “there were many pivotal moments that encouraged me to pursue
higher education. An important moment was the sense of absolute fulfillment I
felt after working with my first patient as a CNA. Until that point in my life,
I’d never actually helped a person with their care, health, or with the simple
aim to make their life a little better. When my patient sincerely said ‘thank
you so much’ to me that day, I knew I wanted to learn as much as I could about
how to do this work. I wanted to expand my ability to have positive impact on
spent the next two decades climbing the professional ladder: he became an LPN,
an RN, was awarded a BSN, went on to take his master’s degree and training as a
Nurse Practitioner, and later received his PhD as a nurse scientist. “Each time
I completed another degree or level of licensure, my scope of practice and
experience changed. The impact I had on patients wasn’t better with more
education, but it was different. I enjoyed being challenged in this way. I
continued this way of thinking through my studies, including my journey to
become a nurse practitioner and nurse scientist (PhD).” Along the way, he
worked in positions ranging from traveling nurse, to ICUs and EDs, to substance
use treatment programs and behavioral health, and teaching CNA, LPN, RN, and
DNP students. “I’ve never forgotten how amazing it feels to empower someone
else,” he says.
is a keyword for Johnson, who vividly recalls “the powerlessness I often felt
throughout my career. Regardless of my level of practice, I always felt that
the work and the care could be better, but I never felt I had any power to
really change anything. My assumption was that more education would lead to
having more say in my practice, and subsequently less feelings of
powerlessness. Well, I was wrong about that. The powerless feeling followed me
throughout many practice settings and scopes of practice.”
ways to overcome this sense of powerlessness, and found that his views were
shared by “hundreds of thousands of nurses out there, who love their work as I
do, but also feel like the healthcare system doesn’t work for them or their
patients.” Seeking empowerment for himself and his fellow nurses, he began to work
in self-advocacy with communities like Show Me Your Stethoscope and Nurses Take
DC, and became a writer and public speaker.
what he feels most passionate about in his career, Johnson replies, “I’m
passionate about many things. I enjoy caring for my patients and love teaching.
However, I’m most passionate about inspiring other bedside nurses to unify
behind causes they believe in. As the largest profession within healthcare, I
believe nurses have the opportunity to be truly revolutionary if we band
together and support each other. This is one of the ideas that motivated me to
start writing my forthcoming book, Nation of Nurses, where I discuss
specific ways nurses can mobilize and revolutionize healthcare.”
He is also
passionate regarding his advocacy groups: “these online communities are filled
with bedside nurses who are passionate about improving the nursing and the
healthcare system. Honestly, through this work, for the first time in nearly 20
years, I feel like nurses are taking back their power; and this gives me so
A recent TEDxColumbus talk on innovation and nursing was given by Tim Raderstorf, DNP, RN. Tim is a nurse, teacher, and Chief Innovation Officer at Ohio State University, and co-author of the book Evidence-based Leadership, Innovation, and Entrepreneurship in Nursing and Healthcare.
Raderstorf opened his talk by declaring, “I am a nurse… It impacts how I think, how I care for others. Even how I pay my mortgage.”
He continued by explaining that nurses are not generally seen
as innovators. They show up at the top of the list of the most trusted
professions—and have done so for years—but they don’t appear on any list of
most innovative professions. Sadly, nursing tends to be overlooked for its
value in innovation.
We say things like “I am just a nurse,” says Raderstorf.
However, he points out that innovation is most impactful when initiated by
those who have the firmest understanding of the problems that need to be
solved. Ergo, nurses!
As Chief Innovation Officer at Ohio State, Raderstorf is
convinced that everyone has ideas that are worth pursuing. Through OSU, he provides
what he calls “inspirational capital.”
The vehicle for this capital is the Ohio State University Innovation Studio, run through the OSU College of Nursing. The Innovation Studio travels the country, making 5 tour stops throughout the year, staying at a different location for 7 weeks at a time. The Studio stops are in high-traffic areas, where they invite prospective teams in and ask them what problems they are interested in solving. Using a microfinance model, the Studio awards small dollar amounts to every team that comes through the door with a good idea, ranging from $250 to $500 for the first round of funding. Teams are encouraged to come back with their next round of development for subsequent rounds of funding and continue to return until the end of 7 weeks, at which time there is a pitch day.
Raderstorf suggests that while such a program may sound like
a Millennial’s pipe dream, it really is a “Participation Trophy Model of
Innovation.” And it’s effective.
Among other studio graduates, a nurse who is a clinical specialist at Ross Hart Hospital headed a team to develop a tamper-proof and tamper-evident tape to go over the port of IVs to prevent opioid addicted patients from gaining direct access to IV lines. With backing from the Innovation Studio, the team ended up with an international licensing deal—after spending just $240.20 to get the idea off the ground. To view Tim Raderstorfs TEDx talk in its entirety, click here.