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.
The Nurse Practitioner Association New York State (NPA), the only statewide professional association of nurse practitioners, has named Janice Ceccucci, DNP, FNP-BC, Nurse Practitioner of the Year, and Daniel Babcock, MS, FNP-C, NP Student of the Year. The awards were presented at The NPA 35th Annual Conference, held in Verona, NY, and were attended by nearly 500 NPs and NP students from across the state.
Stephen Ferrara, DNP, FNP, FAANP, Associate Dean of Clinical Affairs at Columbia University School of Nursing and Executive Director of the Nurse Practitioner Association New York State, said, “As health care professionals committed to excellence in patient care, nurse practitioners are redefining their role. We’re extremely pleased to recognize Janice Ceccucci and Dan Babcock for their dedication and service.”
Forensic NP and Professor at SUNY Polytechnic Institute Is NP of the Year
Janice Ceccucci is an outstanding Nurse Practitioner and SANE (Sexual Assault Nurse Examiner). Ceccucci began her career working with sexual assault victims in the Emergency Department. Recognizing that there were gaps in services, particularly for child sex abuse victims, she decided to pursue forensic nursing. She is committed to ensuring services for child sex abuse and physical abuse patients are widely available.
“Janice takes nursing to the next level,” says colleague (and nominator) Elizabeth Spooner Dunn. “Her passion for the profession, dedication to her patients and commitment to excellence make her not just a trusted colleague but an example and mentor to all.”
has also received the Joan Unger Memorial Award given by the New
York State Coalition Against Sexual Assault for demonstrating excellence and
innovation in services offered to the community in sexual assault. She has also
been published by the Journal of Forensic Nursing and
is co-founder of Forensic Nurse Practitioners of Schenectady.
On Call, Inside and Out of the Hospital
Outside the confines of Saratoga Hospital, Ceccucci is on call at home 36 hours a month to provide teleconsulting services to hospitals in remote areas that lack access to sexual assault nurse examiners (SANEs). In addition, she conducts sexual assault exams for pediatric patients at child advocacy centers—a service that Ceccucci and a colleague introduced in 2011 to better serve sexually abused children.
A leader in promoting the profession to the next generation, Ceccucci is an assistant professor at SUNY Polytechnic Institute. She is also the co-director and developer of Saratoga Hospital’s Advanced Practice Provider Fellowship Program, which mentors new nurse practitioners and physician assistants, also known as advanced practice providers. And, in case that was not enough to take on, Ceccucci is an assistant professor of nursing for SUNY Polytechnic in Utica and helped pilot a hybrid program that delivers live streaming and on-campus classes.
“I wouldn’t want to do anything else.”
Ceccucci received her master’s degree as a Family Nurse Practitioner from SUNY Poly in 2009, and was awarded her doctorate in Nursing Practice from State University of New York Upstate Medical University in Syracuse in 2016.
“I’m proud to be the recipient of the NP of the Year. There are so many wonderful opportunities in nursing. For newer NPs, I would advise they take advantage of every opportunity that presents itself. I love being an NP. I wouldn’t want to do anything else,” Ceccucci said.
For further information on Janice Ceccucci, visit here.
NP Student of the Year Dan Babcock
Dan Babcock is an Air Force veteran and a former professional fire officer and paramedic who is currently a full-time Graduate Family Nurse Practitioner Student in the Decker School of Nursing at Binghamton University. He holds a BS in Nursing from Empire State College and as a Registered Nurse has worked in the emergency department and diagnostic imaging. After retiring as a lieutenant from the City of Binghamton’s Fire Department with 20 years of service, he decided to become a nurse practitioner. As Babcock grew up in rural Delaware County, New York, he has a particular interest in improving the health of the poor, rural and vulnerable populations that influenced his early life.
an honor to be awarded NP Student of the Year. I chose to become a nurse
practitioner because I love being challenged and love the relationships I form
with my patients. Aside from the need for primary care providers, I chose
family practice to give me a solid foundation for medical mission work. My wife
and I do mission work in Guatemala several times a year, and I would like to do
medical missions as a nurse practitioner,” Babcock said.
Nurse Practitioner Association New York State
Nurse Practitioners (NPs) are registered nurses who have completed advanced education, at a Master‘s or Doctorate level, plus additional clinical preparation. These professionals are authorized to independently diagnose illness and physical conditions, perform therapeutic and corrective measures, order tests, prescribe medications, devices and immunizing agents, and refer patients to other health care providers.
The Nurse Practitioner Association New York State (The NPA), the only statewide professional association of nurse practitioners, promotes high standards of healthcare delivery through the empowerment of nurse practitioners and the profession throughout New York State. For more information, visit: www.TheNPA.org.
The nurse residency program
is part of the US Department of Health and
Human Services’ Advanced Nursing Education – Nurse Practitioner Residency
Program Grant, which is designed to prepare new nurse practitioners to deliver
high-quality primary care in community-based settings. The primary care
residency is a year-long program in which nurse practitioner residents will
complete academic coursework and clinical hours in rural and underserved areas.
Nena Sanders, vice provost of the Samford University College of Health Sciences and Dean of the School of Nursing, tells alabamanewscenter.com, “For nearly 100 years, Ida Moffett School of Nursing has prepared well-equipped, compassionate nurses to serve the underserved. This grant affords us the opportunity to enhance the knowledge and skill sets of our graduates and intentionally place caring, competent nurse practitioners where the needs are greatest.”
The grant will facilitate the
launch of the primary care nurse residency which will be housed in the School
of Nursing. The program will focus on developing new family nurse practitioners
with the knowledge, skills, and attitudes necessary to improve the quality and
safety of rural health care systems.
Out of 67 counties in Alabama,
55 of them are considered rural and only two of those 55 are considered to have
the minimum number of providers available. During their rotations, residents
will receive training in vital telehealth technology to help reduce
accessibility issues for patients who are forced to travel long distances
to seek necessary care.
To learn more about the four-year,
$3.5 million grant awarded to Samford University’s Ida Moffett School of
Nursing to help the university place nurse practitioner graduates in
rural, underserved areas for primary care residency, visit here.
Students earning their doctorate of nursing practice (DNP) degree require field placements to meet their degree requirements and to help positively influence their employment after graduating.
Pamela Ann McGranahan, director of the DNP program and associate clinical professor of nursing, tells news.wisc.edu, “To help meet our goal of educating nurses for the entire state, the School of Nursing is emphasizing relationships like the one with Monroe. Some of our students really respond to a well-run clinic that is large enough to offer a fairly intricate level of specialties and technology, but not so large as to become anonymous.”
Monroe Clinic operates 11 clinics in Wisconsin and Illinois, with more than 85 physicians, over 200,000 annual patient visits, and 40 to 50 advanced practice practitioners, primarily nurses. In four years offering clinical placements to UW–Madison DNP students, three have returned to work there as nurse practitioners.
UW–Madison offers DNP degrees to nurses who hold a bachelor’s or masters degree in nursing with one year of working experience. The coursework can be completed in-person and online and prepares nurses to use advanced clinical expertise, advocacy, leadership skills, and research understandings to provide up-to-date practices and best clinical outcomes.
To learn more about the UW–Madison School of Nursing’s partnership with the Monroe Clinic-SSM Health to offer rural placements for nursing students to help address rural healthcare shortages, visit here.
Pennsylvania State University is using telecommunications
technologies to help train nurses for providing better care to sexual assault
victims. The Sexual Assault Forensic Examination Telehealth (SAFE-T) Center connects
experienced professionals with nurses and health care professionals in training
for sexual assault care, while providing patients with crucial help.
The SAFE-T Center is helping provide better access to sexual
assault care in underserved communities across the state. The center, now set
up at three partner sites across Pennsylvania, was launched three years ago
with funding from the Office for Victims of Crime in the U.S. Department of
Forensic nursing is crucial to helping care for sexual
assault survivors. Forensic nurses are trained in very specialized areas like forensic
evidence and collection, and additionally learn how to work with the legal
system, in order to interact and present evidence in courtroom cases. According
to the U.S. Bureau of Labor Statistics, forensic nursing is expected to grow by
26% in the next ten years.
Jane French, a clinical coordinator at the SAFE-T Center, manages
a team of expert sexual assault nurse examiners and local nurses. She helps
ensure that the patients are cared for and that the staff are fully supported
and confident in their work.
A new healthcare nonprofit organization in Maryland recently launched to better address rural patients’ needs. IMBUEfoundation will provide care and transportation services to Maryland’s Eastern Shore communities, to improve residents’ options for care and lifestyle choices.
Recent research by Harvard’s T.H. Chan School of Public Health, the Robert Wood Johnson Foundation and NPR shows that receiving good healthcare is the second-biggest problem for rural American families. Major health concerns for rural Maryland residents include chronic disease, health literacy, care coordination, outreach and education, according to a 2017 assessment by the Maryland Rural Health Association. IMBUEfoundation notes on its site that the lack of services and coordinated care has led many Maryland residents to struggle in finding proper care.
“Healthcare is more than just going to the doctor,” Ross said. “For example, someone who lives in a place like Caroline County, which is both a food swamp and a food desert, is going to have a harder time making healthy food choices, which can lead to obesity— a major factor of chronic disease. It’s a domino effect.”
The new non-profit is helping those in need with nurse practitioners, acting as “clinical concierges” who provide counseling, monitoring, and stewardship activities. The nurse practitioners assist with coordinate care delivery for patients, explain healthcare plans and treatment options, and provide education on alternative care, in addition to other necessary tasks.
“From providing transportation to helping patients coordinate between doctors, IMBUEfoundation is working to make sure Maryland’s mid-shore residents have the resources they need to be healthy and happy,” Ross said. “But there’s still so much work to be done.”