The $125 million donation by Leonard A. Lauder, Chairman Emeritus of The Estee Lauder Companies, to create this first-of-its-kind, tuition-free Program is the largest gift ever to an American nursing school. Mr. Lauder is a Penn alumnus. The gift comes at a time when the COVID-19 pandemic has magnified the nation’s acute shortage of primary care providers, and persisting inequities in access to quality healthcare.
“This is the most timely and consequential gift not only for our university but for our country. It is unprecedented in its potential to address America’s most critical need of providing primary health care to all who currently lack it by investing in nurses,” said former Penn President Amy Gutmann.
“Growing the number of nurse practitioners who are prepared and committed to working in underserved areas is the most practical and inspiring way to ensuring a healthier country. I am grateful and honored that Leonard would make this gift to Penn Nursing, and thrilled to know that it will have an immediate impact that will last far into the future.”
Nurse practitioners are leaders on the front lines of care, a role never more important as Americans confront a primary healthcare shortage in their communities. With their advanced clinical training and graduate education, nurse practitioners have the knowledge and skill to supervise and manage critical aspects of care in a decision-making capacity, from patient diagnosis, to ordering and interpreting tests, to prescribing medication. Nurse practitioners deliver high-quality primary care to people of all ages, such as treating common illnesses, managing chronic conditions, and providing preventive care that helps patients stay healthy.
Nurse practitioners are also able to take on key leadership roles, from managing and operating walk-in or community clinics to leading interdisciplinary teams within health systems. The new Program will better the lives of patients and communities most in need, while providing a pathway for the many nurses interested in advanced education who may not otherwise have the means to pursue it.
Structure: Leonard A. Lauder Community Care Nurse Practitioner Fellows will enroll full-time in a two-year, rigorous Primary Care Nurse Practitioner Program at Penn Nursing.
Community Practice: Fellows will complete at least 50 percent of their clinical education at community partner sites in the greater Philadelphia area that provide direct patient care, an invaluable experience that will prepare Fellows to meet the complex needs of patients and families throughout their careers. Every Fellow will be expected to commit to practice or service in an underserved community for two years after graduation.
Recruitment: Penn Nursing will select 10 Fellows to begin classes this fall, growing the program enrollment through 2026 when it will reach its annual target enrollment of 40 Fellows, continuing in perpetuity. By 2027, the program will have enrolled 140 excellent nurse practitioner students. Fellows will need to show a demonstrated commitment to working in underserved neighborhoods, where they are needed most, and to promoting health equity.
Tuition: All participants in the program will enter the workforce free of graduate school debt, receiving student aid to cover their tuition and fees and thereby eliminating any potential financial barriers for nurses and others who wish to enroll. Fellows with greater financial need will also receive stipends to help with living expenses.
Program Leadership: Penn Nursing will name the first endowed Leonard A. Lauder Community Care Nurse Practitioner Professor, who will oversee curriculum innovation, support of community sites, and program implementation.
Penn Community Partnership: Penn Nursing will provide support for select community partner sites to support the clinical education of Fellows while providing professional development and networking opportunities and access to School and University resources.
“Penn Nursing has a long history of advancing science, promoting equity, practice excellence, and preparing leaders. That’s why Mr. Lauder’s gift is so meaningful. The synergy between Penn Nursing and the Program will improve the health of underserved patients and families, by uniquely preparing primary care nurse practitioners, who will work with them in their communities. The sustained investment in the education and careers of primary care nurse practitioners and communities is unprecedented. We are excited by the opportunity to lead this important Program and to extend its impact beyond Penn Nursing,” says Penn Nursing Dean Antonia Villarruel. “We are deeply grateful to Mr. Lauder for recognizing and investing in this critical need, and for partnering with us in this ambitious endeavor.”
NPs are “key” to health care in underserved communities
Stephen P. Fera, Executive Vice President of Independence Blue Cross, which is one of the community partners that will be involved in the new initiative, noted that nurse practitioners are key to improving individual and community care. Said Fera: “Bolstering the nurse practitioner workforce is a means to improve access to care and strengthen the health care safety net provided by health centers. This is a key priority of the Independence Blue Cross Foundation and our partnership with Penn Nursing has been synergistic in efforts to prepare nurses to work in community-based settings. The Program will build and strengthen our individual and collective efforts toward improving the health and well-being of communities.”
“Now more than ever, the country needs greater and more equitable access to quality primary care—and highly-skilled nurse practitioners are the key to making that happen,” said Leonard A. Lauder. “The program will ensure that more Americans receive the essential health care services that everyone deserves, and I’m so pleased to be working with Penn Nursing on this initiative. I look forward to welcoming our first class of future nurse practitioners this fall. I know their expertise will be matched only by their commitment to serving our communities.”
”Three decades of evidence have shown that nurse practitioners with full practice authority play a vital role in improving health outcomes, especially in underserved communities, Ramos observed in his remarks. Focusing on the connections between FPA, access to care, and health outcomes, the Dean presented his case to the state’s Joint Legislative Committee on Access to Healthcare and Medicaid Expansion at the North Carolina General Assembly and urged them to pass the SAVE Act to grant full practice authority for NPs providing primary care. Ramos, who is also the vice-chancellor of nursing affairs for Duke, was among eight experts presenting varied views on full practice authority.
“Full practice authority isn’t new. This isn’t innovative. We have 30 years of evidence from 24 states, D.C., and several US territories about the benefit of granting full practice authority to NPs.”
In speaking to the joint committee presided over by Sen. Joyce Krawiec, Ramos addressed the role that nurse practitioners have in transforming health care access and outcomes in North Carolina, including the opportunity to expand care in rural areas that face health care shortages. The joint committee is hearing from experts as they consider passing the SAVE Act, which was first introduced in 2021 to expand full practice authority for primary care NPs in North Carolina. A similar version of the SAVE Act has been introduced in previous legislative sessions, but no action was taken on the legislation.
Role of FPA in Access to Care and Health Outcomes
“Nurse practitioners should be able to practice at the highest level of their competencies, education, and licensing,” Ramos said. “Full practice authority isn’t new. This isn’t innovative. We have 30 years of evidence from 24 states, D.C., and several US territories about the benefit of granting full practice authority to NPs. This improves health outcomes and expands health care to underserved populations and will benefit the people of North Carolina.”
Across the state, 97 of 100 counties face a health professional shortage.
Ramos reflected on his role as dean of the top school of nursing in the state and the second-ranked school in the U.S., and the intense pride he has seeing Duke graduates strengthen their career opportunities with the education they gain at Duke. “The nurse practitioner workforce growth is faster in states with full practice laws than in states with restricted practice,” said Ramos, who is interested in attracting NPs to practice in the state.
Ramos observed that the first states to authorize full NP practice authority began doing so in 1994 — nearly three decades ago — and that, once passed, full NP practice authority has never been repealed. “Full practice authority for primary care NPs improves care access, improves care outcomes, and improves workforce supply,” said Ramos, who also addressed a systematic review of 33 studies that showed no evidence for better NP care outcomes in states with more practice restrictions.
NPs with FPA Increase Efficacy of a State’s Health Workforce
In addressing the critical nursing workforce shortages across the U.S., Ramos notes that NP workforce growth is faster in states with full practice laws compared to states with restricted practice. Across the U.S., during the COVID-19 pandemic, states issued temporary waivers of NP practice restrictions. “This enabled more time-responsive NP practice and care provision as well as a streamlined process for NP orders in the absence of physician signature requirements and an increased capacity of the health care workforce to respond to COVID-19,” Ramos said.
Ramos observes that the reliance of nurses in this manner during a pandemic and health care crisis demonstrates the clinical, scientific, and relational expertise that support nurse influence in improving health outcomes, and it demonstrates the confidence that the health care systems and public have in nurses, who have been considered the most trusted and most ethical profession for more than 20 years.
In conclusion, Ramos pointed out to the committee that:
NP practice restrictions contribute to inadequate care access and primary care workforce shortages, particularly in rural areas.
NP practice restrictions can be a barrier to improving health outcomes and reducing health outcomes and reducing health-related economic costs.
NP practice restrictions requirements can lead to an unsafe and fragile care model, including risks such as the possibility of immediate NP loss of ability to care for patients if a physician can no longer provide supervision for any reason, including moving, retiring, and so on.
NP practice restrictions weaken health workforce responsiveness to emergencies.
Physician supervision agreements can contribute to unnecessary and excessive costs.
The SAVE Act (House Bill 277/Senate Bill 249) did not receive a committee hearing during the 2021 legislative long session. However, following the conclusion of the committee’s work later this spring, the bill could move forward when the legislature returns for the 2022 short session on May 18, 2022.
Being a family nurse practitioner (FNP) can be a rewarding path for just about anyone who dreams of making a difference as a nurse. An FNP allows you to become a trusted primary care providerin most states and opens the door to a range of ongoing opportunities for learning and professional growth. And, if you want to do it all… or at least as much as possible, an FNP degree will give you maximum career flexibility. It can position you to create your ideal tailor-made nursing career, whether you want to work in a hospital or clinic setting—or both—while running your own business or pursuing research projects if you wish!
The heart of being an FNP, though, is of course family care… and here’s an overview of what a day in the life of an FNP entails.
Diagnosing a variety of medical conditions for patients of all ages
A family nurse practitioner can care for a wide age range of patients. An FNP may treat everyone from infants to geriatric persons, and this is just one of the reasons the job is almost always lively and interesting.
Am FNP might arrive at the clinic in the morning with or without an idea of their patient caseload on any given day. However, one thing they can count on is variety. You may start your morning with an annual physical of a 35-year-old, then pivot to managing hypertension and diabetes medications for a 71-year-old, before quickly peeking at another patient’s rash, and looking in another patient’s throat. While this may seem intimidating at first, family nurse practitioner certification ensures that you have the necessary breadth of medical acumen and will be prepared to manage whatever comes your way.
Creating treatment plans
After taking a medical history and performing a physical exam, an FNP will formulate a diagnosis for any given condition. Each day, they may use a variety of tools to arrive at their diagnoses—including cultures, blood work, imaging tests, and other medical diagnostics. After reaching a suspected or confirmed diagnosis, an FNP will work with each patient to create a treatment plan, which may include a lifestyle modification, a new medicine, a referral, or another kind of treatment.
Providing a lifetime of primary care
When family nurse practitioners serve as primary care providers, they identify and treat problems, and follow up to ensure the best possible health outcome for each patient. One of the most valuable aspects of being a family nurse practitioner is being able to follow patients throughout their lifespan, anticipating and addressing conditions across decades, and providing patient education.
Preparing for the Next Day
At the end of the day, an FNP may spend time reviewing messages in their electronic medical record inbox, and return phone calls from patients or pharmacies. They will need to catch up on documentation in some patient charts from earlier in the day, communicate with staff members, and make sure everyone on that patient’s team is receiving the assessments and care that they need.
The Center for Rural Health and Nursing is funded by a $4 million legislative appropriation by the state of Texas. The funding will support the center’s efforts to improve rural nursing education and the health outcomes of rural populations.
“I am very thankful of the Legislature for its support of the University’s efforts to educate and train the next generation of rural health care providers,” said Teik C. Lim, UTA interim president. “Through this new center, we can significantly expand the reach of one of the nation’s top nursing programs to improve the health of rural Texans.”
Elizabeth Merwin, the center’s executive director and dean of CONHI, hopes the center will develop and foster a model for providing nursing education to rural residents aiming to become registered nurses and nurse practitioners. This model will support and educate those students while they reside in their home communities. It will also aim to reduce the shortage of nurses and other health providers in an effort to support access to health care for Texas’ rural populations.
“Thanks to generous funding by the state of Texas, CONHI will be able to form sustainable partnerships with rural communities that improve the quality of life for underserved populations in those areas,” Merwin said. “Our goal is to form close relationships with key organizations and stakeholders within rural communities in Texas to improve access to health care by enhancing the health professional workforce.”
In its first year, the center will develop partnerships in rural communities to perform educational needs assessments of registered nurses and nurse practitioners. Once needs have been identified, the center will provide training to support the communities’ current health care providers and educate new, incoming nurses and health professionals.
“UTA has a proven track record both in Texas and nationwide as a leading center of excellence for nursing education,” state Sen. Kelly Hancock said. “I have great confidence in the university’s ability, through its new Center for Rural Health and Nursing, to bring its nationally recognized nursing education and training programs to improve both nursing education and health outcomes in our state’s rural communities.”
Aspen Drude, the center’s manager, said the center aims to support existing providers and recruit young people from rural populations to become nurses in their communities.
“We want to make sure students who are in rural high schools and community colleges have paths into our programs,” Drude said. “We hope that our continuing education programs will meet the needs of current nurses and increase opportunities for rural residents, while meeting the workforce needs of the rural community.”
The center’s nursing education initiatives will be supported by Elanda Douglas, a clinical assistant professor and nurse practitioner with extensive experience as a family nurse practitioner.
“It’s really important for nursing students to understand that when they work in rural communities, they have to be well-rounded because they could be the only nurse in the clinic,” Douglas said. “Our rural health curriculum will prepare students with a broad set of skills to meet the day-to-day demands of rural care.”
According to the Centers for Disease Control and Prevention, rural Americans face numerous health disparities compared with their urban counterparts. They are more likely to die from heart disease, cancer, unintentional injury, respiratory disease and stroke. Factors that put them at greater risk include higher rates of smoking, lower physical activity and less access to health care and health insurance. Rural communities also face unique workforce challenges and, too often, shortages of health care providers.
Reshma Thomas is a first-year student in CONHI’s Master of Science in Nursing program who has joined the center as a student nursing assistant. As a family nurse practitioner in training, Thomas is passionate about serving vulnerable rural populations.
“Nearly 25% of Texas’ population lives in rural communities and suffers from harmful health disparities and lack of care,” Thomas said. “Providing preventive care and raising the health care standards in these communities is vital.”
The Department of Health and Human Services (HHS) has awarded the largest field strength in history for its health workforce loan repayment and scholarship programs thanks to a new $1.5 billion investment, including $1 billion in supplemental American Rescue Plan (ARP) funding and other mandatory and annual appropriations. More than 22,700 primary care clinicians now serve in the nation’s underserved tribal, rural and urban communities, including nearly 20,000 National Health Service Corps (NHSC) members, more than 2,500 Nurse Corps nurses, and approximately 250 awardees under a new program, the Substance Use Disorder Treatment and Recovery Loan Repayment Program. The U.S. Department of Health and Human Services’ (HHS) Health Resources and Services Administration (HRSA) oversees these critical programs.
“Thanks to the American Rescue Plan, we now have a record number of doctors, dentists, nurses and behavioral health providers treating more than 23.6 million patients in underserved communities,” said Health and Human Services Secretary Xavier Becerra. “This demonstrates the Biden-Harris Administration’s commitment to advance health equity and ensure access to critical care across the country. We will continue to invest in our health workforce to make life-saving support within everyone’s reach.”
During the pandemic, thousands of NHSC and Nurse Corps health care providers have served in community health centers and hospitals across the country, caring for COVID-19 patients, supporting the mental health of their communities, administering COVID-19 tests and lifesaving treatments, and putting shots in arms.
Connecting Skilled Providers with Communities in Need
HRSA’s workforce programs directly improve the nation’s health equity by connecting skilled, committed providers with communities in need of care. National Health Service Corps, Nurse Corps, and Substance Use Disorder Treatment and Recovery Loan Repayment Program members work in disciplines urgently needed in underserved tribal, rural and urban communities.
“Today’s awards, which represent a more than 27 percent increase in scholarship and loan repayment awards, support current and future providers who are committed to working in vulnerable communities,” said HRSA Acting Administrator Diana Espinosa. “These awards also provide critical support for health care sites that need to recruit and retain clinicians to meet increasing demand.”
Today’s field strength includes more than 11,900 members working in behavioral health disciplines, including psychiatrists, substance use disorder (SUD) counselors and psychiatric nurse practitioners.
Nurses represent the largest proportion of the field strength, numbering more than 8,000 across all scholarship and loan repayment programs. National Health Service Corps nurse practitioners make up its largest discipline at approximately 5,400 and fill a critical need for primary care where shortages exist throughout the country.
Currently, one-third of HRSA’s health workforce serves in a rural community where health care access may be especially limited or require patients to travel long distances to receive treatment.
More than half of all National Health Service Corps members serve in a community health center where patients are seen regardless of their ability to pay.
Providing Treatment and Care to Patients with Substance Use Disorders
Through dedicated funding for substance use disorder (SUD) professionals, HRSA is now supporting more than 4,500 providers treating opioid and other substance use disorder (SUD) issues in hard-hit communities. The Substance Use Disorder Treatment and Recovery Loan Repayment Program was launched in FY 2021 to create loan repayment opportunities for several new disciplines that support HHS’ comprehensive response to the opioid crisis, including clinical support staff and allied health professionals. In addition, this year’s NHSC awards include 1,500 substance use disorder (SUD) clinicians at approved treatment sites through the NHSC’s Substance Use Disorder and Rural Community loan repayment programs.
Investing in the Future Health Workforce
Through scholarship programs, HRSA is investing in the next generation of providers committed to working in communities most in need. The American Rescue Plan supplemental funding announced today allowed HRSA to award almost 1,200 scholarships — a four-fold increase — in the National Health Service Corps and nearly doubled the number of Nurse Corps scholarship awards to 544. In addition, new awards to 136 nurse faculty are supporting training for the future nursing workforce. This year’s scholarship recipients join 2,500 current National Health Service Corps medical, dental, and health professions students and residents and approximately 900 current Nurse Corps scholars preparing to serve in high-need communities across the country.
HRSA also recently awarded approximately $28.4 million in ARP funding to create new accredited teaching health center primary care residency programs in rural and underserved communities. To further support the expansion of primary care, the Administration plans to continue awarding the full $330 million in ARP funding for Teaching Health Center Graduate Medical Education in the coming months. This additional funding will support the expansion of the primary care physician and dental workforce in underserved communities through community-based primary care residency programs in family medicine, internal medicine, pediatrics, internal medicine-pediatrics, psychiatry, obstetrics and gynecology, general dentistry, pediatric dentistry, or geriatrics. They are based in the communities they serve, with 80 percent located in community-based health centers, such as Health Center Program-funded health centers, Health Center Program look-alikes, rural health clinics, community mental health centers and tribal health centers.
Opportunities Now Open for Loan Repayment Programs
American Rescue Plan funding has made it possible for the National Health Service Corps to make a historic number of awards to all eligible applicants. Additional American Rescue Plan-funded awards are planned, with the next application cycles for the National Health Service Corps and Nurse Corpsloan repayment programs now accepting applications.
The National Health Service Corps helps medical, dental, and behavioral health clinicians pay off their student loan debt through scholarship and loan repayment programs in exchange for working in a Health Professional Shortage Area (HPSA). Nurse Corps participants commit to providing care in facilities with a critical shortage of nurses or as nurse faculty and help reduce the nursing shortage issues experienced across the nation. The Substance Use Disorder Treatment and Recovery Loan Repayment Program makes awards to clinicians, allied health professionals, and support staff who provide substance use disorder (SUD) treatment and recovery services to patients at treatment facilities located in a Mental Health Professional Shortage Area or in a county (or a municipality, if not contained within any county) with a threshold drug overdose death rate defined in statute.
Today’s funding announcement is directly responsive to the recommendations in the final report – PDFof the Presidential COVID-19 Health Equity Task Force.
The COVID-19 pandemic has brought rural healthcare systems to the brink. In 2020, at least 20 rural hospitals closed—a new annual record since 2005.
Even before the pandemic, rural healthcare systems have been fighting for their lives. A recent report from the U.S. Government Accountability Office (GAO) found that 101 rural hospitals closed from January 2013 through February 2020. The report found people in the closed hospitals’ service areas would have to travel substantially farther to access certain healthcare services—the median distance to access some of the more common healthcare services increased about 20 miles from 2012 to 2018.
In addition to putting patients at risk of losing access to healthcare, hospital closures strike at the heart of a community. Hospitals are major employers and communities lose jobs, businesses, tax revenue—and people. Doctors, nurses, pharmacists, and other staff employed by the hospital often have to leave the area. GAO found that the availability of healthcare providers in counties with rural hospital closures generally was lower and declined over time.
The crisis in rural healthcare has many causes and the solutions are far from simple. Luckily, our nation’s leaders are starting to take action through various legislative and regulatory approaches. For example, the American Rescue Plan Act of 2021 provides $8.5 billion to reimburse rural healthcare providers for healthcare-related expenses and lost revenues attributable to the COVID-19 pandemic.
Notably, a bipartisan group of Senators has introduced the Save Rural Hospitals Act of 2021, which would help curb the trend of hospital closures in rural communities by making sure hospitals are fairly reimbursed for their services by the federal government. The House has also introduced the Rural Hospital Support Act, bipartisan legislation that would extend and modernize critical federal programs that rural hospitals rely on to properly serve their communities. If passed, these acts would help these community lifelines keep their doors open as we continue to face the lasting repercussions of the pandemic.
Another important solution gaining momentum among policymakers: allowing advanced practice nurses such as Certified Registered Nurse Anesthetists (CRNAs) and other nonphysician providers to practice to the full scope of their education and expertise.
CRNAs are in the thick of responding to this crisis as the sole anesthesia providers in the vast majority of rural hospitals, enabling these facilities to offer surgical, obstetrical, trauma stabilization, interventional diagnostic, and pain management services. Numerous studies have demonstrated that CRNAs provide safe, cost-effectiveanesthesia care.
Importantly, President Biden’s proposed Fiscal Year 2022 budget calls for added funding for the U.S. Department of Health and Human Services (HHS) to protect rural healthcare access and expand the pipeline of rural providers like CRNAs, noting, “The discretionary request also funds efforts to increase the number of individuals from rural areas going to medical school or other training programs, and returning or staying in rural communities to provide care, with a focus on primary care physicians, nurses, nurse practitioners, nurse anesthetists, and other in-demand providers.”
Additionally, in March 2020, the Centers for Medicare & Medicaid Services (CMS) temporarily removed physician supervision of physician assistants and advanced practice nurses to increase the capacity of the U.S. healthcare delivery system during the COVID-19 Public Health Emergency. This allowed CRNAs to step forward as indispensable providers responding to this unprecedented crisis. The waiver was extended by 90 days in April 2021 and HHS has indicated it is likely to remain through the year.
We can help address the rural healthcare crisis by applying the lessons learned during this tragic, unprecedented year. We need to move forward using all of the resources available and make the commonsense measures taken during the pandemic permanent. As these underserved areas need all of the help and resources that CRNAs and other nonphysician providers can give, the barriers that were temporarily waived last year must stay down.
The COVID-19 pandemic has laid bare fundamental, systemic problems within the U.S. healthcare system that will not go away when the pandemic goes away. Clearly, the nation cannot continue down the same path and do what we have always done.