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In Rural Healthcare, NPs Can Be a Solution to Severe Provider Shortage


In 2018, the New Mexico Nurses Association celebrated 25 years of the state's nurse practitioners being able to practice independently of physicians and having prescriptive authority.

Despite this influx in rural healthcare providers, New Mexico's rural residents -- like many around the country -- are struggling with access to care and a severe shortage of primary care providers.

According to Georgetown University's Health Policy Institute, 20% of the U.S. population lives in rural areas. However, less than 11% of America's physicians are located near or practice in rural America. This shortage creates gaps in rural healthcare.

New Mexico has been hit particularly hard with this problem. Nationally, the U.S. is 19.3% rural, according to 2010 information from the U.S. Census Bureau. At the same time, New Mexico was determined to be 22.6% rural. Of the state's 33 counties, 12 were designated either mostly rural or completely rural in 2010. When it comes to rural healthcare, that doesn't bode well.

How big is the problem?

Johanna K. Stiesmeyer, DNP, RN-BC, director of clinical education and professional development at Presbyterian Healthcare Services in Albuquerque, N.M., says nationally there are 0.83 nurses per 1,000 residents. In New Mexico, the ratio is about one-third of that. "There is just a monster gap for patients out there," she told the Albuquerque Journal newspaper. "To help combat the primary care shortage in rural areas of New Mexico, Presbyterian Healthcare Services and the University of New Mexico College of Nursing have partnered to expand access to primary healthcare providers in rural communities with the creation of a residency program for nurse practitioners," Stiesmeyer said.

The NP residency program is funded by a $3.2 million grant awarded to Presbyterian by the U.S. Department of Health and Human Services, Health Resources and Services Administration.

"This is a first for NPs and rural communities and just what we need in New Mexico," Stiesmeyer said. According to a report by the New Mexico Department of Public Health, rural counties in New Mexico have the highest number of residents older than age 65 (26%) compared to mixed urban-rural counties (16.1%) in New Mexico. It's also more than the national average of 15.6%. With the U.S. population aging rapidly, this could mean many older adults won't have access to necessary care.

New Mexico's NP residency programs

The grant will fund the program -- known formally as the Advanced Nursing Education Nurse Practitioner Residency Program -- for four years, and planning officially began in July 2019, Stiesmeyer said. Years two, three and four involve hiring three cohorts of NP residents, she said. Nine new NPs will be chosen each year for the one-year NP residency programs, which begin each July starting in 2020. "The program has two tracks for the one-year residencies -- family practice and nurse midwifery," said Carolyn Montoya, PhD, RN, PCPNP-BC, associate dean of clinical affairs at UNM's College of Nursing. "Participants will complete their residencies at 10 multidisciplinary Presbyterian family medical clinics in six different counties in New Mexico." The NP residency programs are not exclusive to the UNM's NP graduates, Montoya said.

"These APRN residencies are open to any graduate of an accredited NP or nurse midwifery program who has graduated within 18 months of the start date of the residency," she said.

Interested new grad NPs who want to apply for the program must pass their certification boards and be licensed as an NP or nurse midwife in New Mexico. Those requirements must be met before starting the program, Montoya said. "NP graduates who are accepted into this program will have the opportunity to be precepted by seasoned primary healthcare providers for one year," she said. "They'll complete their residencies in rural areas of New Mexico, thus affording them the opportunity to provide rural healthcare with the support of a preceptor and participate in a curriculum that includes advanced management of selected medical conditions."

Rural healthcare challenges in New Mexico

NPs in New Mexico have the benefit of full practice and prescriptive authority.

"When NPs graduate from the University of New Mexico, they are fully prepared for practice," she said. "This program does not repeat what students in our program have learned. These residencies address medically complex patients in addition to complex geriatric patients, which New Mexico has a large population of."

The hope is rural immersion experience will lead more NPs and nurse midwives to remain in rural healthcare practice New Mexico after their NP residency programs, Montoya said. Various strategies for increasing NPs' retention rates for remaining in rural healthcare practice are being examined, according to Stiesmeyer. "These one-year residencies will provide NPs with a salary and benefits from Presbyterian Healthcare Services," she said. They are looking for NPs who have a passion for caring for patients in rural communities as it takes special people to serve in rural areas, Stiesmeyer said. "We want NPs who are most likely to achieve success working in the rural environment and wish to remain working in rural communities." Rural healthcare patients face numerous social and health challenges, according to Montoya. They typically have lower incomes, lower levels of health literacy and often deal with multiple and complex medical conditions. "We're thrilled that Presbyterian Healthcare Services chose UNM as their academic partner for this program to give us the opportunity to serve these rural communities," Montoya said. The decision to partner with UNM was easy because of the positive past experiences Presbyterian has had with the nursing school and Montoya, according to Stiesmeyer. "To be accepted for the HRSA grant is a wonderful compliment," Stiesmeyer said. "It's a great opportunity to share best nursing practices in the state of New Mexico."

Take these courses to learn more about precepting and mentorship:

Precepting: The Chance to Shape Nursing's Future (0.5 contact hr) Preceptors are role models for professionalism and best practices in the clinical setting, socializing nurses into the work group, while educating and orienting them. High turnover rates, increased cost, and low morale among nurses can occur when the preceptor role is weak or not valued. The number of new graduates, in particular, continues to grow, and as a result, more preceptors are required. 

Partnership: Making the Most of Mentoring (0.75 contact hr) Nurses often confuse mentoring with other career development relationships, such as coaching, precepting, or peer strategizing. This continuing education module offers information about the mentor/protege relationship, the benefits of such relationships, and how to go about establishing one. 

Coaching: An Essential Skill for Nurses (0.5 contact hrs) Leaders in nursing, from the senior management team to the charge nurse and the staff nurse on the front line, can improve performance, facilitate exceptional teamwork, and enhance professional development with coaching. The concepts and coaching skills described in this course will provide the map to transforming your unit and your organization.