Dr. Marquita Lyons-Smith
Expanding healthcare provider training and access in rural areas
June 14, 2024
Dr. Marquita Lyons-Smith
Most people are aware that the COVID-19 pandemic placed additional strain on the United States’ already stressed healthcare system. Between 2020 and 2021, more than 100,000 nurses left the profession, more than at any other time in the last 40 years. A majority of those were young hospital nurses. When nurses are in short supply, errors increase along with mortality and morbidity. Compounding the problem, the resulting high patient-to-nurse ratio also leads to greater nurse burnout and job dissatisfaction, causing some to pursue travel nursing or take non-clinical roles such as teaching, telenursing consulting, and Informatics, to name a few, or leave the profession altogether. It’s become a vicious cycle.
As bad as the problem is in cities and suburbs, it’s dire in rural areas, where health disparities already affect 46 million people, according to the CDC. Over the past 10 years, 115 rural hospitals have closed across the country. In contrast, only three urban hospitals closed during the same time frame. With rural residents more likely to die from causes such as heart disease, stroke, cancer, and respiratory disease, it’s imperative that the healthcare system takes steps to address the crisis.
What’s being done
Some efforts are being made to improve rural health. Last year, Congress gave the CDC $5 million with instructions to create the Office of Rural Health to coordinate the agency’s programs and “improve the health and well-being of rural communities throughout the U.S.” And in March this year, the bipartisan Community Training, Education, and Access for Medical Students (TEAMS) Act was introduced to “increase training opportunities for medical students in rural, underserved communities.” The TEAMS Act is important because it specifically addresses the need to teach medical students about health challenges in rural communities and encourages them to practice in these areas after graduation. The act calls for approaching the problem from both the institutional side by providing grants through the Health Resources and Service Administration (HRSA), and the student side by getting them ready to address the unique issues faced by high-risk populations. The bill’s third prong will increase medical training locations in rural areas, a win for both sides since the healthcare facilities will receive additional personnel while simultaneously, students training there acquire the kind of education they wouldn’t receive elsewhere.
As critical as these efforts are, including other advanced practice health professions is important. Oftentimes, nursing and advanced practice registered nursing (APRN) students are excluded from these opportunities in favor of medical students, a significant error. With such a dire need that will only increase as the population ages, inviting as many disciplines as possible into the healthcare provider tent is key. Nurses account for the largest number of healthcare providers and interact with patients more, including frequency and duration, especially in hospitals, and the educational pathway is comparatively more accessible. And APRNs could help fill the physician gap by performing a majority of the same healthcare functions. Additionally, training APRNs from ethnically diverse backgrounds to work in rural areas can address one of the biggest impacts of the shortage - trust. Patients appreciate and trust healthcare providers who look like them and understand their community and value system. Affinity builds trust, and trust improves compliance. Since rural residents are more likely to die from chronic diseases, improving compliance can really move the needle. It seems logical for rural healthcare facilities to be very intentional in their efforts to attract nursing students and newly licensed nurses.
What hospitals can do
While rural hospitals may feel helpless in the face of a historic talent shortage, there are steps they can take and examples they can follow. Here are a few of them:
● Become a collaborator with nursing programs at nearby universities and community colleges. Working with schools with immersion programs that start early in the academic journey is important so students can discover the joy of delivering healthcare to an underserved population. It is imperative to identify students who want to work in those communities.
● Encourage healthcare teams to participate in provider panels featuring primary and specialty areas of interest for students. This gives rural healthcare professionals a chance to interact with future nurses, and students can acquire knowledge about working in a rural hospital setting.
● Host a “day in the life” event where students can shadow nurses in rural areas and see what their day entails as part of the senior preceptorship experience. These types of programs are already up and running, especially at historically Black colleges and universities (HBCUs), and would be an excellent expansion to the final senior clinical experience.
● Work with the Leading to Equitable Access to Health Professions (LEAHP) program, an element of Duke University School of Nursing Office of Diversity, Equity and Inclusion and collaboration with local HBCUs, The LEAHP program provides mentorship and other resources that support students from underrepresented ethnic groups to ultimately attend advanced practice nursing programs. Started by HRSA, LEAHP encourages students to give back to their communities, emphasizing caring for the underserved.
● Take advantage of tax credits available through the Federal New Markets Tax Credit Program from the U.S. Treasury in exchange for equity investments in low-income communities. Hospitals can use their own funds or encourage partners to invest in rural health programs, such as the Academic Community Health Centers and Rural Health Hub launched by North Carolina Central University in conjunction with Stonehenge Community Development and U.S. Bancorp Impact Finance.
● Look into government programs such as HRSA grants, the National Rural Transit Assistance Program, and state offerings.
What communities can do
Hospitals are key healthcare providers, but they don’t operate in a vacuum. The communities that surround them also have a role to play and ways to improve the lives of their residents. They can:
● Connect with area providers to create or participate in rural health hubs. Fostering a working relationship increases exposure and helps all participants to expand their reach to a broader population.
● Collaborate with local or nearby nursing schools, especially those with RN-to-BSN programs. These programs typically expose nursing students to rural health clinics through their community health practicum. Additionally, Traditional BSN programs often include innovative initiatives such as mobile health clinics as part of the community health courses' clinical experience to serve rural and underserved populations.
● Conduct needs assessments to understand the community's needs and strategize interventions to maximize enhanced health outcomes. Be sure to cast a wide net to reach as many community members as possible.
● Develop win-win campaigns based on the assessment and in conjunction with a local nursing school to find the most effective way to serve the needs of both the community and the school. Health fairs and other community education activities are perfect examples of serving both entities.
Hope for the future
Given the current state of rural healthcare, it would certainly be easy to develop a pessimistic perspective. But government and academic efforts already underway highlight what is possible. The establishment of the CDC’s Office of Rural Health and the TEAMS Act, as well as collaboration between nursing schools and the creation of rural health hubs are signs of what can happen when stakeholders unite to address the problem. Since these programs are in their infancy, their effects are yet to be realized. However, bringing attention and resources to the problem increases the probability of improved rural health access and enhanced outcomes. Witnessing the lightbulb go on when patients feel empowered regarding their health can be a mutually rewarding experience.
About the author: Dr. Marquita Lyons-Smith is a certified Pediatric Nurse Practitioner and director of the RN-BSN Nursing Program at North Carolina Central University.
Most people are aware that the COVID-19 pandemic placed additional strain on the United States’ already stressed healthcare system. Between 2020 and 2021, more than 100,000 nurses left the profession, more than at any other time in the last 40 years. A majority of those were young hospital nurses. When nurses are in short supply, errors increase along with mortality and morbidity. Compounding the problem, the resulting high patient-to-nurse ratio also leads to greater nurse burnout and job dissatisfaction, causing some to pursue travel nursing or take non-clinical roles such as teaching, telenursing consulting, and Informatics, to name a few, or leave the profession altogether. It’s become a vicious cycle.
As bad as the problem is in cities and suburbs, it’s dire in rural areas, where health disparities already affect 46 million people, according to the CDC. Over the past 10 years, 115 rural hospitals have closed across the country. In contrast, only three urban hospitals closed during the same time frame. With rural residents more likely to die from causes such as heart disease, stroke, cancer, and respiratory disease, it’s imperative that the healthcare system takes steps to address the crisis.
What’s being done
Some efforts are being made to improve rural health. Last year, Congress gave the CDC $5 million with instructions to create the Office of Rural Health to coordinate the agency’s programs and “improve the health and well-being of rural communities throughout the U.S.” And in March this year, the bipartisan Community Training, Education, and Access for Medical Students (TEAMS) Act was introduced to “increase training opportunities for medical students in rural, underserved communities.” The TEAMS Act is important because it specifically addresses the need to teach medical students about health challenges in rural communities and encourages them to practice in these areas after graduation. The act calls for approaching the problem from both the institutional side by providing grants through the Health Resources and Service Administration (HRSA), and the student side by getting them ready to address the unique issues faced by high-risk populations. The bill’s third prong will increase medical training locations in rural areas, a win for both sides since the healthcare facilities will receive additional personnel while simultaneously, students training there acquire the kind of education they wouldn’t receive elsewhere.
As critical as these efforts are, including other advanced practice health professions is important. Oftentimes, nursing and advanced practice registered nursing (APRN) students are excluded from these opportunities in favor of medical students, a significant error. With such a dire need that will only increase as the population ages, inviting as many disciplines as possible into the healthcare provider tent is key. Nurses account for the largest number of healthcare providers and interact with patients more, including frequency and duration, especially in hospitals, and the educational pathway is comparatively more accessible. And APRNs could help fill the physician gap by performing a majority of the same healthcare functions. Additionally, training APRNs from ethnically diverse backgrounds to work in rural areas can address one of the biggest impacts of the shortage - trust. Patients appreciate and trust healthcare providers who look like them and understand their community and value system. Affinity builds trust, and trust improves compliance. Since rural residents are more likely to die from chronic diseases, improving compliance can really move the needle. It seems logical for rural healthcare facilities to be very intentional in their efforts to attract nursing students and newly licensed nurses.
What hospitals can do
While rural hospitals may feel helpless in the face of a historic talent shortage, there are steps they can take and examples they can follow. Here are a few of them:
● Become a collaborator with nursing programs at nearby universities and community colleges. Working with schools with immersion programs that start early in the academic journey is important so students can discover the joy of delivering healthcare to an underserved population. It is imperative to identify students who want to work in those communities.
● Encourage healthcare teams to participate in provider panels featuring primary and specialty areas of interest for students. This gives rural healthcare professionals a chance to interact with future nurses, and students can acquire knowledge about working in a rural hospital setting.
● Host a “day in the life” event where students can shadow nurses in rural areas and see what their day entails as part of the senior preceptorship experience. These types of programs are already up and running, especially at historically Black colleges and universities (HBCUs), and would be an excellent expansion to the final senior clinical experience.
● Work with the Leading to Equitable Access to Health Professions (LEAHP) program, an element of Duke University School of Nursing Office of Diversity, Equity and Inclusion and collaboration with local HBCUs, The LEAHP program provides mentorship and other resources that support students from underrepresented ethnic groups to ultimately attend advanced practice nursing programs. Started by HRSA, LEAHP encourages students to give back to their communities, emphasizing caring for the underserved.
● Take advantage of tax credits available through the Federal New Markets Tax Credit Program from the U.S. Treasury in exchange for equity investments in low-income communities. Hospitals can use their own funds or encourage partners to invest in rural health programs, such as the Academic Community Health Centers and Rural Health Hub launched by North Carolina Central University in conjunction with Stonehenge Community Development and U.S. Bancorp Impact Finance.
● Look into government programs such as HRSA grants, the National Rural Transit Assistance Program, and state offerings.
What communities can do
Hospitals are key healthcare providers, but they don’t operate in a vacuum. The communities that surround them also have a role to play and ways to improve the lives of their residents. They can:
● Connect with area providers to create or participate in rural health hubs. Fostering a working relationship increases exposure and helps all participants to expand their reach to a broader population.
● Collaborate with local or nearby nursing schools, especially those with RN-to-BSN programs. These programs typically expose nursing students to rural health clinics through their community health practicum. Additionally, Traditional BSN programs often include innovative initiatives such as mobile health clinics as part of the community health courses' clinical experience to serve rural and underserved populations.
● Conduct needs assessments to understand the community's needs and strategize interventions to maximize enhanced health outcomes. Be sure to cast a wide net to reach as many community members as possible.
● Develop win-win campaigns based on the assessment and in conjunction with a local nursing school to find the most effective way to serve the needs of both the community and the school. Health fairs and other community education activities are perfect examples of serving both entities.
Hope for the future
Given the current state of rural healthcare, it would certainly be easy to develop a pessimistic perspective. But government and academic efforts already underway highlight what is possible. The establishment of the CDC’s Office of Rural Health and the TEAMS Act, as well as collaboration between nursing schools and the creation of rural health hubs are signs of what can happen when stakeholders unite to address the problem. Since these programs are in their infancy, their effects are yet to be realized. However, bringing attention and resources to the problem increases the probability of improved rural health access and enhanced outcomes. Witnessing the lightbulb go on when patients feel empowered regarding their health can be a mutually rewarding experience.
About the author: Dr. Marquita Lyons-Smith is a certified Pediatric Nurse Practitioner and director of the RN-BSN Nursing Program at North Carolina Central University.