Rural Nurse Practitioners Research Articles

A regional approach to the education of nurse practitioner candidates to meet the health needs of rural Australians

Background: Local health services expressed interest in supporting a nurse practitioner (NP) program specifically designed for rural practice environments. Aim: To develop and deliver a generalist NP program that prepares candidates for practice in rural contexts. Methods: The Master of Clinical Nursing (Nurse Practitioner) program was designed with an understanding of the burden of disease impacting on rural Australians, application of the national health priorities, the Australian Government’s refocus on preventative health care and rural health workforce shortages. Results: This program offers nurses who work in rural and remote settings an opportunity to advance their careers. Increasing the numbers of rural NPs will improve rural populations access to healthcare and potentially improve health outcomes. Conclusion: This program will equip those seeking endorsement as a NP to effectively work in rural contexts.

Decreasing barriers for nurse practitioner social entrepreneurship.

To describe difficulties associated with the business-related aspects of practice in role transition of rural nurse practitioners (NPs), and to give practice implications. This focused ethnographic study derived data from semi-structured interviews. Participants provided information about rural NP practice ownership and barriers. The sample consisted of 24 rural NPs living throughout the United States. The majority were 51-60 years of age (45%) and females (93%) who had been in rural practice for 1 to over 20 years. NP social entrepreneurs experience difficulties related to scope of practice, business skills, and role conflict. To decrease barriers for NP clinic ownership and management, NPs need to receive education related to financing a rural practice, legal/regulatory practices, strategic planning, leadership, and clinic management.

What do nurse practitioners do? Analysis of a skills survey of nurse practitioners

To report findings from a survey, analysis, and evaluation of the frequency and criticality of clinical skills and procedures (CSPs) used by nurse practitioners (NPs). In addition, data regarding NP demographic, geographic, and educational preparation were also obtained. Participants were a convenience sample of 452 NPs in Oregon (31% response rate). Findings point to the importance of assessing both frequency and criticality of practice skills. Demographic and geographic data reflected significant dichotomies between urban and rural practice. Rural NPs face challenges of providing care with more distant physician specialists and reported the use of a greater number of CSPs. A majority of participants reported learning most of the CSPs used in practice outside of their NP educational programs. The frequency and criticality of CSPs utilized in practice are both important considerations for NP clinicians and educators. NPs planning to practice in rural areas may need broader exposure and training in CSPs. An understanding of CSPs used by NPs may better inform administrative, reimbursement, licensure, and certification issues for advanced practice nursing. NP clinicians and faculty involved in NP education should seek to promote improved congruence between the CSPs taught in programs and those used in clinical practice.

Nurse practitioner attitudes and treatment practices for childhood overweight: How do rural and urban practitioners differ?

Pediatric overweight and obesity has become an epidemic problem of our nation. Nurse practitioners (NPs) are exposed to overweight pediatric patients on a regular basis. The purpose of this study was to investigate NP attitudes toward pediatric overweight and obesity and explore their current diagnosis and treatment practices. Differences between rural and urban NPs were also investigated. Survey data were gathered from 1088 family and pediatric NPs from the American Academy of Nurse Practitioners member list randomly. Only family and pediatric NPs were included in the sample. NPs in the sample believed that pediatric overweight and obesity are problems in need of treatment, but also reported not assessing and diagnosing the condition per current guidelines. Initiation of treatment was reported at very low rates. Rural NPs reported having fewer referral resources than urban NPs. NPs are in an ideal position to properly assess, diagnose, and treat pediatric overweight and obesity. The findings suggest that more education on these topics is necessary for NPs. Rural NPs reported fewer referral services, and may need to have more knowledge about how to provide obesity treatment services in their own practice settings due to this disparity.

No Longer an Island: Rural Nurse Practitioners Gain Support Through Telehealth

Rural nurse practitioners (NPs) fill a desperate need for obstetric and gynecologic health care in remote areas of Arkansas. They often provide care for many counties and travel from clinic to clinic daily. The rural NPs are often on their own and do not have the option to call a colleague into the patient's room for a consultation. This sometimes creates a situation where rural NPs feel isolated and alone in practice. The Arkansas Health Department and the University of Arkansas for Medical Sciences began a new collaboration in July 2009 to improve resources and support for the rural NP.

Development of a Flexible Sigmoidoscopy Training Program for Rural Nurse Practitioners and Physician Assistants to Increase Colorectal Cancer Screening among Alaska Native People

At the Alaska Native Medical Center in Anchorage, colorectal cancer screening rates improved dramatically with the initiation of a dedicated flexible sigmoidoscopy screening program staffed by mid-level providers. We describe the development and implementation of a program to train rural nurse practitioners and physician assistants in flexible sigmoidoscopy.

Rural-Urban Practice Patterns of Nurse Practitioners in Washington State

Comparing characteristics and practice patterns of Washington nurse practitioners (NPs) in urban and rural settings furthers understanding of NP contributions to rural health care. Data were collected in 2006 using a statewide survey of Washington NPs. Rural NPs were more likely to be certified in family practice, provide primary care, and care for 12 more total patients per week than urban NPs. Additional research on rural NP practice nationwide could provide the foundation for developing innovative solutions for the recruitment and retention of NPs in rural areas to improve access to care.

Outcomes of a Lipid Management Program in a Rural Nurse Practitioner Clinic

Outcomes of a Lipid Management Program in a Rural Nurse Practitioner Clinic

Perceived Barriers to Nurse Practitioner Practice in Rural Settings

Rural residents experience the same incidence of acute illness as urban populations and have higher levels of chronic illness. Overall, access to adequate rural health care is limited. Nurse practitioners (NPs) have been identified as safe, cost-effective providers in meeting these challenges in rural settings. This replication study was conducted to examine NP perceptions of barriers to rural practice in Minnesota. Findings were compared to earlier studies to examine issues that have persisted over time. A Barriers to Practice checklist was mailed to NPs from the database of the Board of Nursing of a midwestern state. Rural NPs (n = 191) identified and described barriers to practice and rated the overall restrictiveness of their practice. Barriers to practice were perceived to be prevalent. Persisting barriers continued to stand in the way of full utilization of NP roles. Lack of understanding of NP roles on the part of the public and other health professionals has been particularly problematic over time. Key issues in 2001 were low salaries, lack of adequate office space, and a limited peer network. Perceived restrictiveness of the practice climate, gauged as somewhat restrictive, remained unchanged between 1996 and 2001. NPs have an excellent history of meeting rural primary health care needs. Enhancing the NP work environment could prove instrumental to retaining these professionals in the work force and thereby contribute to improved access and quality of care in underserved rural communities.

Perceived barriers to rural nurse practitioner practice.

Studies of barriers to nurse practitioner (NP) practice show similar results for more than 20 years. Comparisons of barriers to rural NP practice have not been performed. Descriptive data about perceived barriers to practice were collected from 292 NPs in one midwestern state (urban, 229; rural, 63; response rate, 60%). A primary barrier was a lack of understanding by the general public about the NP role, which respondents found was detrimental to practice success. Physicians also lacked knowledge about the NP role. Rural practice barriers also included lack of peer support, suggesting that isolation from other NPs detracted from practice success. Educating the public and health professionals about NP education, scope of practice, and roles continues to be necessary. Media campaigns can increase understanding of NP practice. Rural NPs can use electronic means to communicate with each other to decrease practice isolation. Removing barriers to practice remains an ongoing task to enhance rural nursing practice.

Rural nurse practitioners: perceptions of ethical dilemmas.

The purposes of this study were to identify ethical dilemmas encountered by rural nurse practitioners in primary practice and to identify constraints or enhancers that influenced ethical decision making. Nine nurse practitioners from Wyoming and Colorado responded to in-depth interviews. Six categories of ethical dilemmas and a list of constraints and enhancers were identified. One central concept, conflict between personal values and professional responsibility, emerged. Beneficence, nonmaleficence, justice, and patient autonomy, as core ethical principles, were related to this central conflict.

A model for development of an off-campus rural nurse practitioner program.

A model for development of an off-campus rural nurse practitioner program.

The rural nurse practitioner: a challenge and a response.

From a cohort of 525 employed nurse practitioners (NPs) who graduated between May 1975 and June 1976, 85 (16 per cent) reported practicing in rural areas. While 91 per cent of the rural NPs chose the short-term certificate programs rather than the master's degree for their NP preparation, 47 per cent had already earned a baccalaureate or master's degree prior to NP training. Family NPs comprised the most frequent specialty area chosen, followed by pediatric and adult specialties. Of the 85, 99 per cent were actually providing a broad array of primary care services to clients over a wide age range. Physicians were periodically available on site in about 80 per cent of the practices, by telephone in 97 per cent of the practices, and in 60 per cent of the practices provided additional consulation by record review. Major motivations of the NPs for entering rural practice were to participate in a creative approach to health care delivery (50 per cent of the practice setting were less than five years old), and for the opportunity for role autonomy. Over 95 per cent of these NPs and employers were satisfied with the NP role.

Rural Nurse Practitioner Clinic

When a lumbering town in the state of Washington had difficulty finding and keeping a physician to man its new clinic, the Washington/Alaska RMP helped it set up a nurse-practitioner clinic. Two University of Washington researchers share the results of an early utilization study showing strong public acceptance of the clinic. One of the nurses tells the nursing story.