Top Nurse Leaders Explore Ways to Improve Health and Health Care in Rural America

Nursing experts call for implementation of recommendations in Institute of Medicine report on the future of nursing.

    • June 20, 2011

A panel of top nursing leaders came together in the nation’s capital Monday, June 13, to discuss how nurses can improve health and health care in rural and frontier areas, where residents tend to have the greatest need for health care but the least access to it.

Nurses have played and continue to play “a critically important role” in meeting the vast and deep need for affordable, high quality health care in rural America, said Mary Wakefield, Ph.D., R.N., a North Dakota native who, as head of the Health Resources and Services Administration, is the highest ranking nurse in the Obama administration.

Wakefield and other experts and nurse leaders offered solutions to meet the need for health care in rural communities during the AARP Solutions Forum, which was organized by the AARP Public Policy Institute, the Robert Wood Johnson Foundation (RWJF) and the National Rural Health Association. Speakers from the Indian Health Service, Veterans Health Administration and Lewis & Clark Law School addressed solutions at the federal level while participants from health organizations in Arkansas, Colorado, Texas, Maine and Georgia offered local perspectives.

Nurses, Wakefield said in her keynote address, have and can continue to take a lead role in creating new ways to meet the unique health care challenges facing rural America, which is home to a comparatively weak health care infrastructure and a population that has more chronic conditions but is less likely to have health insurance.

“Necessity is the mother of invention,” Wakefield said. But she added that, when it comes to nursing and rural health care, necessity is also “the mother of innovation.”

Nursing has responded to the need for more and better health care in the past with the development of new models of care delivery, such as the nurse managed clinic, and new roles for nurses, such as the nurse practitioner, she said. Nurses have opportunities now to build on their legacy of invention and innovation in rural America, Wakefield added.

Nearly one in four Americans live in rural areas, and rural Americans tend to be older, poorer and sicker than those who live in urban or suburban areas, according to the AARP Public Policy Institute. They are more likely to be uninsured and must often travel great distances to access health care services. Rural areas also face more acute shortages of nurses.

Nurses who do practice in rural health settings face particular challenges, according to the National Rural Health Association. They must be familiar with the “expert generalist role;” they may lack adequate educational preparation to provide patient care in rural settings; and they have more difficulty accessing continuing education required by most states to maintain licensure.

Nurse Leaders Praise IOM Report on Future of Nursing Profession

The groundbreaking report released last year by the Institute of Medicine, The Future of Nursing: Leading Health, Advancing Change, offers strategies to improve health and health care in rural America, speakers said. The report calls for a transformed health care workforce in which nurses contribute as essential partners.

It makes the following general recommendations: expand opportunities for nurses to lead and diffuse collaborative improvement efforts; implement nurse residency programs; advance nurse education levels; ensure that nurses engage in lifelong learning; prepare and enable nurses to lead change to advance health; remove scope of practice barriers to allow nurses to practice to the full extent of their education and training; and build an infrastructure for the collection and analysis of interprofessional health care workforce data.

Implementing all of the report’s key recommendations will improve health and health care in rural America, said Susan Reinhard, R.N., Ph.D., F.A.A.N., senior vice president of the AARP Public Policy Institute and chief strategist at the Center to Champion Nursing in America (CCNA), a joint initiative of AARP, the AARP Foundation and RWJF.

A paper distributed by the AARP Public Policy Institute at the forum on nursing in rural America outlines some of the IOM report’s specific recommendations that would come to the aid of rural Americans.

The paper sites the IOM’s recommendations that Medicare include coverage of advanced practice registered nurse (APRN) services within the scope of practice of applicable state law; authorize APRNs to perform Medicare admission assessments and certification of patients for home health, hospice and skilled nursing services; change requirements for Medicare hospital participation to ensure that APRNs are eligible for clinical and admitting privileges; increase Medicaid reimbursement rates for APRNs providing primary care services; and urge states to amend unduly restrictive state APRN regulations.

The paper also underscores the importance of interprofessional collaboration.

The Robert Wood Johnson Foundation and AARP have created a campaign to implement the IOM report’s recommendations. The Future of Nursing: Campaign for Action is built around partnerships from diverse sectors in health care, including physicians, nurses, insurers, consumers, business, government, foundations, academia and health systems.

For its part, the National Rural Health Association called on nursing schools to include coursework on rural health and health care; encourage more nurses to pursue a career in nursing education; improve retention and job satisfaction among nurse professionals; disseminate “best practice” models in rural nursing; and draw nurses to rural areas with scholarships or tuition reimbursement in return for a commitment to practice in rural settings.

Wakefield meanwhile, pledged support from the federal government, which she said has, among other things, increased funding for investments in training and education for nurses, provided incentives for nurses to work in rural areas, and supported community health centers and health clinics led by nurses—all of which she said will improve health and health care in rural America.

More recently, the administration created a White House Rural Council on June 9 that will focus on policy initiatives—including in the areas of health and health care—for rural Americans.

Rural health care is not a “backwater,” Wakefield said. For nurses and nursing in particular, it is a “headwater” for invention and innovation.

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