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Nursing News HighlightsNurses Leading Innovation

Homegrown: Leveraging Local Nurses to Make a Big Impact on Rural Community Healthcare

Lack of access to primary and mental healthcare is an issue faced by many across the country, and a situation that is even more challenging for rural communities.

Ingrid Johnson, DNP, MPP, RN, FAAN, is the CEO and President of the Colorado Center for Nursing Excellence. In 2003, Ingrid launched the “Grow Your Own” APRN program, which aims to meet the primary care and mental health needs of rural, underserved communities across the state by employing an innovative nurse education model for nurses who live in those communities.

While many states across the U.S. have piloted programs to bring nurses and other healthcare providers to practice in rural and underserved areas, in Ingrid’s experience, many of these programs fail because these providers have not been able to acclimate well to the local community and/or leave when higher paying roles come available.

The question facing Ingrid and the Center crystallized: why attempt to pull nurses with advanced degrees from outside of underserved regions to rural areas when a wealth of nurses in rural communities could be upskilled instead?

This was Ingrid’s lightbulb moment.

“Rural communities were faced with systemic access to care issues,” said Ingrid. “The likelihood of getting physicians, specialists, community service and better health education to these rural communities is low. Instead, we can build APRNs for the community, from the community.”

Thus, the “Grow Your Own” APRN program was born. The Center encourages existing BSN-prepared nurses already living in rural and underserved communities to return to school and attain an advanced degree. The Center provides $20,000 in stipend funds over the course of their education, plus monthly coaching or mentoring to support them in their endeavors. The nurses pay for the balance of their educational costs and can go to any nursing school they get into.

There were two enabling factors that helped make this approach successful. As a result of laws passed in 2010, Colorado recognized the need for nurses to be able to engage at the top of their scope of practice, particularly in rural communities—and Nurse Practitioners were no longer required to work under physician supervision. Additionally, nurse advocacy groups in Colorado were able to significantly lower the number of hours needed for APRNs to attain full prescriptive authority. This APRN-friendly environment coupled with strong funding from federal and state health institutions led to an incredibly strong debut of the Center’s APRN program. Ingrid received over 200 applicants to the inaugural class.

The program has been successful at nurturing a homegrown rural nursing workforce. To date, 100 nurses have successfully completed the program, and nearly all have remained in state. Two great examples of nurses who have gone through the program and are now serving their local communities are Jesse Smith, MSN, FNP, RN, and Christy Smith, MSN, FNP, RN. The two graduated in the inaugural APRN class and have since set up bases at opposite ends of Colorado—in Burlington to the East and San Luis to the South, respectively. They are true champions in their communities, with unique perspectives on what it means to work as caretakers and nurses.

“Working in rural and underserved healthcare has a lot of unique challenges that other providers may not experience. Sometimes it feels like my co-workers, partners and I are in a healthcare desert,” said Jesse. “A traditional nurse education program does not prepare you for all the hats you may have to wear in these unique areas. You must have the willingness to just jump in and think outside the proverbial box.”

Nurses in these small communities are required to think creatively to support patients who often don’t have access to specialty clinics or large hospital systems.

Both Jesse and Christy noted a reality from their experience working in rural areas: a strong education and license to practice is only half the battle. The communities they serve are distinct and diverse, full of unique challenges that require daily ingenuity, and an expanded understanding of what nurses can do.

“In order to meet the needs of their local communities and fill vacated positions, we need to encourage and uplift nurses out in rural communities and give them the resources and tools they need to be able to go back to school and get educated, all while still being able to work and not having to leave their town,” said Christy.

Feedback from the nurses in the field—like Christy and Jesse—informed the Center of the need for an additional level of care for their patients and communities, specifically focused on mental health. Using the recruitment and retention model developed with the “Grow Your Own” APRN program, the Center launched a new program—developed with funding from the United Health Foundation—to create access to behavioral health care in rural communities lacking in mental health providers. This program supports nurses who wish to obtain a Psychiatric-Mental Health Nurse Practitioner (PMHNP) post-graduate certificate so they can treat their patients for both physical and behavioral health diagnoses.

Today, Ingrid’s approach to tackling the nurse retention issues in Colorado appears to be working. The program has helped hundreds of nurses become community champions as APRNs and mental health specialists in hospital systems across the state. Now, she and the Center are shifting towards establishing a new initiative aimed at tackling diverse recruitment—building an organic nurse pipeline at the K-12 level in rural and underserved communities to help spark interest in the profession at the earliest phases of career education. The program looks to educate both students and career counselors in schools across the state about opportunities in the nursing profession to bolster interest in the profession and deeper engagement in their community health. As the program expands in the future, it aims to educate and train more nurses of color to mirror the population of patients served—currently, the nursing workforce in Colorado is nearly 90% white, while the population is 30% diverse.

Ingrid, a nurse innovator, advocate and educator, is truly changing the way healthcare leaders tackle challenges in the nursing profession and, under her leadership, the Center continues to innovate to figure out new ways to educate and grow nursing talent in communities where this talent is most needed.

To Ingrid, the APRN alumni across the state of Colorado are truly her heroes. “They just amaze me with their energy and growth. Wherever I go in the state, I always hear about their work. How can you ever highlight all the amazing work that they’ve done?”

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