Health Policy and Role of the Advanced Practice Nurse Assignment.
Practicing in Rural Communities
Rural healthcare is a common practice in certain regions of the country and remains a troubling area for the healthcare community to address effectively. A community is considered rural if there is a population of less that 2,500 people and 7-499 people per square mile (Stingley & Schultz, 2014). A community is considered frontier if there are less than seven people per square mile, which is the case in most of Montana (Stingley & Schultz, 2014). In the United States in 2010, the average number of primary care providers (PCPs) per 100,000 people was 121; however, Montana only had 90, and eleven counties did not have even one PCP (Stingley & Schultz, 2014). With the number of residents in rural and frontier communities expected to grow by up to 30% by 2020, it is essential to find a way to improve access to care for these patients. Health Policy and Role of the Advanced Practice Nurse Assignment.
The following sections will examine rural and frontier healthcare practice in the state of Montana. The sections will go into more depth regarding practice guidelines, challenges and benefits of rural practice, common complaints from patients, professional boundaries, and information regarding practice authority.
Montana is considered a full authority practice state (Scope of Practice Policy, 2018). This means that an advanced practice registered nurse (APRN) can practice independently without supervision or collaboration with a physician. APRNs can assess, diagnose, treat, and manage care of acute and chronically ill patients. APRNs in Montana also have full independent prescriptive authority (Scope of Practice Policy, 2018). They can prescribe devices, medications, and scheduled III-V controlled substances. The can also prescribe scheduled II controlled substances via telephone to a pharmacist. In Montana, APRNs can also be recognized as primary care providers (PCPs). Health Policy and Role of the Advanced Practice Nurse Assignment.
Challenges of Care in Rural Areas
It is anticipated that roughly 30% of the rural physician workforce is set to retire and there are not enough young physicians to take their places (National Conference of State Legislatures [NCSL], 2018). With only 10% of practicing physicians working in rural communities, most of Montana is considered a health professional shortage area making providing care for these residents challenging (University of Texas Arlington [UTA], 2018). Health Policy and Role of the Advanced Practice Nurse Assignment.
Prior to the implementation of the Affordable Care Act (ACA), most rural residents were uninsured or underinsured causing delays in preventative and acute care (UTA, 2018). Due to delays in care and inadequate resources, Montana residents have different and sometimes more complex healthcare issues such as cancer, teen pregnancy, and preventable hospitalizations (UTA, 2018). Since there is also a higher level of poverty in rural and frontier Montana, transportation can be another issue. Most healthcare facilities can be several tens of miles away or even in the next city with little to no public transit available (UTA, 2018). These concerns, along with common patient complaints, create a challenging, complex environment for APRNs to provide care within. Health Policy and Role of the Advanced Practice Nurse Assignment.
Two Chief Complaints and Strategies to Educate Patients
Benefits of Practicing in Rural Areas and Recruitment Strategies
Benefits of practicing in rural healthcare include saving on student loans, better quality of life, better provider-patient relationships, and expanded learning experiences and opportunities due to rural communities need for a wider variety of services.Health Policy and Role of the Advanced Practice Nurse Assignment. Many rural states provide special financial benefits such as loan forgiveness or relocation benefits to encourage health care providers to practice in their rural communities. Another benefit of working in rural healthcare is no shortage of job openings. The demand for advanced practice nurses in Montana, especially in rural areas, remains high due to Montana’s aging population, increasing people with co-morbid disease, a growing population, physician shortages, the implementation of health care reforms, and changing delivery systems. Health Policy and Role of the Advanced Practice Nurse Assignment.Due to the majority of Montana’s health care providers working in urban medical centers, there are many job openings vacant in rural health care facilities.
Montana developed an initiative in 2017 to engage Montanans in understanding health care efforts, develop a “grow your own” program to train Montana citizens as healthcare professionals, encourage further education and training in rural and underserved areas, and developed specific techniques to recruit and retain health care professionals across the state (Montana Healthcare Workforce Advisory Committee, 2017). Health Policy and Role of the Advanced Practice Nurse Assignment.
APRN Professional Boundaries
Practice Authority and Obstacles to APRN Practice
The Institute of Medicine (IOM), found that access to primary care increases, hospitalizations are reduced, and the cost of care decreases by 20-35% when APRN’s provide care (NCSL, 2018). Rural states, such as Montana, are needing to find creative ways to provide primary health care access to patients especially in the rural and frontier areas where there is little or no access to health care services.Health Policy and Role of the Advanced Practice Nurse Assignment.
Montana Healthcare Workforce Advisory Committee. (2017). Montana healthcare workforce statewide strategic plan. Retrieved from http://healthinfo.montana.edu/Strategic%20Plan%202017.pdf
National Conference of State Legislatures. (2018). Meeting the primary care needs of rural
America: Examining the role of non-physician providers. Retrieved from
Scope of Practice Policy. (2018). Montana scope of practice policy: State profile. Retrieved
Stingley, S. & Schultz, H. (2014). Helmsley trust support for telehealth improves access to care
in rural and frontier areas. Health Affairs, 33, 336-341. Health Policy and Role of the Advanced Practice Nurse Assignment.
University of Texas Arlington. (2018). How to overcome obstacles as an NP in rural areas.
Retrieved from https://academicpartnerships.uta.edu. Health Policy and Role of the Advanced Practice Nurse Assignment.