Rural nursing issues discussed

Expanding the use of advanced practice nurses, improving educational opportunities for nurses, and establishing medical homes within the Indian Health Service were some of the recommendations rural health experts cited as ways to improve rural healthcare at a forum Monday in Washington.

Sponsored by the AARP, Robert Wood Johnson Foundation and the National Rural Health Association, the event focused on ways to maximize nursing in rural America, which is home to nearly one in four Americans, or about 70 million people. Experts—led by keynote speaker Mary Wakefield, administrator of HHS' Health Resources and Services Administration—examined recommendations outlined in a recent Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health.

Together, the Robert Wood Johnson Foundation and the AARP Foundation established Campaign for Action, a national effort to implement those recommendations, including one that nurses should practice to the full extent of their education and training. The report also urges Congress, the CMS and other agencies to remove scope-of-practice barriers for nurses.

Wakefield, a registered nurse with experience in rural healthcare, mentioned the challenges affecting rural residents, such as higher rates of poverty, obesity, alcohol, tobacco and methamphetamine use than for those in urban areas.

She also outlined provisions in the Patient Protection and Affordable Act related to nursing, which she said is mentioned almost 400 times in the 2010 law. Chief among those measures is $15 million to support 10 nurse-managed health centers over three years, and $1.5 billion over five years for the Affordable Care Act's home-visiting program that sends nurses and social workers into the community.

In a panel discussion on state perspectives, Mary Guyot, a registered nurse who is a principal at healthcare consulting firm Stroudwater Associates, said she would like to see a five-year program for nurses that includes a one-year residency added on to a four-year baccalaureate program to help the nursing workforce gain more experience.

Meanwhile, Sandra Haldane, nurse collaborative director of the Improving Patient Care Program at the Indian Health Service, said the agency is “moving rapidly” toward the medical home model in the Indian Health Service, with close to 100 sites “well on their way to becoming an Indian Health Service medical home.”