When Lauren Allen’s father unexpectedly passed away a month ago from a heart attack, the registered nurse couldn’t help but wonder if things would have turned out differently if he’d lived in a big city. In the rural mountains, he was far away from a major heart center.
Allen is among 44 students in UNCG’s Post-Baccalaureate Adult Gerontology Primary Care Nurse Practitioner (AGPCNP) Doctor of Nursing Practice (DNP) program training to help rural residents gain access to medical care, thanks to a $699,700 grant from the Department of Health and Human Services (DHHS) Health Resources and Services Administration (HRSA).
“We need more providers, in more places, so that people have the opportunity to access affordable, quality care,” Allen said.
Adult Gerontology refers to adolescents and adults 13 years and older. Projected growth indicates America’s older adult population will more than double by year 2060 to 98 million people, according to a 2015 study by the Administration on Aging.
North Carolina, a state where 80 out of 100 counties are rural, has a substantial number of medically underserved populations, noted Dr. Laurie Kennedy-Malone, professor of nursing and project coordinator/principal investigator of the “Advancing Nursing Education Workforce: Academic Practice Partnerships Today for Competent Practitioners Tomorrow” grant.
Dr. Karen Amirehsani, preceptor coordinator, and Dr. Kristin Curcio, AGPCNP project coordinator, are actively working with Kennedy-Malone to fulfill the project objectives, which are twofold: 1. Improve access to quality healthcare by preparing adult gerontology primary care NPs to manage the complex health needs of adults and older adults, rural and medically underserved populations; and 2. Enhance the AGPCNP DNP program curriculum by ensuring that students recognize the impact of the social determinants of health on the delivery of healthcare through the use of clinical simulations, competency measures and the use of select clinical sites that serve diverse adult and older adult populations to include patients in rural and medically underserved areas.
Older adults are medically underserved due to physical handicaps, lack of resources and inadequate transportation systems that make healthcare inaccessible, according to DHHS. North Carolina has a significant number of medically underserved populations in diverse counties both urban and rural, with a growing, aging diverse population.
DHHS estimates by 2025, the projected demand for nurse practitioners in North Carolina will reach 8,640.
North Carolina has eight universities that offer nationally accredited graduate nurse practitioner programs, but only three prepare NPs to specialize in adult gerontology primary care, of which one is UNCG. Funding from the grant will allow for enhancements in the curriculum to address social determinants of health in medically underserved communities and prepare AGPCNPs to care for these populations through partnerships with local healthcare facilities.
Funding is for one year, and if successful, UNCG could receive the same funding next year, explained Kennedy-Malone. The project has designated three academic-practice partnerships – Novant Health systems, Davidson Medical Ministries Clinic and Cone Health Community Health & Wellness Center. An underlying goal of the grant will be to increase the number of partnerships in the upcoming year. The School of Nursing has contracts with over 500 clinical agencies throughout North Carolina.
“A big piece of this grant is that it provides students traineeship money with additional stipends,” Kennedy-Malone said. “Given the financial support, students will spend more time immersed in their clinical practice areas.”
Additionally, she added, the grant will provide educational opportunities for “preceptors” – clinicians who train and mentor NP students in a clinical setting. Training is provided for current mentors as well as graduating students. Preceptors play an integral part in preparing nurse practitioners.
Austin Beshears, a grant fund recipient, plans to use the clinical training to better serve the rural community where he grew up, in Elkin, North Carolina. Specialists in rural areas are hard to come by, he said, and patients often face a commute of up to an hour.
“Doctoral-prepared nurse practitioners are on the cutting edge of research and evidence-based practice,” said Beshears, who works as a registered nurse at Wake Forest Baptist medical center. “I want to take what I’ve learned in the big city and apply it.”
Tyesha Harvey, an RN from Lancaster, Virginia, has gained a new perspective during her time in the DNP program at UNCG:
“The way I look at things now, it’s about quality improvement – how can I make a process better to improve patient care? It’s not just, ‘How I can treat this patient?’ It’s the whole big picture.”
Lancaster has fewer than 1,500 people, Harvey said, so it’s easy for her to relate to the healthcare disparities facing rural communities targeted by the grant. This fuels her passion for the project and her goal to bring healthcare to underserved areas.
Harvey works at Moses H. Cone Memorial Hospital while tackling a full course load. Rather than digging into her savings, funding from the grant helps to cover unmet costs.
It’s a sentiment shared by most of the students, who receive about $2,500 each.
“It’s been a sigh of relief, for all of us, I think,” Allen said. “The grant money helped me to take a step away from work to focus on my education at this pivotal point in the program.”
Allen believes firmly that with better access to quality care, outcomes will improve, and the project’s scope will be far-reaching in impact:
“Having more nurse practitioners available in rural areas changes the culture of health.”
By Elizabeth L. Harrison
Photography by Martin W. Kane