The delivery of rural health care presents many challenges, but as Mary Wakefield, administrator of the Health Resources and Services Administration, said recently, "Necessity is the mother of innovation." Wakefield was the keynote speaker at a June "Solutions Forum" called "Advancing Health in Rural America: Maximizing Nursing's Impact." The forum was convened by AARP, in collaboration with the National Rural Health Association and the Robert Wood Johnson Foundation.
The aging of the rural nursing workforce and the trend of fewer students entering the profession pose challenges in many rural communities, according to Wakefield. The myth is that rural Americans live an idyllic life, she said, but the reality is vastly different: rural Americans are less likely to work for employers who offer health insurance, and about a third receive food stamps. Many rural areas also have higher rates of obesity, chronic disease, and dental disease, and it's not unusual for more traumatic injuries to be seen in rural areas than in urban ones.
Several recurring themes, such as primary care, illness prevention, and health promotion, are laced throughout major parts of the Patient Protection and Affordable Health Care Act, noted Wakefield, not to mention the role nurses will play in the future of rural health. She highlighted the recent funding of home visiting programs, school-based health programs, and community health centers, almost a third of which are located in rural communities. She also noted that the federal administration is aligned with the October 2010 report from the Institute of Medicine (IOM), The Future of Nursing: Leading Change, Advancing Health, which calls for collaborative efforts toward improving research on health care workforce requirements and developing less fragmented and more team-oriented interdisciplinary care.
In addition to the keynote address by Wakefield, two expert panels, composed mostly of nurses, discussed national and state perspectives on using nurses more effectively to improve health in rural areas. Most of these perspectives were either based on or dovetailed with the IOM report.
The first panel addressed federal initiatives to improve rural health and health care. Innovation in the Veterans Health Administration (VHA) has been prompted by challenges in rural settings, where 38% of all U.S. veterans live, according to Catherine Rick, chief nursing services officer of the VHA. Rick described the "pivotal role" of the RN care manager in the VHA's recently developed approach, "the patient-aligned care team," in which four primary care team members coordinate care for each veteran, who is the fifth team member. Rick also mentioned the VHA's efforts to obtain "authority for federal supremacy," which would override states' medical staffing bylaws to allow advanced practice nurses (APNs) to practice independently within the VHA system.
In contrast, such independent practice is already accorded the Indian Health Service (IHS), according to Sandra L. Haldane, who said that under the IHS federal scope of practice, APNs are licensed independent practitioners. "The only time they have to refer back to their state's scope of practice is for the prescription of controlled substances," she added. Haldane is the nurse collaborative director of the Improving Patient Care Program at the IHS.
The second expert panel discussed regional programs, such as the Arkansas Aging Initiative, which includes more than 700 partnerships to improve geriatric care across the state. Panel members also discussed the need for a better-educated nursing workforce in rural areas, noting that in states like Colorado and Texas there's a growing emphasis on residency programs for nursing graduates and on implementing collaborative care models.
For more details, view the complete Webcast online at http://bit.ly/jEWHpQ.—Gail M. Pfeifer, MA, RN, news director