Targeting the nurse practitioner workforce: Influences and barriers in choosing rural practice

Background and objective: Recruitment and retention of primary care providers are projected to worsen in rural regions. Nurse practitioners (NPs) are a crucial solution to the shortage of primary care providers in rural America. Little research exists regarding factors influencing new NPs’ decisions to practice in rural settings, as well as practice readiness. The purpose of this study is to explore factors influencing new NPs’ decision to practice in rural settings.Methods: A survey of family nurse practitioner (FNP) graduates in a rural state was conducted. The survey measured rural background, current practice environment, the impact of rural clinical experiences on readiness to practice, and perceptions of rural NP practice.Results: The data collected over five years (N = 42) indicated several factors that influenced an NP’s decision to choose a position in a rural or underserved setting. A wide scope of practice, rural roots, a desirable job offer, and strong relationships were influential when choosing rural practice.Conclusions: Most respondents (69%) were not practicing in rural or underserved areas. Among those who were, the ability to practice to the full scope of education and autonomy were the most important factors. However, respondents were also apprehensive and intimidated with the broad skill set required in rural care. Implications: This study provides insight into factors and barriers for new graduate NPs in choosing a rural practice setting as well as possible solutions to the rural workforce shortage.

ANEW Project to Develop and Support Rural Primary Practice

South Dakota is one of the nation’s most rural and frontier states and has the highest proportion of rural dwellers in the Midwest. Many of the state’s counties suffer from provider shortages, with nurse practitioners increasingly being called upon to fill the role of the primary care provider in clinics and critical access hospitals. However, family nurse practitioner (FNP) education programs are not required to provide the training and skills necessary to meet the unique challenges of rural practice. An Upper Midwest land grant university prepares both masters and doctoral FNP students to fill primary care provider needs in South Dakota and the surrounding region. The purpose and scope of this two-year Advanced Nursing Education Workforce (ANEW) project was to enhance an existing academic/practice partnership to prepare primary care advanced practice registered nursing (APRN) students for practice in rural and/or underserved settings in the state and region. The ANEW project provided FNP students with a longitudinal primary care clinical traineeship experience in rural clinical settings. Trainees benefited from traineeship funds, learning advanced procedures and skill concepts through attendance at a series of educational workshops, and job placement efforts postgraduation. The ANEW project also provided for a comprehensive preceptor development collaborative designed to enhance competence and confidence for independent rural practice and facilitate job placement in rural communities after graduation. This project strengthened the quality of FNP education through an academic/practice partnership which resulted in a symbiotic, synergistic relationship to address rural work force supply and the identification of the knowledge and skills needed for current and future rural healthcare providers. Keywords: family nurse practitioner, education, preceptor, academic, practice partnership, rural primary healthcare, healthcare provider shortage DOI: https://doi.org/10.14574/ojrnhc.v21i1.649

Diagnostic reasoning: relationships among expertise, accuracy, and ways that nurse practitioner students self-explain

ObjectivesTo improve diagnostic ability, educators should employ multifocal strategies. One promising strategy is self-explanation, the purposeful technique of generating self-directed explanations during problem-solving. Students self-explain information in ways that range from simple restatements to multidimensional thoughts. Successful problem-solvers frequently use specific, high-quality self-explanation types. In a previous phase of research, unique ways that family nurse practitioner (NP) students self-explain during diagnostic reasoning were identified and described. This study aims to (a) explore relationships between ways of self-explaining and diagnostic accuracy levels and (b) compare differences between students of varying expertise in terms of ways of self-explaining and diagnostic accuracy levels. Identifying high-quality diagnostic reasoning self-explanation types may facilitate development of more refined self-explanation educational strategies.MethodsThirty-seven family NP students enrolled in the Doctor of Nursing Practice program at a large, Midwestern university diagnosed three written case studies while self-explaining. During the quantitative phase of a content analysis, associational and comparative data analysis techniques were applied.ResultsExpert students voiced significantly more clinical and biological inference self-explanations than did novice students. Diagnostic accuracy scores were significantly associated with biological inference scores. Clinical and biological inference scores accounted for 27% of the variance in diagnostic accuracy scores, with biological inference scores significantly influencing diagnostic accuracy scores.ConclusionsNot only were biologically focused self-explanations associated with diagnostic accuracy, but also their spoken frequency influenced levels of diagnostic accuracy. Educational curricula should support students to view patient presentations in terms of underlying biology from the onset of their education.

Incorporating a Mindfulness Program in a Graduate Family Nurse Practitioner Program

Mindfulness-based stress reduction (MBSR) activities have been shown to have psychological benefits. Studies have identified increased perceived levels of stress in graduate students; however, this is not specific to graduate nursing students. There is very little data on the use of MBSR as a nonpharmacologic tool to decrease stress levels in graduate nurse practitioner students. Therefore, the purpose of this study was to determine if the implementation of MBSR improves the overall perceived stress of graduate nursing students. The pilot MBSR program covered topics such as different forms of mindfulness meditation practice, mindful awareness during yoga postures, and mindfulness during stressful situations. Perceived stress scores mean for the sample ( n = 25) was elevated at 26 (+4) indicating moderate stress prior to the MBSR training and significantly decreased post 14-week MBSR training (+6) ( p < .05). This finding suggests that the MBSR activities have contributed to the overall reduction in stress in these students. The graduate family nurse practitioner students are now familiar with the benefits of MBSR and can share this practice with their patients. Having this skill as a part of their clinical tool kit and practice will allow them to apply this to patient care and subsequently provide holistic care.