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Rural Nursing

November 28, 2016

Building a Healthcare Model for Rural America

UNC’s grant-funded program for nurses strives to provide template for rural healthcare

By Anne Cumming Rice

Over the past 15 years, Sara Jacobsen has been a surgical, oncology, ICU, home care and hospice care nurse. But she has always been interested in nursing in geriatrics, so when she learned about UNC’s new Adult-Geriatric Acute Care Nurse Practitioner (AGACNP) program, she was ecstatic.

Jacobsen — whose goal is to care for the geriatric population in palliative care — was among the first cohort of students in UNC’s AGACNP program in fall 2015. UNC received a three-year, $1.78 million grant from U.S. Health Resources and Services Administration to create a program that others could emulate. The program trains nurses who already work in rural areas or those who see patients who come from rural communities, preparing them to work with patients from adolescence to geriatrics in acute care, critical care, specialty units and clinics, rehabilitation and long-term care.

The program combines online courses and two summer programs on campus so that nurses like Jacobsen can continue working in their communities while pursuing an advanced degree.

“Our goal is to recruit nurses from rural environments to this program. After completion, they might be one of the few advanced-practice nurses in their communities,” says Audrey Snyder, assistant professor and coordinator of the AGACNP program.

By 2050, the U.S. over-65 population is expected to double. In Colorado, demand for health services is expected to outpace the supply of registered nurses. Those demographic changes may contribute to a growing problem: Rural communities have difficulty recruiting and maintaining medical staff, and geriatric patients in rural communities have unique challenges and needs.

One of the most important aspects of working with patients who come from rural communities is managing their care so they don’t have to return to the hospital after being discharged.

“If patients return to the hospital within
30 days for the same reason they were originally admitted, the hospital gets penalized,” Snyder says. “A big part of an AGACNP’s job is to collaborate with physicians and nurse practitioners in the patient’s home community to make sure they get the care they need after leaving the hospital.”

“Nurses are known for caring and listening to patients and being the advocates for them when doctors might not be available,” Jacobsen says. “Through this program, patients can feel comfortable with the fact that nurse practitioners caring for them will not only have a solid knowledge base but also have the important skillset of listening in times of crisis or when dealing with chronic diseases.”

It’s knowledge that has already helped Jacobsen in her work with patients.

She remembers one elderly patient, newly diagnosed with heart failure and diabetes, who faced a lot of new medications and lifestyle changes.

“Because of what I learned in class, I knew simply telling him about all the changes he was going to have to make would be overwhelming,” Jacobsen said. “Instead, I spent over 30 minutes asking him what was important to him and finding out what activities he knew he could be successful in without becoming overwhelmed. He had a sense of relief in his eyes when he left, knowing he didn’t have to be perfect and make
a million changes at once.

“A lot of times, the geriatric population gets overlooked and they aren’t always listened to because of lack of time or because of multiple co-morbidities that can be difficult to treat,“ she says. “Learning about a different way of approaching patients and understanding what their motivations are has helped me time and time again.”