In 2018, Frontier Nursing University (FNU) was honored to receive the prestigious Advanced Nursing Education Workforce (ANEW) grant from the Health Resources and Services Administration (HRSA). The goal of the grant is to support innovative academic programs to prepare advanced practice registered nurses (APRNs) for clinical practice in rural and underserved areas.
The populations in the rural communities impacted through this program are at a higher risk for chronic illness and poor health compared to urban populations. Rural populations experience higher rates of infant mortality, heart disease, child obesity, and preventable hospital stays, to name a few. According to the Centers for Disease Control and Prevention, rural Americans are susceptible to increased mortality rates as a result of five leading causes: heart disease, cancer, unintentional injuries, chronic lower respiratory disease and stroke.
For many rural populations, low educational levels often relate to higher rates of poverty among residents. Subsequently, poor reading skills and health literacy are prevalent, leading to poorer health status, increased risk for hospital stay, and a reduced likelihood to receive preventable services and health screenings.
Throughout its history, FNU has placed an emphasis on providing primary care for the vulnerable in rural and underserved communities. The ANEW grant has allowed FNU to achieve a great deal to this end over the past two years. Let’s take a look at what FNU has accomplished through the four main objectives of the ANEW grant!
Informing the Curriculum
The ANEW grant has allowed FNU to develop preceptor and alumni surveys to facilitate the enhancement of active learning activities in the didactic curriculum. The surveys asked alumni and preceptors to identify specific concepts that needed further development in the curriculum. Survey results revealed that curriculum development should focus on the concepts of genetic testing, abnormal infant weight gain, EKG and prescribing medications to special populations (i.e., geriatric, adult, and pediatric). FNU is working to ensure these are fully introduced, reinforced, and applied across the family nurse practitioner (FNP) curriculum.
In 2019, the curriculum was mapped for the concepts of complex care, telehealth, psychiatric mental health, healthcare team communications and TeamSTEPPS. Survey data helped determine the placement of this information in the current curriculum. In 2020, the concepts of diversity and inclusion will be added to curriculum mapping projects.
Clinical Training in Rural Settings
One of the aims of the ANEW grant is to train nursing students for practice in rural primary care settings. Though it has approximately 600 students in clinicals all over the country, for this project FNU has been able to partner with five clinical sites in federally designated rural areas to form a clinical practicum advisory committee (ICPAC). Located in Richmond, Ky.; Tuba City, Ariz.; Elma, Wash.; Tahlequah, Okla.; and Batavia, N.Y., each site is hosting FNU students for their clinical practicum and participating in quarterly CPAC meetings. FNU regional clinical faculty are also meeting monthly with the participating clinical sites to evaluate and assess grant activities, using the rapid cycle quality improvement (RCQI) process to provide ongoing feedback throughout the grant period.
Students’ experiences at the rural clinical sites teach them how to address the challenges unique to a rural setting. Current DNP Class 37 student Mindy Brown-Lechner, CNM, said her experience in Tuba City, Ariz. has been transformational.
“I came into Tuba City with very little knowledge of the culture of the native populations in Arizona,” said Mindy. “I was fortunate to be provided an opportunity to glimpse the unique birth practices of the Navajo and Hopi women and their families that I worked with. I was fascinated by the rituals surrounding pregnancy, birth, and the postpartum period.”
At his rural clinical site in Elma, Wash., DNP student Joe McFadden, CFNP, RN gained valuable knowledge from the providers he worked with.
Joe said, “I worked with many excellent providers in Elma, including my regional clinical faculty Dr. Mary Ellen Biggerstaff, Dr. Belinda Lear and Amy Graham. I feel I was well prepared to understand the resource limitations providers and patients have to work with but also the strength of working in a tight knit community.”
Precepting in Rural Settings
For nursing students to receive training and complete their clinicals in rural settings, the need arose to grow the number of preceptors in rural communities. FNU has had the privilege of implementing recruiting activities at major nursing conferences like the American College of Nurse-Midwives and the American Association of Nurse Practitioners.
For existing preceptors, FNU’s clinical network database was enhanced in 2019, introducing tools to track students’ progress in daily, weekly and monthly increments. FNU now offers quarterly online continuing education (CE) programs for preceptors and will continue to introduce new CE courses in the future. Over 560 preceptors have completed FNU’s Gift of Precepting continuing education program, and 18 have completed the Master Preceptor continuing education program!
Support for FNU Students
Another goal of the ANEW grant was to financially support students entering the clinical practicum in a rural setting. FNU has achieved its objective of providing 175 students with $2,000 in traineeship support. Mindy said the grant offered much needed support during her time in a remote location.
“It was such an honor to be given the opportunity to participate in the intrapartum experiences at Tuba City, and having the ANEW grant helped support me financially while I was away from work and home,” said Mindy.
Going forward, all trainees’ progress will be tracked through graduation to determine if they are employed in a federally designated rural or underserved area.
Strategies for APRN and Nurse-Midwife Distribution
In order to impact the lives of rural underserved patients in the long-term, the ANEW grant placed emphasis on strategies for distributing APRNs and nurse-midwives into rural clinical settings after graduation. Some rural clinical site students like Joe are called to remain on location to serve post-graduation.
“I had such a great experience in Elma working with the population in Grays Harbor that I knew I wanted to work there and didn’t even apply anywhere else,” said Joe. “I’m very thankful for the opportunity to train in Elma and I appreciate my preceptors and the ANEW grant for helping make it all happen.”
FNU offers employment assistance for all graduates, including an active job board on the FNU alumni portal, online resources such as interviewing and resume guidelines, and guidance included in the Principles of Independent Practice course taken by all students during their studies.
Most recently, the Alumni Career Center was developed to further support our trainees and graduates.
The ANEW grant expires in June 2020, but its effects will last far longer. FNU is proud to partner with ANEW to accomplish the mutual goal of providing quality healthcare to improve the lives of patients in rural and underserved areas!