Rural Nurse Practitioners

Battle for Acceptance

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The chainsaw slipped. The 4-wheeler flipped. The jack stand fell. The cut's infected. The baby won't stop crying. Momma can't keep anything down.

Nurse practitioners seem to be the perfect answer to the severe rural-RN deficiency. But ignorance is the enemy.

"We're talking about my baby here. Can't we see a real doctor?"

"Hey, you can actually prescribe medicine and stuff?"

"You're just a nurse, right? How do you know this is the best way to treat this thing?"

It's true that nurse practitioners are one answer to the critical shortage of primary care services, in many rural areas. It's also true that community acceptance of nurse practitioners, (in rural medically underserved areas), has steadily improved.

But community acceptance implies not only satisfaction with care received, but also willingness of the community to support NP practice.

As we move into this century, rural families and friends increasingly encourage one another to seek care from an NP. Especially in those under-served communities.

However, much ignorance remains, of the NP's training and skillsets. That's the big challenge to the modern NP in the rural setting.

The most common specialty areas for nurse practitioners are family practice, adult practice, women's health, pediatrics, acute care, and geriatrics. However, there are a variety of other specialties that nurse practitioners can choose, including neonatology and mental health. Advanced practice nurses can prescribe medications in all States and in the District of Columbia.

While still more difficult to fill than urban vacancies, there are bigger "carrots" to help recruiters fill NP slots. The increased salary, challenge, and independence help draw nurse practitioners out of the city.

For example, in California, more than 200 federally-designated rural health centers must employ at least a half-time "mid-level practitioner" (nurse practitioner or physician assistant). Designated rural health centers are still on cost-based Medicare reimbursement--- enabling very competitive salaries to NP's.

But with all that said, rural nurse practitioners still sometimes face another uphill battle. Many NP's are winning over their patients, but many more are struggling to win physician acceptance.

NP's often compete directly with MD's. Many rural physicians are progressive, supportive, and encouraging. But many other MD's resist the advanced practice role for nurses.

The acceptance of nurse practitioners is a significant issue in some rural areas, according to Jeff Bauer, PhD, of Hillrose, Colorado, (a health futurist, medical economist, and author of Not What the Doctor Ordered, a book about nursing and allied health alternatives in health care).

Bauer says, "I think rural doctors—not all of them, of course—tend to be a bit more traditional and treat nursing personnel in a more subservient way. In rural areas, you are more likely to be working with doctors who want to ‘put you in your place."

In the past, the lack of previous exposure to NPs confused people. This has helped fuel distrust and ingnorant reactions of the NP role.

But the NP can win over the rural patient populace.

How? By good work, of course. And by becoming accepted in these communities. It isn't always easy.

It requires friendliness, competence, and most of all perhaps--- a willingness to enter into the life of the community.

Get to know the people. Let them get to know you. Like you. Respect you.

Remember, you live there too--- you need them as much or more than they need you.

For the Nurse practitioners to effectively serve as a primary or a specialty care provider, a blend of nursing and healthcare services to patients and families isn't enough. The local health services, the volunteer fire department, the local Ruritans, the churches, all provide entry points into the trust of every rural community.

And once you win that trust, your knowledge and abilities can steadily improve that community, and your practice will flourish.