10/29/19 Presenter Disclosures Academic-Practice Partnerships Audrey Snyder, PhD, RN for an Interdisciplinary Rural (1) The following personal financial relationships with Adult-Gerontology Acute Care commercial interests relevant to this presentation existed during the past 12 months: Nurse Practitioner Program. “ No relationships to disclose ” Audrey Snyder, PhD, RN, ACNP-BC, FAAN Gwyneth Milbrath, PhD, RN, MPH, MSN Other collaborators: Joyce Weil, PhD, Marcia Patterson, DNP, Teresa Sharp, PhD, Elizabeth Gilbert, EdD, Jeanette McNeill, PhD, and Kathleen Dunemn, PhD Objectives Rural Health Care Challenges ´ Describe the development of an ´ Well publicized through the national reports of the Institute of Medicine (2010), the Robert Wood Interdisciplinary (Public Health, Gerontology Johnson Foundation (2013), and the National and Nursing) Rural Adult-Gerontology Acute Governors Association Center for Best Practices Care Nurse Practitioner Program to address (2012). shortages of providers in rural communities. ´ Challenges are associated with the rapidly aging population, increased demand from health care ´ Evaluate challenges and opportunities in reform measures and concerns about access and barriers to care for the increased number of developing academic practice partnerships insured individuals with the ACA (Congressional in the rural communities. Budget Office, 2012). Potential Rural Health Workforce Shortage Disparities ´ Demand for nurses in the Colorado, Wyoming and Nebraska is consistent with national projections from the ´ Lower socioeconomic status Bureau of Labor Statistics, and the Bureau of Health Professions; however, Colorado’s and Wyoming’s nurse ´ Geography-based health behaviors supply per capita (per 100,000 population) ranks well below ´ Issues of the built environment and infrastructure the US average with Colorado ranking 17 th and Wyoming (inadequate housing, transportation) ranking 8 th in the U.S. (HRSA, 2013) ´ Environmental issues (air quality, natural disasters) ´ Colorado will face a rapidly increasing demand for health care during the coming decade because the state’s population will expand by one million and there will be 389,000 more adults over age 65 (Colorado Center for Nursing Excellence, 2010) 1
10/29/19 Rural community outcomes Older adults ´ Rural Coloradoans have lower income, education, ´ Rural older adults have greater rates of physical and health-care access with generalists in rural impairment, more frailty (Prasad, Dunn, Hillier, communities handling specialty care and high McAiney, Warren & Rutherford, 2014), and less patient-to-practitioner ratios (Marshall & mobility than their non-rural counterparts. VanRaemdonck, 2012) ´ Younger generations are leaving rural areas, and ´ Higher rates of chronic disease (e.g. heart disease, older persons experience higher rates of isolation diabetes), negative health behaviors (e.g., smoking, diet/obesity), and less access to health and are often “left behind” in settings absent of and preventative services (Hash, Krout, & Jurkowski, geriatricians and geriatric care (Mattson, 2011) 2015) ´ Lower numbers of medical specialists and reduced life expectancies with this gap widening (Singh, 2014) Implications Development of ideas ´ Rural-urban health disparities are well documented and are due in part, to inadequate health personnel and facilities. ´ Nursing, Community and Public Health, and Gerontology faculty: Dr. Sharp and Dr. Gilbert (Public health), Dr. McNeill and Dr. Snyder ´ With the aging of America and a projected doubling of the (nursing) discussed the development of a community based course population age 65 and older by 2050 there is a need for crossing community health, nursing and geriatrics. Dr. Weil healthcare providers who specialize in the care of the elderly (Gerontology) and Dr. Dunemn, Dr. Milbrath and Dr. Patterson (Nursing) and manage multiple co-morbid conditions. joined the discussions. ´ Place matters with identified unique needs of elders residing in ´ An internal grant proposal i@UNC was developed. the rural environment. ´ An Advanced Nursing Education Proposal was submitted(HRSA- 15-046) February 2015 based on the i@UNC proposal: Rural Care ´ Part of the efforts to improving patient access to high-quality Transitions: Creating an Interdisciplinary Adult-Gerontology Acute Care care is to the increase in the number of Advanced Practice Nurse Practitioner program. Nurses who practice in rural and/or underserved areas. ´ Health professions trained in rural training tracks are more likely to practice in a rural area (Rosenthal, 2000). Purpose The purpose of the Advanced Nursing Education (HRSA- 15-046) grant call was to create multifaceted innovative proposals that included: • Creating innovative academic-clinical partnerships . • Instituting a clinical training model for graduate nursing students to provide safe, quality care within complex practice-based environments. • Establishing at least one new partnership/or enhancement of an existing partnership between an academic institution and rural/ underserved clinical practice site(s) . • Improving the quality of preceptor training . • Promoting graduate nursing student readiness to practice in the rural environment . 2
10/29/19 Logic Model Timing ´ Institutional need for growth, desire for additional graduate Program: An Academic-Practice Partnership to train AGACNPs to improve care of rural adults across the transitions of care Inputs Outputs Outcomes students Activities Participation Short Medium Long ´ Market analysis - practice based master’s degrees University of Northern Expert Faculty Graduate Master's and Implement a hybrid Recruit more AGACNP- Sustainable hybrid Colorado (UNC) Doctorally Prepared AGACNP program trained faculty and obtain AGACNP program faculty and facilities in AGACNPs ready to ´ Healthcare systems needs, feedback from area facilities with a focus on rural medical simulation at UNC with a focus Improved medical nursing, gerontology provide safe, quaity healthcare needs equipment on rural populations simulation and public health care in the rural ´ Community need for APNs environment Innovative, Graduate Enroll qualified students interdisciplinary AGACNPs with a ´ Aging population in rural areas into UNC Improved acute cirriculum with Improve rural access focus in rural AGACNP program Expose students to the adult and geriatric nursing, gerontology, to care for adults and health unique challenges of care for patients ´ Lack of providers in rural environment and public health elders across the rural practice and care living in areas with transitions of care. Adult and elderly Establish clinical sites transistions in rural low access and patients in rural including hospitals, ´ Ideal grant call with rural priority environments accessibility areas Preceptors that are rehabilitation, palliative current practitioners care, hospice, and long- ´ Lack of regional AGACNP programs working in Colorado, Expand a community- Practitioners in term care facilities Western Nebraska, based partnership to the rural setting Strengthen professional and Wyoming improve preceptor Enhance academic - relationships between training and promote Provide preceptor training practice Trained academia and clinical retention of through new partnerships Preceptors practice practitioners in the collaborations with between UNC and Partner Health rural environment. practice and community rural health facilities Facilities partners New community Develop and partnerships implement an AGACNP Students innovative academic- Academic- practice partnership Practice that will support the Partnership HRSA Funding program. Centennial Area Assumptions : Full support of program by the University of Colorado; External Factors : Student enrollment and Health Education motivated and engaged students; preceptor cooperation from clinical sites; financial support; policy changes; program Consortium (CAHEC) enriching clinical experiences at rural clinical sites; larger rural health offerings from other local universities; lack of provider work force will improve care in the rural environment control over what patients present for care Plan Program Details ´ The Adult Gerontology Acute Care Nurse Practitioner ´ A predominantly on-line program with a focus on recruiting BSN Program prepares graduates to work with clients prepared nurses from rural areas or who work with patients from the from adolescents through the frail elderly with a rural area (recruitment areas: northern Colorado, Wyoming and focus on the rural/frontier environment and western Nebraska) and continue to work in their current position while transitions of care with an understanding of aging in in graduate school. place whether this is home, a rehabilitation center, ´ Two required summer intensives at UNC for health assessment check assisted living or nursing home. off, advanced practice skills, competencies, simulation, and a ´ The AGACNP program focuses on understanding of community engagement project. rural culture, resources in the rural environment and coordination of care and collaboration to help prevent hospital readmissions. Expanded partnerships Program Options ´ Post-Master’s AGACNP certificate for those nurses already with a MSN ´ Traditional MSN degree with a focus on AGACNP ´ BSN-DNP with a focus on AGACNP 3
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