In Montana, 52 of 56 counties are classified as medically underserved and ten counties have no physician. This is why nurses play such an important role there, and why the Montana Office of Rural Health/Area Health Education Center (MORH/AHEC) is working to get more nurses in rural, underserved communities.
“Montana is different than other states because of our extreme frontier nature, so nurse practitioners (DNPs) have a full scope of practice here,” said Kristin Juliar, MORH/AHEC Director. “In many communities, they may be the sole primary care practice, and physician supervision is some distance away.”
Using a grow-your-own approach, MORH has joined with the Montana State University College of Nursing (MSU CON), where it is housed, to get more nurses trained and working in rural areas. The effort has been funded by two Health Resources and Services Administration grants, Nurse Education, Practice, Quality and Retention (NEPQR), which prepares BSN-level nurses to work in rural primary care, and Advanced Nursing Education Workforce (ANEW), which trains rural-ready DNPs.
Kailyn Mock, MORH Project Coordinator, said the best ANEW candidates are already working in rural settings. “We are trying to leverage their skill set,” Mock said. “They have dug their heels into their town, are working already as an RN, and want to continue work in their communities. They can provide a different level of service to their communities as a DNP.”
“Our DNP program is an all-online program so it’s especially suited to advance their education in rural,” Juliar said. “We have DNP students from all over the state. If you are a DNP in a rural setting you need a broader set of skills than you would need in a more urban clinic. The ANEW grant is focused on establishing academic clinical partners with Critical Access Hospitals (CAHs), Community Health Centers (CHCs), tribal and Indian health, and Rural Health Clinics (RHCs), and developing the curriculum to help those nurses working in those settings.”
ANEW students do their schoolwork from their homes and communities and do not go to class unless there is a skills lab requirement a couple of days in a row at the start of the semester, Mock said. “We also set up clinicals outside of where their usual job is, to help them find an experience outside of what their normal practice looks like,” she said.
For the NEPQR grant, students are enrolled in a traditional brick and mortar program based on campus, Juliar said. MORH works with MSU CON on the outreach component of the grant, and to help develop undergraduate nursing didactic education so that it is in line with the needs of rural and underserved sites in Montana, she said.
“There’s a focus on establishing more clinical sites, and getting more students out into primary care settings, like CHCs, CAHs, RHCs, and tribal health sites,” Juliar said. “We also are looking at trends in healthcare transformation and care coordination models, and how nurses can be up to speed on these developments in how health care is delivered.”
Undergraduate nursing students who elect to be in the Rural Primary Care Track receive additional education through the AHEC Scholars Program, which focuses on interprofessional education and team-based care, Mock said. “These students also have priority preference for completing the clinical component of their coursework in rural locations.”
NEPQR grant funding began in July 2018 and ANEW grant funding began in July 2019, Mock said. Both are four-year grants. “Our first ANEW cohort started at the end of last summer with 15 in the first group, and we have 21 students lined up for 2020-2021,” she said.
The NEPQR grant supports rural immersion costs for undergraduate nursing students, including travel costs to rural sites for clinical rotations, and conference registration fees. The ANEW grant covers all tuition, plus up to $9,000 for books and clinical travel.
The grants represent a partnership between MORH/AHEC and MSU CON to address critical rural health workforce issues, Mock said.
Providing healthcare to all parts of Montana is challenging, with 1,068,778 people spread across 145,546 square miles. Finding nurses to work in rural Montana is especially challenging because most nurses in the state work in urban areas and the nursing workforce is aging, with the average age of all nurses around 49 years old.
But Mock sees hope in getting more rural students into nursing school. “Our best success stories are those who grow up in rural returning to rural,” she said.
By: Beth Blevins
A farmers market, a community garden, chemo care kits—these projects and others were started with the help of Mini Grants from the Montana Office of Rural Health’s (RHI). The grants were awarded last fall and earlier this year to a total of seven community organizations across the state, using leftover funds from the first Montana Healthy Communities Conference, held in the fall of 2015.Bigfork/Ferndale Community Square Foot Garden
“The conference has been a great way to integrate the resources and the network and the people within the RHI community with national and foundation resources,” according to Natalie Claiborne, MT-ORH Assistant Director. RHI worked and partnered with several foundations to fund the conference, including the Federal Reserve Bank of Minneapolis, the Robert Wood Johnson Foundation, and the Montana Healthcare Foundation. “We’re not just looking at health in terms of hospital care, but also how you leverage resources like the Federal Reserve that do economic development in those communities, to create a healthy community in all aspects,” Claiborne said.
“RHI is unique in and of itself,” said Amy Royer, RHI Project Director. “It’s been ongoing and has a lot of state interest and partners, but now we’re taking it to the next step with the conference, and by utilizing those resources and other state partners.” The next conference is planned for October of this year.
The conference, and the Mini Grants that sprang up from it, are the latest initiatives from RHI, a local health and wellness resource center that has been run by MT-ORH since 2008. Through its web site, the program showcases local wellness initiatives via , provides evidence-based program ideas, and offers monthly health and wellness webinars. In addition, it publishes a weekly online newsletter.
“There are a lot of wonderful health and wellness initiatives out there, but to translate that from an urban setting into a rural or frontier setting with different perimeters and limited resources can be challenging,” Claiborne said. “To be successful in a rural setting, a different set of programs might have to be implemented, whether it’s a walking trail, a community garden, or a backpack food program for kids.”
RHI provides a network between communities so they can describe their barriers and share their successes, Royer said. “A lot of rural communities don’t know what’s going to fit for them,” she added. “Someone might say, ‘We don’t know how to get a diabetes education program started.’ But I can refer them to our site and say ‘this town and this town did it, with limited resources and with a similar population. Here is their contact info.’ With every profile, we make sure that it’s easy for another town to emulate the programs and knows who to contact.”
With the Mini Grants, RHI also aims to get organizations to network within their communities to make sure that their projects are sustainable. “For example,” Royer said, “the Richland County Backpack Food Program (which received one of the recent Mini Grants) was able to get local schools and grocery stores to pledge to keep the program going.” The program serves 75 children who are at risk for inadequate nutrition on weekends and holidays. Each backpack includes non-perishable food, which the children return each Friday to refill. The Richland County program is now one of several backpack food programs profiled by RHI on its website.
“It circles back,” Royer said. “Each success story serves as an example for others.”
RHI also is an active presence on Facebook, Twitter, and Instagram. This month, as part of Mental Health Awareness Month, RHI is holding a contest that invites users to post photos on Instagram showing what they do to improve their mental health. Past RHI contests have included a Health Care Careers Interview Contest and a Rural Health Photo Contest for National Rural Health Day.
“By using networking and social media, we’re a facilitator between not just Montana resources, but state and national information applicable to these small communities,” Claiborne said.
By having students write https://homework-writer.com/ in blogging format, you foster community and idea sharing
Natalie Claiborne, MPH, is the Assistant Director of the Montana Office of Rural Health. In addition, she is the co-chair of the NOSORH Educational Exchange Committee.
What have you learned (and what could others learn) from being on the NOSORH Educational Exchange Committee?
I have been the Co-chair for the Educational Exchange Committee (EEC) for two years. I have very much enjoyed my experience and learned a lot from being a part of it. We liken the EEC to a “gateway committee”—it’s a great committee to join (especially if you’re new) to learn about NOSORH, other State Offices and to find out about all the opportunities available through NOSORH! Right now the Committee is in need of another representative from Region A—we try to make sure that all regions are represented on the committee.
What does the EE Committee do—and why is it important?
The EEC can provide a lot of information that is current and meaningful to State Offices. The EEC has really worked hard to align the educational offerings with current topics and issues in rural America and to make sure the educational opportunities align with the NOSORH Strategic Plan. Not only has NOSORH been able to provide more webinars (thanks in large part to Stephanie’s hard work), but there has also been an increase in NOSORH webinar attendance.
In addition, in the last few years there has been an increase in SORHs who utilize the NOSORH Travel Scholarship opportunity, which helps fund peer-to-peer exchanges (also known as “educational exchanges,” or “EE” for short). I think this is one of the most beneficial offerings NOSORH has to offer, as it allows SORHs to meet with other SORHs to develop or enhance their expertise or knowledge, leadership skills, adoption of a promising practice, or improve effectiveness of program management, strategic planning and implementation. We all know how many skilled and lovely people are part of NOSORH, and it’s a wonderful way to tap into that knowledge.
Is there a typical (peer-to-peer)“educational exchange”? What are some of the most requested topics? And how does a SORH apply for one?
SORHs have worked on a broad range of topics in recent years: health information exchanges, recruitment and retention, strategic planning, etc. A while back some stand-alone (non-university or government-based) SORHs got together in an EE as a group to see how their needs are different than other SORHs. Often a SORH will request an EE when someone is new to the SORH, to teach him/her how to get going in that position. SORHs will ask a leader to help them rethink how to do daily work, and to look at the structure of their office. They can choose what areas they want to focus on.
Melinda (my EEC co-chair) and I approve the applications. The EE was under-utilized for a time, but we’ve been getting a fair amount of requests for it in the last couple of years. It’s such a positive thing, if people are getting the education they need, we don’t mind if we are busy!