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Advancing the Primary Care Workforce

The KU School of Nursing has been awarded a multi-million dollar grant to support training APRNs for rural and underserved areas

Photo of Cara Busenhart, Ph.D., CNM, APRN, clinical assistant professor in the KU School of Nursing, taking notes as a patient describes their problem.

The University of Kansas School of Nursing has been awarded a nearly $2 million dollar grant to launch an innovative post-doctoral fellowship program that will allow primary care advanced practice nurses (APRNs) to gain additional training in primary care practices in rural and underserved areas. The fellowship will provide financial support as the APRNs spend a year being exposed to clinical mentoring and a robust didactic program in primary care health care environments across the state of Kansas, with the eventual goal of training and placing more primary care providers in rural and underserved areas of the state. The four-year grant was awarded in the summer of 2019 by the Health Resources and Services Administration (HRSA).

The demand for primary care services is increasing as the population in the United States grows and ages. According to the Medicare Payment Advisory Commission, only about 11 percent of the nation’s physicians work in rural areas, despite nearly 20 percent of Americans living there. Moreover, physicians providing care in rural areas often serve large geographic areas that require long travel times. These areas may be substantially underserved by hospitals and other health care facilities. Demographic shifts, such as the aging rural physician workforce and the growth in the rural elderly and near-elderly population will increase demand for primary care services.

HRSA believes one possible solution is expanding the role of advance practice registered nurses to help meet the need for primary care services. Improving access to primary care providers, like doctors and advance practice registered nurses, is especially important in rural and underserved areas. In addition, populations in these areas often face significant health challenges and health disparities.

“The KU School of Nursing has done an excellent job of preparing primary care providers to provide beginning-level care across the state of Kansas,” said Cara Busenhart, Ph.D., CNM, APRN, clinical assistant professor in the KU School of Nursing, program director for the school’s advanced practice and nurse-midwifery programs, and project director for the post-doctoral fellowship program. “What makes this different is that it allows nursing graduates to build up their core competencies with specific emphasis on caring for populations in rural and underserved communities.”

The post-doctoral fellowship will support recent Doctor of Nursing Practice (DNP) graduates as they gain additional skills in primary care practices in rural and underserved community-based settings across Kansas. The fellows will spend time with preceptors in clinical situations and learn to develop skills in telehealth and telemedicine, clinical mentoring and specialty rotations. Four doctorally-prepared fellows from a primary care specialty area will participate during the first year of the program in 2020, with each fellow being placed in a rural or medically-underserved community-based clinic setting. By the program’s completion in 2024, at least 15 fellows will have completed the post-doctoral fellowship.

Cynthia Teel, Ph.D., RN, FAAN, associate dean of academic affairs at the KU School of Nursing, said rural health care is a specialty area that requires a broadening of provider skills across diverse specialties, while taking into consideration varied resource availability.

“This fellowship will help expand the skill sets of new primary care DNPs who are currently working as family nurse practitioners, adult-geriatric primary care nurse practitioners, psychiatric-mental health nurse practitioners and nurse-midwives,” Teel said. “We hope this will translate into enhanced resources for patients in rural communities, where health care provider availability is typically more limited.”

Busenhart said the School of Nursing’s primary clinical partner in the grant is The University of Kansas Health System.

“The University of Kansas Health System is an ideal partner for this program because it’s mutually beneficial for both the academic and practice sides of our institutions,” Busenhart said. “The School of Nursing gains incredible practice sites for learners with seasoned advanced practice preceptors, while the health system benefits from robust, evidence-based educational preparation for new providers, which hopefully leads to increased retention and job satisfaction.”

Busenhart said the School of Nursing is also partnering with the KU Center for Telemedicine and Telehealth to prepare the fellows to provide telehealth services. The U.S. Department of Health and Human Services and HRSA have identified telehealth as a priority area for funding and health workforce development. Other partners include KU Medical Center’s Rural Health Education & Services, the Sunflower Health Network, and the Community Care Network of Kansas.

Busenhart said that throughout the program, the KU School of Nursing and its partners will continue to evaluate the progress of the fellows to see if what they are doing is working.

“It is critical that we determine whether we are meeting the needs of Kansas and our new advanced practice providers,” Busenhart said. “But most importantly, we want to help improve patient outcomes in the communities in which we prepare these fellows.”

KU School of Nursing

University of Kansas Medical Center
3901 Rainbow Boulevard
Kansas City, KS 66160