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Advancing Nursing Education in a Rural State
Alabama is a rural state with all 67 counties containing federally designated medically underserved areas or medically underserved populations (MUA/MUP). In Alabama, as in many rural states, entry into nursing practice for the majority of nurses is at the LPN and/or Associate Degree (ADN) level. In 2011, in response to the 2010 Institute of Medicine: Future of Nursing Report recommendation to increase the proportion of BSN prepared RNs to 80% by 2020 the state of Alabama, expanding on previous partnerships, formed a taskforce to address seamless academic progression. The Advancing Education Taskforce includes nurse educators from 2 and 4 year institutions, and representatives from all types of healthcare agencies, including the Alabama Department of Public Health. In 2012 the Advancing Education Taskforce joined forces with the Alabama Health Action Coalition (AL-HAC). In 2013 AL-HAC was awarded a State Implementation Program (SIP) Grant from the Robert Wood Johnson Foundation (RWJF). The focus of the project was to improve Alabama’s RN workforce by increasing RN to BSN progression.
Paramount to accomplishing the goals set by the task force was fostering strong respectful relationships across educational programs. The Advancing Education Taskforce includes nurse educators from 2 and 4 year institutions, and representatives from all types of healthcare agencies, including the Alabama Department of Public Health. Some states have chosen to meet the 2020 goal by promoting BSN degrees as the entry to practice. Instead, the Alabama Advancing Education Taskforce is focusing on improving the nursing education system by creating seamless academic articulation from LPN through graduate education. Data indicates that the efforts in the state are working. Alabama saw a 13.8 % increase in enrollment in nursing mobility programs from 2012 to 2014. Board of Nursing data also indicates an increase in the proportion of RNs with a BSN degree or higher from 35% to 50%, from 2010 to 2014. The state was recently awarded a second round of SIP funding from the RWJF which will be used to continue to increase the educational level of the nursing workforce in the state.
Michelle Cheshire EdD, MSN, RN; Alabama Health Action Coalition
Future Directions for Rural Health Research
“Nearly one in five Americans live in rural communities totaling about 57 million people” (HRSA, 2015). It has also been noted that the lives of over 400 thousand rural residents are impacted by federally funded rural health programs (HRSA, 2015). The United States Department of Health and Human Services, Health Resources and Services Administration provides funding for community-based health programs, state hospitals, telehealth, & policy research aimed to increase access and improve quality of healthcare for those living in rural areas.
The Federal Office of Rural Health Policy (FORHP), operating within HRSA, provides funding each year through eight rural health research centers and three rural health policy analysis initiatives. These rural health centers focus on rural health research and policy. The following is a list of links to rural health centers funded September 2015 by the FORHP:
- Maine Rural Health Research Center Health Insurance and the Uninsured, Long-Term Services and Supports, Rural Health Clinics (RHCs), Mental Health, Substance Abuse
- North Carolina Rural Health Research and Policy Analysis Center Medicare, Medicaid and S-CHIP, Health Care Financing, Health Policy
- North Dakota and NORC Rural Health Reform Policy Research Center Health Policy, Health Services, Frontier health, Workforce
- RUPRI Center for Rural Health Policy Analysis Health Policy, Medicare, Medicare Advantage (MA), Health Insurance and the Uninsured, Health Services
- South Carolina Rural Health Research Center Health Disparities, Minority Health, Health Services
- Telehealth Focused Rural Health Research Center Telehealth, Health Information Technology, Technology
- University of Minnesota Rural Health Research Center Quality, Health Information Technology, Health Services
- WWAMI Rural Health Research Center Workforce, Health Services
(USDHHS, HRSA, 2015)
Identifying the future directions for rural health research might best begin with a reflection of current rural health research. Exploration and careful review of the funded research centers and their current areas of expertise can easily paint a picture of the most current state of rural health research. Below is a word cloud constructed from text from the FORHP website regarding current research funded to rural health centers by FORHP. This image provides a quick overview of what is currently being done in rural health research.
For those interested in the future of rural health research a closer review of the currently funded projects at the FORHP website can draw an even clearer picture of what is being done in rural health research today. From this review, researchers can determine what may be needed next for rural research for the future.
US Department of Health and Human Services (USDHHS) (2015). Health Resources & Services
Administration (HRSA). Federal Office of Rural Health Policy (FORHP). Retrieved from: http://www.hrsa.gov/rural health
Ann Graves, PhD, RN; Associate Professor, University of Alabama
As I See It: Infusing the Human Factor at the Bedside for Rural Health Care Consumers
The role of the Clinical Nurse Leader (CNL) is ideally suited to lead and support nurse generalists who are working in rural settings. Rural healthcare consumers are looking for nurses to be educationally prepared, compassionate professionals who have an understanding of the challenges and opportunities of rural life (Sivamalai, 2008). These attributes require advanced education for nurse generalists and a desire to emerge as a change agent for individuals in need of care in acute, chronic, and community-based settings.
The CNL is a masters-prepared clinician certified by the Commission on Nurse Certification. Graduate education is mandated because the CNL must bring an advanced level of clinical skills and synthesis of didactic knowledge to the point of care and serve as a leader for the nursing team. In practice, the CNL oversees the plan of care from admission to discharge and integration of care for a distinct group of patients. This master's degree-prepared clinician puts evidence-based practice into action to ensure that patients benefit from the latest innovations in care delivery. The CNL evaluates patient outcomes, assesses cohort risk, and has the decision-making authority to adapt care plans when necessary. The flexibility of this role makes it ideally suited to rural healthcare environments. The next step should be for nurse leaders to seek funding for pilot research studies to investigate the patient care outcomes and nursing satisfaction in rural settings that support the role of the CNL.
AACN (2015). What is CNL certification? Retrieved from: http://www.aacn.nche.edu/cnl/cnc/what-is-cnl-certification
Simamalai, S. (2008). Desired attributes of new graduate nurses as identified by the rural community. Rural and Remote Health 8(938), Retrieved from:http://wwwrrhs.org.au
Judith M. Paré, Ph.D., RN, By-Laws Committee Chairperson
Online Journal of Rural Nursing and Health Care
Ranking of Online Journal of Rural Nursing and Health Care
The Online Journal of Rural Nursing and Health Care is the official organ of the Rural Nurse Organization (RNO)
An analysis of free scholarly electronic journals (EJ) conducted by Isfandyari-Moghaddam, Danesh and Hadji-Azizi (2015) identified the Online Journal of Rural Nursing and Health Care as one of the top-ranked free EJs in medical sciences.
The top-ranked free EJs in the medical sciences according to Isfandyari-Moghaddam et al. (2015) are:
Health: New South Wales Public Health Bulletin, PLoS Biology and Environmental
Health Perspectives – National Institute of Environmental Health Sciences.
Nursing: Online Journal of Rural Nursing and Health Care and Online Journal of
Dentistry: BMC Oral Health and Brazilian Oral Research.
Medicine: Brazilian Journal of Medical and Biological Research, Clinics and Sao
Paulo Medical Journal.
Isfandyari-Moghaddam, A., Danesh, F., & Hadji-Azizi , N. (2015). Webometrics as a method for identifying the most accredited free electronic journals. The Electronic Library, 33(1) 75 – 87. http://dx.doi.org/10.1108/EL-10-2012-0141___
Pamela Stewart Fahs, Editor-in-Chief
Outstanding Performance of Rural Nurses:
The Anna Mae Ericksen RNO AwardCongratulations! Dr. Angeline Bushy, PhD, RN, FAAN
The Rural Nurse Organization (RNO) is an international organization formed for the purposes of recognizing, promoting and maintaining the specialty of Rural Nursing practice. As such, the RNO wishes to recognize leadership in the specialty of Rural Nursing and the provision of health care in rural populations. This leadership may have been exhibited in one or more of multiple roles, not limited to practitioner, educator, or researcher. The recipient of this award will have provided a voice for rural nursing in nursing or health care agencies, professional organizations, academia, community and/or government. Typically, the winner of this award will have influenced rural nursing beyond the local level with work that is recognized as supportive of the specialty of rural nursing and / or health care for rural populations. The award winner’s work will be recognized as having long lasting influence in rural nursing and health care. This award may be based on recognition of a single achievement or a trajectory of work in the area of rural nursing.
Catherine V. Belden, RN, DHSc, MSN, RNO Education Committee Chair
Pam Stewart Fahs, RNO President
Springer Publishing Company is pleased to announce the March 2013 publication of:
Rural Nursing, Fourth
Concepts, Theory, and Practice
Winters, Charlene A.
Pub. Date: 03/28/2013 – ISBN-13: 9780826170859 – 520 pp., Softcover – The fourth edition of the only text to focus on nursing concepts, theory, and practice in rural settings continues to provide comprehensive and evidence-based information to nursing educators, researchers, and policy-makers. The book presents a wealth of new information that expands upon the rural nursing theory base and greatly adds to our understanding of current rural health care issues. Authored by contributors from the United States, Canada, and Australia, the text examines rural health issues from a national and international perspective.