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The Role of the Family Nurse Practitioner in Underserved Communities

by Carson-Newman … on October 5, 2020
A nurse working with a patient in an underserved area

America faces a growing need for nurse practitioners who can fill primary care roles. The U.S. Bureau of Labor Statistics (BLS) projects a 46% growth in nurse practitioner roles by 2031. The greatest area of demand will come from underserved communities across the country.

The role of family nurse practitioners in these areas goes beyond primary care. They strengthen their communities by promoting healthier lives and advocating for better services. Aspiring nurse practitioners should understand demographic and professional trends as they consider practicing in communities with limited health services.

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Meeting the Needs of Underserved Communities

The phrase "underserved communities" is used by state and federal officials in assessing public health challenges. The U.S. Department of Health & Human Services (HHS) notes that the following groups are considered underserved due to historical inequities:

  • African American, American Indian, and Latino populations
  • Individuals with disabilities
  • Refugees
  • Uninsured and underinsured young adults

These groups often live in Health Professional Shortage Areas (HPSAs) designated by the Health Resources & Services Administration (HRSA). HPSAs are geographical areas or populations with insufficient access to primary care, dental, and mental health providers. HRSA estimated that 94,782,800 people lived in HPSAs in 2021 with 16,477 practitioners needed to remove designations.

Rural areas from Alaska to Tennessee are heavily represented in HPSA designations. HRSA found that 65.4% of HPSAs were non-metro counties with populations of 35 people per square mile. A new generation of family nurse practitioners is needed to help those living outside of large cities.

Impacts of HPSAs on Underserved Populations

Family nurse practitioners working in underserved rural and urban areas buoy struggling communities. They provide long-term guidance for patients who previously drove long hours or spent days away from home in search of care. One of the most important roles of nurse practitioners is countering the harmful impacts of HPSAs.

A 2020 report by the U.S. House Committee on Ways and Mean highlighted how primary care shortages wreak havoc on communities:

"Residents of these communities also cope with a higher burden of disease and lower life expectancy, being more likely to die prematurely from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke than individuals living in areas with greater access to health resources."

FNPs act as portals to the latest advances in medicine for patients with preventable or early-stage diseases. Their advanced education can facilitate solutions that counter social determinants like poverty. Prior experiences as registered nurses provide valuable insights on how to confront the full spectrum of health issues.

Addressing America's Primary Care Gap

HPSA designations are likely to stay steady or grow due to a continued shortage of primary care physicians. The Association of American Medical Colleges (AAMC) projects a shortage of up to 124,000 physicians by 2034. This estimate includes a shortage of up to 48,000 primary care physicians.

The imbalance between health care demands and physician supply is primarily caused by an aging population. Older patients require more services and attention than their younger counterparts. The Federation of State Medical Boards (FSMB) also found that a majority (52.5%) of physicians were aged 50 and older.

Another cause of the primary care gap is the increasing shift of physicians toward other concentrations. The AAMC found that only 37.8% of active physicians were engaged in primary care areas like internal medicine, pediatrics, and family medicine. An uptick in new physicians may not fill the gap given this trend.

Regulatory Environment for FNP Practices

A 2020 survey by the American Association of Nurse Practitioners (AANP) shows how nurse practitioners are well-positioned for primary care roles. Eighty-seven percent of respondents specialized in primary care fields including 65.3% in family practice. This trend means nurse practitioners are prepared to serve underserved communities.

The role of family nurse practitioners varies slightly based on where they live. Twenty-six states, the District of Columbia, and two territories authorize full-practice authority for nurse practitioners. This authority allows nurse practitioners to evaluate, diagnose, and treat patients without cooperative agreements or physician supervision.

Family nurse practitioners can still address the primary care gap in states with more limited authority. Medical practices and hospitals in underserved communities expand their patient roster by employing nurse practitioners. Patients of all ages can visit nurse practitioners for preventive care rather than relying on emergency services.

Serving Underserved Communities as an FNP

Researchers found that nurse practitioners were 25.2% of primary care providers in rural areas in 2016. This figure represented a significant growth from the 17.6% share identified in 2008. The role of family nurse practitioners in underserved rural communities has grown for the following reasons.

Job Satisfaction

Family nurse practitioners can magnify their impacts on rural patients in ways that are difficult to achieve in cities. A 2017 study in Medical Care Research and Review determined that rural nurse practitioners had greater autonomy than their urban counterparts. This conclusion stems from the following trends:

  • 85.2% in isolated small rural areas had DEA numbers (74.2% for urban areas)
  • 79.2% had their own patient panel (55.6%)
  • 25.3% had hospital admitting privileges (14%)

These factors create fulfilling professional experiences for nurse practitioners in underserved communities. This study found that 96.2% of nurse practitioners in isolated small rural areas were satisfied or very satisfied with their work. Professional satisfaction comes from turning advanced training and education into healthier outcomes for overlooked patients.

Incentives for Rural Practitioners and Clinics

The ongoing demand for rural nurse practitioners has led to the creation of state and federal incentive programs. South Dakota's Recruitment Assistance Program is one of many state-level programs responding to the primary care gap. Licensed nurse practitioners working at qualifying rural practices receive state incentive payments in exchange for three years of practice.

The HRSA expands opportunities for family nurse practitioners in rural areas through incentives to public and private care providers. For example, the Advanced Nursing Education - Nurse Practitioner Residency (ANE-NPR) assists with funding one-year rural residencies at community clinics. A combination of incentives for practitioners and improved funding for clinics begins to address rural provider shortages.

Preparing for FNP Roles at Carson-Newman University

Registered nurses take the next step in helping underserved communities with Carson-Newman's MSN-FNP program. This degree accommodates the personal and professional lives of students with completely online coursework. A three-day, on-campus residency builds camaraderie among future FNPs.

The University works with FNP students to identify clinical placement opportunities in their communities. MSN-FNP courses are taught by active nurse practitioners who can speak to the needs of underserved populations. The 46-credit curriculum and placement experiences build advanced skills in areas like:

  • Advanced Health Assessment
  • Advanced Pathophysiology
  • Advanced Pharmacology

Carson-Newman offers a valued-centered private school education without typical private school costs. Available grants, scholarships, and loans reduce the program's $29,900 tuition. The University demonstrates its commitment to the value of prospective students by not charging application fees.

Contact an enrollment advisor today to learn how we can prepare you for a role as an FNP.

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