NP Residency Programs Fill Rural Healthcare Primary Provider Gaps

Rural areas in the U.S. are suffering from a severe shortage of primary care providers.

According to statistics from Georgetown University’s Health Policy Institute, 20% of the U.S. population lives in rural areas. But less than 11% of America’s physicians are located near or practice in rural America. This shortage creates gaps in rural healthcare.

New Mexico has been hit particularly hard with this problem. A large number of the state’s residents live in rural areas, said Johanna K. Stiesmeyer, DNP, RN-BC, director of clinical education and professional development at Presbyterian Healthcare Services in Albuquerque, N.M.

According to a report by the New Mexico Department of Public Health, rural counties in New Mexico have the highest number of residents older than age 65 (26%) compared to mixed urban-rural counties (16.1%) in New Mexico. It’s also more than the national average of 15.6%.

“To help combat the primary care shortage in rural areas of New Mexico, Presbyterian Healthcare Services and the University of New Mexico (UNM) College of Nursing have partnered to expand access to primary healthcare providers in rural communities with the creation of a residency program for nurse practitioners,” Stiesmeyer said.

The NP residency program is funded by a $3.2 million grant awarded to Presbyterian by the U.S. Department of Health and Human Services, Health Resources and Services Administration.

“This is a first for NPs and rural communities and just what we need in New Mexico,” Stiesmeyer said.

About New Mexico’s NP residency programs

An NP residency program offers rural healthcare to a New Mexico patient.The grant funds the program for four years and officially began program planning in July 2019, Stiesmeyer said.

Years two, three and four involve the hiring of three cohorts of NP residents, she said.

Nine new NPs will be chosen each year for the one-year NP residency programs, which begin each July starting in 2020.

The residency program’s formal name is the Advanced Nursing Education Nurse Practitioner Residency Program, said Carolyn Montoya, PhD, RN, PCPNP-BC, associate dean of clinical affairs at UNM’s College of Nursing.

“The program has two tracks for the one-year residencies — family practice and nurse midwifery,” Montoya said. “Participants will complete their residencies at 10 multidisciplinary Presbyterian family medical clinics in six different counties in New Mexico.”

The NP residency programs are not exclusive to the UNM’s NP graduates, and not a requirement of the UNM, Montoya said.

“These APRN residencies are open to any graduate of an accredited NP or nurse midwifery program who has graduated within 18 months of the start date of the residency,” she said.

Interested new grad NPs who want to apply for a residency in this program must pass their certification boards and be licensed as an NP or nurse midwife in New Mexico. Those requirements must be met prior to starting the NP residency program, Montoya said.

“NP graduates who are accepted into this program will have the opportunity to be precepted by seasoned primary healthcare providers for one year,” she said. “They’ll complete their residencies in rural areas of New Mexico, thus affording them the opportunity to provide rural healthcare with the support of a preceptor and participate in a curriculum that includes advanced management of selected medical conditions.”

Healthcare challenges in rural New Mexico

Nurse practitioners in the state of New Mexico have full practice and prescriptive authority and have for many years, Montoya said.

“When NPs graduate from the University of New Mexico, they are fully prepared for practice,” she said. “This program does not repeat what students in our program have learned. These residencies address medically complex patients in addition to complex geriatric patients which New Mexico has a large population of.”

The hope is for the rural immersion experience to lead to more nurse practitioners and nurse midwives to remain in practice in rural New Mexico after their NP residency programs, Montoya said.

Various strategies for increasing the retention rates of NPs to remain in rural practice are being examined, Stiesmeyer said.

“These one-year residencies will provide NPs with a salary and benefits from Presbyterian Healthcare Services,” Stiesmeyer said. “Additionally, we’re looking for NPs who have a passion for caring for patients in rural communities as it takes special people to serve in rural areas. We want NPs who are most likely to achieve success working in the rural environment and wish to remain working in rural communities.”

Patients in rural communities face numerous social and health challenges, Montoya said. They typically have lower incomes, lower levels of health literacy and often deal with multiple and complex medical conditions.

“We’re thrilled that Presbyterian Healthcare Services chose UNM as their academic partner for this program to give us the opportunity to serve these rural communities,” Montoya said.

The decision to partner with UNM was easy because of the positive past experiences Presbyterian has had with the nursing school and Montoya, Stiesmeyer said.

“To be accepted for the HRSA grant is a wonderful compliment,” Stiesmeyer said. “It’s a great opportunity to share best nursing practices in the state of New Mexico.”