Nurses take on expanded roles to provide access to health care in rural, underserved areas

Jul 4 2018

To help address access to health care for rural and underserved areas, registered nurses can take on expanded roles in primary care delivery.

"Nurses can practice to the full scope of the RN license and expand their scope of influence within the community-based primary care team," said South Dakota State University Associate Nursing Professor Heidi Mennenga. She pointed to care management, such as the hospital-to-home transition or management of chronic health conditions, and management of warfarin, a prescription medication designed to prevent blood clots, as examples.

However, many registered nurses have not been fulfilling these roles which are within the scope of their licensing simply because they have not historically done so.

Mennenga will lead a nursing team that will train senior nursing students and practicing RNs to expand their roles in the primary care setting through a four-year, nearly $2.8 million grant from U.S. Health Resources and Services Administration (HRSA).

According to the 2011-2015 South Dakota Primary Care Needs Assessment, 48 of the 66 counties in the state are designated by HRSA as medically underserved areas/populations, meaning they have too few primary care providers, high infant mortality, high poverty or high elderly populations.

One of the goals of the grant project, IMPACT-RNS-;Impacting Models of Practice and Clinical Training for Registered Nurses and Students, is to prepare 1,032 nursing students and at least 260 practicing RNs to function in these expanded roles.

Essentially, RNs will be doing some of the work that medical doctors, physician assistants and nurse practitioners are currently doing. The role that RNs can assume will be out of their ordinary practice, but fully within the scope of their RN license, according to Mennenga, whose expertise is in nursing education, curriculum development and rural nursing.

"This will mean rearranging how the other members of the health-care team function," she explained. It may also require a change in mindset regarding what nurses should be doing. Ultimately, Mennenga noted, this may aid in improving patient care and outcomes.

Developing curriculum to train students

The first year will involve capacity building, according to Mennenga. By the second year, the curriculum will be in place to begin training nursing students.

In addition to classroom instruction and laboratory simulations, a select group of nursing students will receive 150 hours of clinical training at one of 13 health-care facilities in South Dakota and Minnesota that serve diverse populations. "We currently use most of these clinical sites, just not in this capacity," Mennenga explained. "That's why it's important to have site leaders as part of the research team on each campus who are the contact point for those clinical facilities."

Other team members are Assistant Professor Alham Abuatiq; Assistant Professor Robin Brown; Assistant Dean Leann Horsley of the University Center site in Sioux Falls; Assistant Dean Linda Burdette in Aberdeen; Director of Academic Nursing Education Programs Christina Plemmons in Rapid City; and Brookings Clinical Site Coordinator Cassy Hultman. A full-time coordinator will also be hired to work on the project.

Identifying opioid addiction

Another major aspect of the project will be to train nurses regarding their role in addressing the opioid epidemic, including the assessment, intervention and evaluation of opioid use disorders. "Opioid use is a public health concern, not only in the nation but in the state as well," Mennenga said.

This will support the South Dakota Department of Health's Prescription Opioid Abuse Prevention Initiative, which is funded through a grant from the Centers for Disease Control and Prevention. The goal is to reduce hospitalizations and deaths due to opioid misuse and abuse and thereby reduce health-care costs.

The National Institute on Drug Abuse reported 42 opioid-related overdose deaths in South Dakota in 2016. Though that's far below the national average, the S.D. Division of Behavioral Health website states "enough opiate doses were prescribed to South Dakotans in 2015 to medicate every adult in the state for 19 straight days."

Health Systems Development and Regulation Division Director Tom Martinec, who chairs the opioid initiative advisory committee, will serve as a resource for the SDSU team developing the opioid content. The professional development training related to opioid use will be delivered online so it is accessible to practicing nurses at the participating facilities.

"By year four, we want to be able to have it more widely available to share with facilities across the state, not just those working with us during the grant project," Mennenga said. Furthermore, she noted, "We will have lots of ways to evaluate the entire curriculum and training and will then make changes based on detailed program objectives."

This program will help strength the role that RNs play in primary care while addressing opioid addiction and, in the long run, increasing access to health care among rural, underserved populations.