Tug of War: Solutions and Setbacks to the Rural Healthcare Dilemma
By G Hatfield
Rural health systems face a myriad of challenges that have widespread implications for rural communities, including underfunding and clinician shortages.
According to Dr. Valerie Fuller, president of the American Association of Nurse Practitioners (AANP), access to care and transportation are also barriers that stand in the way of patient care.
“I grew up in rural Maine, I certainly understand the challenges that rural patients face in accessing healthcare,” Fuller said. “Even getting to areas to receive care can be a challenge for people that live in more rural and underserved areas.”
CNOs in both rural and urban health systems need to strategize ways to get quality care to rural patient populations, and advocate for more investment in rural healthcare when opportunities such as the Rural Healthcare Transformation (RHT) Program arise.
What is the RHT Program?
The RHT Program is a $50 billion funding measure authorized by the One Big Beautiful Bill Act (OBBBA) with the goal of improving access to care, quality, and patient outcomes in rural communities. States who apply for the program must use the funds for the approved uses.
Fuller explained that the most encouraging thing for the AANP was that part of the program application included recognizing nurse practitioners (NP) and the importance that they bring to rural healthcare.
“We have 27 states, the District of Columbia, as well as two territories which have full practice authority, meaning the nurse practitioner can work to the full extent of their education, certification, and training,” Fuller said. “The states that applied for the [program] that have full practice authority for nurse practitioners [are] actually eligible for higher amounts of those [funds].”
The benefits of full practice authority are numerous for nurses and patients and also for outcomes and ROI. According to Fuller, Arizona’s NP workforce more than doubled after the state passed full practice authority, and the state saw immense growth in rural areas. Nebraska also experienced a similar result.
“It’s notable that nurse practitioners are essential to rural healthcare,” Fuller said. “Information from the Medicare Payment Advisory Commission shows that 66% of rural Medicare patients receive their primary care from a nurse practitioner or PA.”
According to Fuller, the AANP is optimistic that the RHT Program will incentivize more states to enact full practice authority for NPs.
“Nurse practitioners are not filling gaps temporarily,” Fuller said. “We are sustaining access to healthcare permanently in rural areas, and we are a foundation for more accessible healthcare, more equitable healthcare, and a sustainable primary healthcare system in rural areas.”
Implications and future challenges
The RHT Program will likely encourage more people to enter the nursing profession, Fuller explained.
However, there are some obstacles that will stand in the way of the program reaching its full potential. The Department of Education’s proposed rule that eliminates the Grad PLUS program and excludes nursing from the definition of “professional degree” programs under new federal loan eligibility will have a detrimental impact on nursing, in both urban and rural environments, Fuller explained.
“What was proposed is very incongruent with how this administration and other administrations have been in terms of recognizing the care that nurse practitioners provide and that was championed by this administration in the RHT Program,” Fuller said.
The proposed rule also requires that nursing educators be master’s or doctorally prepared, which will throw an additional wrench into the nursing pipeline where there are already steep faculty shortages. The lack of faculty will mean more undergraduate nursing students getting turned away from nursing programs, which is alarming as more nurses and NPs approach retirement and nursing shortages continue, Fuller explained.
“We have to have a robust pipeline of nurse practitioners ready to step in and ready to meet the needs of patients in rural areas and within our healthcare system,” Fuller said. “Hampering a student’s ability to finance their education is going to weaken the pipeline and our nation and our healthcare system simply can’t afford that.”
“It’s very important that people put in personal comments…so the Department of Education hears the concerns that the nursing community has,” Fuller said. “This is going to affect everyone, [and] it’s going to be devastating for nursing if this goes through as proposed.”
G Hatfield is the CNO editor for HealthLeaders.