Rural placements for nursing students help address rural health-care shortage

As rural regions of Wisconsin cry out for better health care – and more of it – a partnership between the Monroe Clinic-SSM Health and the University of Wisconsin–Madison School of Nursing offers one solution. The reason is simple: Students earning a doctorate of nursing practice (DNP) require several field placements or preceptorships, and a positive post in, say, a small city can influence their later choice of employment.

Rural placements for nursing students help address rural health-care shortage 1

“To help meet our goal of educating nurses for the entire state, the School of Nursing is emphasizing relationships like the one with Monroe,” says Pamela Ann McGranahan, director of the DNP program and associate clinical professor of nursing. “Some of our students respond to a well-run clinic that is large enough to offer a fairly intricate level of specialties and technology but not so large as to become anonymous.”

If the challenge is great enough, if teamwork on the job and community spirit in town is sufficient, the clinic can count on a steady influx of highly educated doctors of nursing practice who appreciate the small-city atmosphere. Now an adult-geriatric primary care nurse practitioner at the central clinic in Monroe, Sarah Smith served two rotations with the branch in Durand, Illinois.

“The nurse practitioner I worked with had a lot of independence in her practice. Other providers within the clinic were very supportive if she had a question. It was a collaborative environment, working together as a team.” Even before Smith attained her DNP in 2018, she appreciated the challenge of rural work. “It was a tiny rural clinic, and I got to see a lot of different issues, which is what interested me in rural work in general and Monroe Clinic in particular.”

Monroe Clinic operates 11 clinics in southwestern Wisconsin and nearby Illinois, with more than 85 physicians, over 200,000 annual patient visits, and 40 to 50 advanced practice practitioners, primarily nurses. In the four years that Monroe Clinic has given experience to UW–Madison DNP students, three have returned to work there as nurse practitioners.

Challenge and complexity influenced the career calculations of Claire Johnson, a psychiatric mental health nurse practitioner with a doctorate in nursing practice from UW–Madison. “I work across the lifespan with people with mental health conditions, schizophrenia, bipolar disease, anxiety,” she says. “We see a lot of complexity in a rural area, with trauma history and mental illness, just as you would in a city.”

She says a second draw was a return to the small town where Johnson grew up. “I missed being in a small community. I feel like when I am contributing more, I have a greater impact.”

The ability to attract new hires from a top nursing school does not surprise Monroe Clinic CEO Mike Sanders. “This relationship with the School of Nursing helps us recruit,” he says. “We hear from people that they did not know you could have a practice like this in a small community, with access to technology and specialties but with a small-town feel.”

The DNP at the School of Nursing is available to holders of a bachelor’s or master’s in nursing degree with one year of experience. The coursework can be taken via a combined in-person and online delivery. “The degree builds on the former masters-level nurse practitioner program, offering more clinical practice hours and a deeper dive into leadership and applying research to practice,” says McGranahan. “We all know medical science and technology are expanding and growing more complex.

Patient needs and expectations are likewise growing, and the Wisconsin population is aging, especially in rural areas.” The DNP is, in essence, a response to changing demands, McGranahan adds. “The UW-Madison DNP program prepares nurses to use advanced clinical expertise, advocacy and leadership skills, and understandings of research to assure that the practice is up to date, the system is working the way it should, and clinical outcomes are at their best.” Experience in rural hospitals and clinics turns out to be more challenging — and satisfying – than students expect, says McGranahan.

“People may think the scope is small and that they won’t see much high-acuity stuff, but people get hurt, sick, have a heart attack or stroke, and are hit by cars everywhere. And then there are farm accidents….” As a result, McGranahan says clinic staff – like the students rotating through – “get to see and do things that would be outside the scope in Madison, where you have medical students, residents, and specialists who are ready to take over.”

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