Residency program helps rural clinics, like Park Rapids and Walker, retain nurse practitioners

Kelsey Stay works primarily at the Walker Clinic in Essentia, but also sees walk-in patients at Park Rapids, mostly on weekends. She started work in April after graduating in May 2020 from the College of St. Scholastica in Duluth with a Doctorate in Nursing Practice.

As of October, Stay has also been one of four nurse practitioners (NPs) in the Essentia Health System participating in a 12-month residency program, in partnership with North Dakota State University.

For Essentia, this is an extension of the healthcare system’s transition to practice program, which helps new NPs and physician assistants move from the classroom to clinical practice.

“As a new graduate, I feel like it’s a very difficult process for a nurse practitioner to go from school to being like, ‘Alright, here are your patients,’ Stay said. “Most nurse practitioners start off as nurses, and you’re used to having almost a menu of – ‘Okay, your patient is in pain. Here are your drug choices; here are your dosage choices. Now, as a nurse practitioner, you prepare this menu.

In response to this, Stay said, “Essentia has been incredibly supportive with this integration system.”

It includes regular visits with an experienced nurse practitioner in Fargo, doctors from the Walker Clinic and his own in-house mentor.

“I’ve never felt so supported, jumping into a new role before. It’s wonderful, ”Stay said. “You can speak to anyone with questions. Everyone is ready to help.

Focus on the rural

Added to this is the residency program, funded by the NDSU School of Nursing, which three years ago received an advanced nursing nurse practitioner residency grant of $ 1.575 million over four years through of the Health Resources Services Administration.

Dr Mykell Barnacle, residency program director and DNP faculty member at the NDSU School of Nursing, said it doesn’t matter whether residents are NDSU graduates; in fact, none of this year’s NP residents are.

Barnacle said he initially decided to partner exclusively with the Essentia health system as part of the school’s focus on rural health care.

“We wanted to work with a specific organization to make the opportunities more transparent,” said Dr. Dean Gross, residency program coordinator and NP program director at NDSU. “It also eliminated us from the selection process”, meaning that Essentia chooses the candidates.

Over the past decade, Gross and Barnacle have worked to change the mission of the NDSU School of Nursing to focus on rural practice.

“We found that unless a person was born in a rural community and had family there, they didn’t really go back unless they had been exposed to that rural community,” Gross said. “We worked together to encourage our nurse practitioners to travel to rural areas and complete their clinical placements there.

More support needed

Barnacle said the school recognizes the complexity of the NP’s role and the difficulty of transitioning to a rural area, where a new graduate may not have as many supports to lean on as in an urban clinic.

“It’s a great transition anywhere,” she said. “There is certainly a lot of responsibility with the transition from the role of student to provider. “

This is especially true in rural areas, Barnacle noted. “Typically, rural providers have a very broad scope of practice, so they deal with people who might be referred to a specialist in a more urban area. They do a lot more procedures than people in urban areas.

For example, rural patients may not want to travel two hours to have a nail removed. “It’s really becoming a customer service issue,” Barnacle said. So instead of sending them to a specialist, rural PIs need to develop a wider range of skills.

As part of the residency program, the NDSU offers training, such as a two-day procedural workshop at Baxter, where “they do everything from splinting to advanced suturing techniques and, as I said, said, at nail removal, ”Barnacle said.

They also have an in-person emergency preparedness simulation and other hands-on day-long activities, as well as virtual meetings and webinars. The grant also covers the travel costs of residents to clinical placements in specialized practices.

For example, Stay has a rotation in the radiology department in December in Detroit Lakes and looks forward to a rotation in pediatrics in January at the Park Rapids Clinic.

“Last month there was educational training on sleep medicine,” she said. “We covered topics on lab values ​​and lung function testing. “

Kelsey Stay, a new family nurse practitioner, registers on her computer on November 29, 2021 at the Essentia Health-Walker clinic.  Also serving part-time at the Park Rapids Clinic, Stay participates in a collaborative residency program with North Dakota State University.  Robin Fish / Company Park Rapids

Kelsey Stay, a new family nurse practitioner, registers on her computer on November 29, 2021 at the Essentia Health-Walker clinic. Also serving part-time at the Park Rapids Clinic, Stay participates in a collaborative residency program with North Dakota State University. Robin Fish / Company Park Rapids

Improve the result

Although she just started her residency in October, Stay said it had already been great, allowing her to connect with the other three residents – two in Detroit Lakes and one in Hibbing – and have them bounce back ideas.

It also puts her in touch with suppliers of the Essentia system, in case she has any questions. “Just being able to choose the brains of people who work in specialties,” she said, allows her “as a family medicine provider to have a better understanding of those specialties. … I think it also helps to establish a good working relationship with these people.

“We have a huge health care system, but you feel a bit lonely, in a rural setting,” said Christie Erickson, NP and Director of the Transition to Practice program at Essentia. “Once you connect with all of these other people, you suddenly feel less alone. “

Prior to starting this onboarding program, Erickson said, Essentia had 18% annual PI turnover, but it has now fallen to around 5% – despite the higher stress level for healthcare providers. health due to the COVID-19 pandemic.

The numbers speak for themselves. In the first two years of the current grant, Gross said, “We had eight residents who completed the program, and all eight were retained in the rural clinics where they were hired… an incredible retention rate of 100%.

War of attrition

“The support that people need as health care providers, especially in our rural communities – I think this is needed more than ever,” Erickson said. “They regularly have difficult conversations with patients about health care in general, but with the pandemic…

Barnacle added that the stressors of the pandemic include the large number of patients to be treated, many of whom are ill or die. “I think it was emotionally draining,” she said.

Gross said some nurses may have left the profession during the pandemic due to the stress of double and triple shifts. However, this has opened up many opportunities for new nursing graduates.

“There is a perception, nationally, that there is a shortage of nurse practitioners in rural areas,” Gross said. “We haven’t felt this for the past two years due to COVID and institutions reducing the number of advanced practice providers. But Essentia is moving forward with many rural nurse practitioners in the very near future to address this issue. “

Measurable progress

The residency program helps new Essentia NPs feel competent and confident as they advance in their careers, Erickson said, showing them they have the support they and colleagues need. who to connect with.

Along with all the connections the programs make to help fill gaps in her clinical knowledge, it also connects her to a network of contacts who can provide even more resources, as well as three other residents who understand exactly what she is. crosses. It is “a wonderful network of support at all levels,” she said.

“We entered this question without knowing what the outcome would be,” Gross said. “But after the first two years, we’ve seen significant improvement as we’ve taken care to get information from attendees, residents, and their managers, about what they need to be successful there.”

He said their comments even led to improvements in their school’s NP curriculum.

“It has been a transformation for us,” Gross said. “We are able to implement more rural expectations, which translates well in any primary care environment. “

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