Rural American communities frequently struggle to provide adequate primary care services due to limited healthcare facilities and a shortage of qualified professionals. Advanced practice RNs (APRNs) are highly trained and skilled healthcare providers who can play a significant role in addressing this healthcare gap. One solution to this healthcare crisis involves aligning APRN state scope of practice laws with federal rural health clinic policies. The expansion of the scope and standards of APRN practice can improve access to care, increase healthcare efficiency, and contribute to better health outcomes for rural populations.
Current challenges in rural healthcare
Rural communities face challenges such as healthcare professional shortages, long travel distances to receive care, and limited access to specialty services. Additionally, federal rural health clinic policies are outdated and don’t consider state scope of practice laws. According to the Rural Health Clinic Code of Federal Regulations, APRNs are prohibited from serving as medical directors; physicians must hold these positions. This doesn’t align with states that have given APRNs full practice authority. In all states, APRN-owned practices must demonstrate that a physician serves as clinic director. This federal regulation impacts the decision to open a rural health clinic in areas experiencing access issues. These challenges lead to delayed care, health disparities, and decreased quality of life for rural residents.
Role of APRNs
APRNs receive extensive clinical training to diagnose acute and chronic illnesses, prescribe medications, and provide a wide range of healthcare services. They’re well-equipped to offer primary care, preventive services, and chronic disease management. Much of the literature demonstrates that APRNs provide quality healthcare to the communities they serve. Depending on state practice authority, APRNs can practice independently, owning and operating healthcare practices.
Aligning federal rural health clinic rules with state scope of practice laws has several benefits. This federal regulation change would allow APRNs to open independent practice and bring qualified professionals to rural communities. This alignment would fill the gap caused by physician shortages, ensuring that rural residents have timely access to care. APRNs can provide primary care services with a focus on prevention, decreasing morbidity and mortality from several disease processes. Additionally, APRNs can provide cost-effective care and increase patient satisfaction with healthcare.
Policy action recommendations
To increase access to health care in rural America, we must align federal rural health clinic regulation with state scope of practice laws. The Rural Health Clinic Burden Reduction Act introduced in the 118th Congress aims to modernize rural health clinic provisions and includes updating medical director requirements. Support of this bill will impact individual states’ ability to optimize care delivery, especially in rural communities. Updating these regulations also will reflect the capabilities of APRNs, ensuring that their education and training are recognized and utilized effectively. Aligning the state scope of practice requirements with federal rural health clinic requirements can significantly contribute to addressing healthcare disparities and improving the overall health of rural populations.
The National Association of Rural Health Clinics is actively working to reintroduce this provision, which was previously supported by the American Association of Nurse Practitioners and the American Academy of Physician Associates. By implementing policies that enable APRNs to practice to the full extent of their training, policymakers can enhance access to quality care, promote patient-centered healthcare delivery, and create a more robust and resilient rural healthcare system.
Denise Schentrup, DNP, APRN-BC, FAANP, CNE is a Clinical Associate Professor at University of Florida College of Nursing, Gainesville, Fla.
References
42 CFR Part 491 Subpart A—Rural Health Clinics: Conditions for Certification; and FQHCs https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-491/subpart-A
Callaghan T, Trujillo KL, Lockman A, Falia G. Rural healthcare access and quality. In: Ferdinand AO, Bolin JN, Callaghan T, Rochford HI, Lockman A, Johnson NY, eds. Rural Healthy People 2030. College Station, TX: Texas A&M University School of Public Health, Southwest Rural Health Research Center; 2023.
Kapu A. Patients are choosing nurse practitioners as their primary care provider in many communities across the US. J Nurs Adm. 2021;51(9):422-3. doi:10.1097/NNA.0000000000001040
Zwilling J, Fiandt K, Ahmed R. Comparison of rural and urban utilization of nurse practitioners in states with full practice authority. J Nurse Pract. 2021;17(4):386-93. doi:10.1016/j.nurpra.2020.12.033
