Newswise — With fewer primary care physicians in the nation’s countryside, rural healthcare in America is beginning to look a lot less like the standard doctor-patient interaction and much more like a roundtable conversation involving the patient, social workers, public health professionals, nurses, occupational and physical therapists, physician’s assistants, nurse practitioners and pharmacists.
In athletic parlance, to Cathy Phillips, it’s a little like a relay race.
“You do what you can, you run your part and you pass the baton, but you still keep a very close eye on what’s happening,” said Phillips, a psychiatric nurse practitioner in Hastings, Neb. “In rural areas, we see less delineation of roles, simply out of necessity. In rural communities, it’s so ingrained to work together, anyway. Everything is a lot less rigidly defined. Things need to get done and everyone pitches in. It’s not unheard of in small local facilities to see the director of nursing doing bedside care. Out here, you live the model more than anything else.”
As a nurse practitioner with bachelor’s and master’s degrees in nursing from Creighton University, Phillips often sees herself and her nurse practitioner colleagues as running anchor in that race.
Nurse practitioners are often the first line of healthcare for patients in rural America and, with the interdisciplinary approach evolving, nurses and nurse practitioners have seen and done a little (or a lot) of just about everything within their scopes of practice. According to the Nebraska Rural Health Advisory Commission, 65 counties in the state have primary care shortages, a statistic that has led to legislation passed this year to provide greater freedom of practice for nurse practitioners.
“There’s a major shortage of healthcare providers nationwide, generally,” Phillips said. “Changing the law for nurse practitioners is going to help immensely, because we’re not projected to improve provider numbers unless we do something. The need is huge.”
In psychiatry, where Phillips concentrates, the dearth widens and deepens. Eighty-eight of Nebraska’s 93 counties have behavioral health provider shortages, with substantial gaps in care for the elderly, a population Phillips said she has felt called to serve.
While operating out of the Behavioral Services Department of Mary Lanning Healthcare in Hastings, Phillips and her nurse practitioner colleagues regularly make circuit runs to smaller outlying communities like Red Cloud, Blue Hill, Fullerton, Harvard, Sutton, Fairmont, Geneva, York, Superior and Wood River as part of Mary Lanning’s Geriatric Outreach Program. In Minden, a 35-mile drive west of Hastings, the program has piloted a telehealth platform with a nursing home, a project which has already proved to be paying dividends.
“I came into telehealth with a few biases,” Phillips said. “I worried about not having that provider-to-patient contact, but we’ve seen that it really works about the same. Just being able to see a face and to have a chat really helps.”
In the hospital’s Behavioral Services Department, there is a comprehensive team of providers, including psychiatrists, psychologists, psychiatric nurses and neuropsychologists, but it’s the psychiatric nurse practitioners, Phillips said, who do the outreach diagnosis and medication management in the long-term care facility settings.
“It’s something I’ve always felt called to do,” she said. “We have issues with access to healthcare in rural Nebraska, and it becomes pretty pervasive in some pockets, including among our elderly population. Provider shortages exist in urban areas of Nebraska also. We feel blessed to be able to serve the population we do and to provide for a need that is certainly evident in south-central Nebraska.”
Working in an in-demand field combining geriatrics and psychiatry, Phillips said her skills are needed all over the country and she gets, on average, three to four recruiting inquiries on a weekly basis.
“Right now, I’m satisfied where I am,” she said. “I have a true heart for this kind of service. I want to bring more awareness to mental healthcare and push some of the important programs we’re working on now. We need more access to healthcare in rural Nebraska and it’s something to which I want to draw attention.”
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