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

July 23, 2019 By David Tenenbaum

Sarah Smith was trained at Monroe Clinic while earning her doctorate in nursing practice at the School of Nursing at UW–Madison. “I liked the patient population,” she says. “They are down-to-earth, good people who really listen to what you are saying.” Photo by Alexander André

As rural regions of Wisconsin cry out for better health care – and more of it – a partnership between the Monroe Clinic-SSM Health and 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 placement in, say, a small city, can influence their later choice of employment.

“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 really 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.”

And if the challenge is great enough, if teamwork on the job and community spirit in town are sufficient, the clinic can count on a steady influx of highly educated doctors of nursing practice, who appreciate the small-city atmosphere.

Sarah Smith, now an adult-geriatric primary care nurse practitioner at the central clinic in Monroe, 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 really collaborative environment, working together as team.”

Even before Smith attained her DNP in 2018, she appreciated the challenge of rural work. “It was a very small rural clinic, and I got to see a lot of different issues, which is what interested me in rural work in general and in 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 been giving experience to UW–Madison DNP students, three have returned to work there as nurse practitioners.

Photo: Claire Johnson

“In a rural community, you get to know colleagues in all the disciplines,” says Claire Johnson, who holds a doctorate in nursing practice from UW–Madison. “Everybody works together for the good of our patients.” Photo by Alexander André

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 who have 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.”

A second draw was a return to the kind of small town where Johnson grew up, she says. “I missed being in a small community. I feel like when I am contributing more; that I have 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 masters in nursing degree with one year of experience. The coursework can be taken via a combined in-person, 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 the application of 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 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.”

Photo: Mike Sanders leans on a desk and drinks coffee.

Mike Sanders, CEO of Monroe Clinic-SSM Health, says, “As nurse practitioners and doctorates in nursing practice became a bigger part of the workforce, we have looked at this as an opportunity to provide a training location.” Photo courtesy Monroe Clinic

To Sanders, the collaboration with UW–Madison is a creative solution with deep roots.  “Monroe Clinic has had a long tradition of  involvement in medical training that  goes back to the 1930s,” he says. “It’s part of our culture, and it goes back to our founding physicians.”

Guiding students takes effort, and the clinic is not paid for the service, but the relationship offers a big payoff, says Sanders. “We give our people time to do this, and promote it as something that has value. Our goal is to have a top team here, and one of our fundamental strategies is to create an organizational environment that helps us recruit and retain top talent. That involves teaching and precepting, and celebrating those people who make their own life a little more hectic by taking on students. We think it makes their job more appealing, and they become more engaged in their work. It’s shortsighted to look at the opportunity to offer a preceptorship and say, ‘It will take more time. We can’t do it. Sorry.’”