Caring for all of Wisconsin: Acute Care Nurse Practitioner program supports rural health care students

Ashley Wilson hadn't been in Fond du Lac, Wisconsin very long before finding out that the staffing levels at her hospital were a bit leaner than what she was used to.

"One of my co-workers told me that most people only move to Fond du Lac for love or for family," Wilson remembers.

In Wilson's case, it was both: she has family in Wisconsin and her boyfriend owns a house in the city. While Fond du Lac's population of 44,469 can hardly be classified as small, it's still much smaller than Baltimore, where Wilson had been working in the neurotrauma ICU at the city's R Adams Cowley Shock Trauma Center. She also did a stint on Johns Hopkins' epilepsy monitoring unit.

"There is such a huge need for nurse practitioners here in the Fox Valley, specifically in the field of neurology, which I hope to go into," Wilson says.

Marquette has launched a program to help nurses like Wilson - who practice outside of southeastern Wisconsin - still get the knowledge they need to better serve patients. The Adult-Gerontology Acute Care Nurse Practitioner Program (AGACNP), an advanced practice degree for nurses who want to specialize in acute elder care, is piloting a program that allows students from other areas of the state to participate remotely. Marquette helps these students find preceptors in their area to complete clinical requirements.

The program allows nurses from around Wisconsin to stay in practice while pursuing their degree, which both maintains a source of income for the nurse and keeps a skilled health care practitioner in the community. Dr. Debra Casper, clinical instructor and program director of the AGACNP, says the idea for accommodating remote students outside of the Milwaukee metro came about during the COVID-19 pandemic.

"Throughout 2020, you had a lot of cases where patients had to be transferred from rural sites to urban healthcare organizations due to lack of resources, thus taxing the receiving systems." Casper says. "More recently, I'm hearing stories of people having to be transferred from smaller hospitals for routine procedures, such as central line insertion. If patients can receive the care they need in their home environment instead, everyone wins."

While the nationwide nursing shortage is negatively impacting all populations, its burdens are especially heavy on rural and elderly populations. The most recent data from the Rural Health Information Hub indicates that two-thirds of communities facing primary healthcare worker shortages are classified as rural. These communities also have a much higher percentage of patients who are age 65 and older than do suburban and urban areas, which means those patients will be utilizing healthcare more frequently.

Kelli Koch, another student in the AGACNP program, is familiar with the challenges of rural healthcare. Koch's family moved to Minocqua, Wisconsin, a picturesque lake town in the north-central part of the state, when she was 10 years old. While the area has a relatively high concentration of registered nurses, the nursing workforce in its county has an average age over 51 years old, one of the highest figures in the state.

Older folks deserve the best care and deserve to live out as many days as they possibly can with dignity and respect."

Over her eight years of travel nursing, Koch has worked in areas with care shortages and knows the challenges that await her hometown if the issue is not addressed.

"Being a nurse in a rural area means we often don't have access to specialists," Koch says. "We have to stabilize the patient, and then we may have to send them an hour or two away, even if it's down to Madison or Milwaukee."

"While patients receive the care they need when they're transferred, they are separated from their support system of friends, family and spiritual providers, which are just as important in the recovery process," Casper says. "If patients can receive the care they need in the home environment, everybody wins. So our team thought that we needed to focus on training people from those areas."

Marquette's support is especially valuable when it comes to finding preceptors. Many advanced practice programs ask students to find their own preceptors to complete the necessary 750 hours of supervised clinical practice to attain their certifications. Students in Marquette's programs are guaranteed preceptor placement, removing a critical barrier to success.

While portions of the program, such as skills labs and simulations, need to be done in Milwaukee, the flexibility to tackle large portions of the program remotely is a boon to learners like Wilson.

"I love the idea of a hybrid program because I can take my classes online, but then I'm still able to practice the hands-on skills I need in person," Wilson says.

Casper envisions growing the AGACNP program's rural presence to the point where six to eight students from outside southeastern Wisconsin are graduating in each cohort. It will be an important contribution to relieving the state's healthcare provider shortage.