Purpose

The Advanced Nursing Education Workforce (ANEW) aims to increase the number of primary care nurse practitioners and certified nurse midwives trained and prepared to provide primary care services, mental health and substance use disorder care, and maternal health care. It supports the training and graduation of advanced practice registered nursing (APRN) students in these disciplines. Students are provided a scholarship that supports their tuition and educational expenses, builds academic-clinical partnerships to facilitate clinical training, and continues to develop and sustain clinical faculty and preceptors as needed. The focus is clinical training of APRN students to practice in underserved and rural communities.

Goals

• Increase the number of nurse practitioners (NPs) and certified nurse midwives (CNMs) trained to serve rural, urban, and tribal underserved populations.
• Increase the diversity of the nursing workforce to better address the needs of the populations they serve by recruiting and supporting students and faculty, including those from diverse populations such as students and faculty from disadvantaged backgrounds and underrepresented minorities in the nursing profession.
• Build/expand academic-clinical partnerships to create experiential learning opportunities that prepare students to efficiently address health equity and Social Determinants of Health (SDOH) for rural, urban, and tribal underserved populations.

Background

The demand for primary care services has increased primarily due to a growing aging population.¹ HRSA's National Center for Health Workforce Analysis (NCHWA) projects the demand for primary care professionals, including physicians, nurse practitioners, and physician assistants practicing in primary care specialties, will increase 16 percent between 2020 and 2035.² There is also a projected shortage of 35,260 full-time equivalent (FTE) primary care physicians in 2035.

In addition to primary care, there is an increasing demand for behavioral health and maternal health providers. According to NCHWA, a shortage of 14,260 FTE adult psychiatrists is projected in 2035.²  Currently, the nationwide shortage of obstetricians-gynecologists (OB/GYNs) is projected to be 5,790 by 2035.² APRNs are anticipated to help meet this growing need for primary care, behavioral health, and maternal health services, and can address this gap because they are often the primary care providers at the forefront of providing preventive care services to the public. However, the supply of APRNs is affected by nursing school faculty and clinical preceptor shortages, which threaten the training of needed APRNs.³ 

Improving access to primary care providers, like APRNs, is especially important in rural and underserved areas. APRNs are well-positioned to improve health equity, especially for patients and families in rural and underserved communities with widespread health inequities.⁴  A diverse nursing workforce is a high priority for addressing the nursing shortage, meeting the cultural needs of an increasingly diverse population, and achieving health equity in the US.⁵ The current healthcare workforce does not reflect the nation's diversity; people of color represent more than 25 percent of the total population but only 15.8 percent of APRNs.⁶ The National Nursing Workforce Study revealed that in 2021, only 12.6 percent of APRNs were male, and only 7 percent were black.⁶ Nurses with diverse backgrounds may be more sensitive to the issues of inequities and are more likely to work in underserved areas, providing health care to those who experience health disparities.⁷ 

¹ Workforce Analysis. 2016. National and Regional Projections of Supply and Demand for Primary Care Practitioners: 2013-2025. Rockville, Maryland.

² Workforce Projections. (Accessed January 2023). Data.hrsa.gov. https://data.hrsa.gov/topics/health-workforce/workforce-projections  

⁴ Smith, G. R. (2007). Health Disparities: What Can Nursing Do? Policy, Politics, & Nursing Practice, 8(4), 285–291.

https://doi.org/10.1177/1527154408314600  

⁵ American Association of Colleges of Nursing. (2020). Fact Sheet: Enhancing Diversity in the Nursing Workforce. Washington, DC. https://www.aacnnursing.org/Portals/42/News/Factsheets/Enhancing-Diversity-Factsheet.pdf  

⁶ Smiley, R. A., Ruttinger, C., Oliveira, C. M., Hudson, L. R., Allgeyer, R., Reneau, K. A., Silvestre, J. H., & Alexander, M. (2021). The 2020 National Nursing Workforce Survey.Journal of Nursing Regulation, 12(1),S1–S96. https://doi.org/10.1016/S2155-8256(21)00027-2  

⁷ How Nurses Can Help Address the Health Disparities Problem. (n.d.). Eastern Michigan University Online. Retrieved June 16, 2022, from https://online.emich.edu/articles/rnbsn/the-health-disparities-

problem.aspx#:~:text=Workplace%20Diversity%3A%20A%20diverse%20nursing%20workforce    

Background

The Transformative Lifelong Learning Model guides IMPACT implementation. The Institute of Medicine Committee on Educating Health Professionals to Address the Social Determinants describes the model as a framework that supports health professionals' understanding and need to address social determinants of health in rural, border, and medically underserved communities. The core components of transformative learning occurring in the educational domain of this model include experiential learning, collaborative learning, integrated curriculum, and continuing professional development. The components of transformative learning will be experienced within the longitudinal clinical immersions in the rural, border, and medically underserved community clinical sites, contributing to connectivity and practice preparedness.

This immersion approach embodies the belief, supported by evidence, that community-driven education is vital to developing providers who will stay and work in rural and underserved communities. Community immersion is a type of service learning. With prolonged clinical training, students become members of the health team and active contributors to health care and gain clinical confidence embedded in a local context. Active community participation provides social support for students and contributes to the student's understanding of the local social determinants of health. The student becomes part of the community. Although focused primarily on physicians, the research has shown that the most significant factors associated with going into rural practice are having a rural background, positive clinical and educational experiences in a rural setting, and targeted postgraduate medical education.

Project IMPACT

Provides immersive 12-month clinical training rotations for diverse cohorts of FNP, PMHNP, and CNM students (19 per year) that support workforce development and align with the mission of UACON healthcare partners that provide culturally competent care.

Each IMPACT partner will provide local contextual learning opportunities for ANEW trainees to learn about the people and their communities. This immersive community clinical practice immersion experience allows the ANEW trainee to 1) learn more about the community, 2) immerse themselves in the culture, 3) learn about social issues that the community experiences, and 4) gain skills to respond to the health challenges experienced by individuals and communities within the local context. The ANEW trainee will be given opportunities to confront fundamental social determinants of health situations to understand better their influence on primary, mental, and maternal healthcare.

Each ANEW trainee must complete a one-year, three-semester clinical immersion experience with an IMPACT partner. ANEW trainees will engage in rural telehealth education, completing three courses required for the UACON Rural Telehealth Certificate program. Each student will commit to working in a border, rural, and underserved medically underserved community for at least one year after graduation.

The clinical partners for this project serve rural, border, and medically underserved communities with a team-based approach using an integrated healthcare approach with expert medical providers. As described in Benner's From Novice to Expert Theory, expert practitioners embody the integration of practical knowledge with a theoretical understanding of the process to achieve excellence in healthcare. The challenge for expert nurse educators and preceptors is articulating expert primary care practice to novice or advanced beginner students in the clinical environment. IMPACT aims to facilitate growth in novice FNPs and PMHNPs as they prepare to become tomorrow's expert primary care providers in rural, border, and medically underserved areas.

Meet our wonderful team of students here!

• Chiricahua Community Health Center (CCHCI)
• Desert Senita Health Center
• El Rio Health
• Mariposa Community Health Center
• MHC Healthcare (MHC)
• Arizona Maternity and Women's Clinic
• United Community Health Center (UCHC)

The College of Nursing is generously supported by Designated Campus Colleagues (DCCs) who contribute their time, services, and expertise to help the College accomplish its mission. Current DCCs serve the College as clinical preceptors, guest lecturers, research collaborators, and vendor partners. DCCs may be eligible for UA privileges by virtue of their relationship with the College. These include obtaining a CatCard, access to UA Libraries, a UA email address, Campus Recreation membership options, key/card access to UA buildings. For more details about DCC benefits, Click Here.

If you are interested in becoming a DCC affiliated with the College of Nursing and are committed to supporting our mission, please submit an application using the following link: DCC Application https://form.jotform.com/211025861817049.

Preceptor Toolkit - https://www.nursing.arizona.edu/resources/preceptor-toolkit

All DNP program FNP, PMHNP, and Certificate FNP, PMHNP students who anticipate completing clinical training in 2025 are encouraged to apply.

Yes, you can apply if you have other educational funding.

There are no repayment requirements associated with the ANEW funding.

Students are assigned to one of the ANEW clinical partners listed on the ANEW webpage. The ANEW team collaborates with the students to align clinical placements. The ANEW clinical partners are primarily located in southern Arizona.

You must complete NURS 638 Conceptual Foundations for Rural Health (Spring Semester, 1 unit) and NURS 773 Rural Health Systems (Summer Semester, 3 Units). See the Rural Health Professions Program web page for details.

• ANEW Project Manager – Valerie Kogut at vkogut@arizona.edu
• ANEW Project Director – Allen Prettyman at apretty@arizona.edu