Nurse Practitioners in Rural Areas: Working as an NP in Rural America

It’s no coincidence Nicole Walters became a rural NP. She grew up in Central Appalachia and, as she describes, in a hollow of a mountain in a very rural, small coal-mining town in West Virginia.

“The closest hospital was an hour or two away with only a small clinic as a stop if you didn’t have emergent needs,” Walters says.

In communities like these, the town relies on one another for everything including basic healthcare, Walters points out. She describes rural life as finding ways to cope if you aren’t bleeding to death or actively dying. But Walters believes this is unacceptable.

“Once I became a nurse, I was determined I would live and serve in a community, so people didn’t have to make those hard choices,” Walters says. “People should have access to some form of quality healthcare on the most basic level.”

Today, Walters is a provider in a small town in southwestern Virginia. She is one of only a handful of providers within 1-2 hours driving for many of her clients. Walters serves a specialty population of women with perinatal and postpartum mental health who otherwise would not have this option for treatment. She uses telehealth services as a nurse practitioner mainly to communicate with her patients from three different states.

With the rise of telehealth services since the beginning of the COVID-19 pandemic, it has revolutionized healthcare by:

But providing quality care comes with its challenges.

A challenge faced by many community/rural health providers is the need to be knowledgeable about your community, Walters says.

“Every community has its own needs, and each has specific environmental and cultural aspects that greatly affect healthcare,” Walters points out. “When a provider shows an interest and knows these intricacies, the patient population can trust them.”

Additionally, challenges include the need for more:

Rural communities often suffer economically. Keeping costs to a minimum goes hand in hand with being innovative and using the resources you have on hand, Walters says.

Despite the challenges, Walters finds her work rewarding. She chooses to live out her healthcare needs exactly as she practices. She had home births with her children delivered by a midwife, and a local community provider meets her family’s healthcare needs.

Amy Wise was drawn to rural nursing because the role intrigued her. She loves being able to serve and provide quality healthcare to patients who may lack the ability to access care. Wise is a doctorally prepared certified pediatric nurse practitioner. For over six years, she has worked in an outpatient rural community health center in southwest Arizona on the border of Mexico.

“I see patients for well visits and sick visits, make referrals to specialists, and order laboratory and diagnostic testing for my patients based on their clinical needs,” Wise says.

As a rural NP, you may sometimes have to learn as you go. Because of the lack of resources, you may have to navigate areas in healthcare that would otherwise be referred to a specialist.

One major challenge Wise faces daily is the lack of necessary resources. One of those resources is access to specialists, especially in the pediatric population she serves.

“Many of the pediatric specialists are around three hours of drive time away,” Wise says. “Many of the families are unable to make this trip whether due to their legal status, transportation difficulties, or the overall impact it has on them financially.”

But rather than forcing her patients to become noncompliant or missing out on necessary care because of the lack of resources, Wise collaborates with specialists. Collaborating with specialists allows her to see what she can do to help meet those gaps in care however possible.

But if all options are exhausted, and the patient has no option but to see a specialist, Wise arranges transportation for the families.

“Many times, we are able to get transportation costs covered through Medicaid/Medicare services or through taxi services offering their services to meet community needs,” Wise says.

Josh Hamilton grew up in a rural area. The best way to provide care and support for the community he knew was to work as an NP. The healthcare system and the strengths and challenges of the community were well-known to him.

“My training gave me additional skills and authority to directly intervene to promote health, prevent illness, and to care for a variety of health issues as they emerged,” Hamilton says.

After providing primary care services for a few years, Hamilton saw more patients with mental health conditions. Access to mental health services in rural areas is challenging. Reasons include:

Mental health and mental disorders are higher in rural areas than in urban settings. Suicide rates are nearly double, and men between the ages of 20-30 and over the age of 85 are at greatest risk.

Hamilton decided to complete additional training and receive his credentials online as a psychiatric mental health nurse practitioner (PMHNP). This way he could address the mental health conditions in his community.

Distance or online education allows students in a rural community like Hamilton to earn graduate credentials with some flexibility.

“The only university in Wyoming is located 2.25 hours away from my hometown, so I was thrilled by the access to online coursework,” Hamilton says.

It also allowed him to earn his PMHNP into his program of study within eight months of his doctoral graduation.

Hamilton’s practice which provides telepsychiatry reaches individuals and families in remote and rural areas of Nevada, Minnesota, Arizona, Idaho, and Oregon. He meets with patients via telehealth to assess, diagnose, and treat various mental health conditions like:

“I provide medication management and counseling/psychotherapy services to patients and families of all ages in this setting,” Hamiltion says.