How to Train APPs to Thrive in a Rural Inpatient Programs

Over the last 15 years, the quantity and role of nurse practitioners and physician assistants—sometimes known as advanced practice providers—have both expanded considerably.

Projections suggest that advanced practice providers (APPs) will grow to 67.3% of the workforce between 2016 and 2030, and a recent study found that integrating them into clinical care and empowering top-of-license practice can have significant positive impact on care delivery, compensation models, and organizational culture. Similarly, a systematic review of studies evaluating APPs in emergency and critical care indicated that introducing APPs to the care team improves LOS, mortality, patient satisfaction, and costs.

Though APPs are incredible assets in many environments, they are arguably most necessary in rural areas where care deserts abound, and clinician recruitment is often more challenging. In this blog post, we’ll discuss why APPs are such a powerful addition to rural programs, and how to ensure your APPs are trained to thrive in rural settings.

Why Leverage Trained and Experienced APPs in Your Rural Hospital  

As highly skilled and extensively trained clinicians, APPs offer valuable benefits to the organizations and care teams they are a part of, as well as the patients they serve.

  1. Increase access to care: Patients everywhere experience barriers to care, but in rural locations, these challenges are exacerbated and multiplied. APPs help fill gaps in schedules and services, providing more opportunities for the community to get the education and care they need, when they need it.
  2. Enhance continuity of care: APPs are essential to establishing care continuity for patients in rural populations. With a wide scope of practice and advanced training, they can guide patients through a centralized, smooth care journey that may not otherwise be possible given the acute physician shortages in remote areas. This continuity fosters better communication, patient engagement, and improved patient outcomes.
  3. Support collaborative approaches: APPs are uniquely positioned to bridge gaps between other healthcare professionals and round out the expertise of an interdisciplinary clinical team. This collaborative approach promotes efficient and coordinated care delivery, enhancing patient outcomes and satisfaction.
  4. Expand services: Rural programs can suffer from a shortage of available services and specialists, causing patients to travel long distances to get the care they need (or not get care at all). By bringing in APPs, hospitals can offer a bigger range of tests, treatments, procedures, and educational programs.
  5. Drive cost-effective care delivery: APPs are compensated differently than physicians, which can be an advantage to rural programs which typically have tighter budgets and fewer expendable resources. Additionally, APPs fill critical gaps in care, often leading to savings for both patients and provider organizations.
  6. Augment patient satisfaction: By filling out the schedule and relieving pressure on all providers, APPs can help reduce clinician burnout and improve patient interactions overall. Their unique expertise and training also equip them to advance patient-centered care, community engagement, and value-based initiatives.

How to Ensure Your APPs are Trained to Thrive in Rural Setting

When physicians and APPs work together, patients reap immense benefits. As we described in the last section, this collaboration can lead to improvements in wait time, access, experience, and outcomes. On the other side of the coin, the physician-APP partnership is also actively helping organizations expand programs, remain financially sustainable, overcome recruiting challenges, achieve quality metric goals, and cultivate a healthy work environment.

We’ve distilled our experiences working with rural hospitals into four best practices to adhere to when introducing APPs to your program.

  1. Require specific training or experience: Working in rural hospitals demands high levels of flexibility, adaptability, and independence. Many settings are ideal for new APPs, but rural is not one of them. Look for APPs with formal, focused training in emergency or hospitalist programs or multiple years of specialty-specific experience.
  2. Seek specialized training: If you find exceptional candidates who don’t yet have the necessary training or experience to thrive in a rural environment, one great option is to partner with an organization that offers concentrated education and guidance as a part of the hiring agreement. For example, Aligned Providers provides a 12-month fellowship to recent grads and inexperienced APPs that equips them with the tools and capabilities they need to successfully practice in intense critical care environments.
  3. Ensure competence in key procedures: For rural hospitals, this includes following evidence-based medicine protocols, handling difficult airways, managing strokes and STEMIs, and expertly navigating trauma situations (blunt or penetrating). Most importantly, ensure your APPs are confident in determining acuity, triaging, and making efficient, patient-centric care decisions.
  4. Provide ongoing support: Beyond the initial onboarding procedures, ensure you have a strong support system in place for your clinicians. Beyond the basic inclusion of a supervising doctor, we recommend having an involved medical director who can perform case and chart reviews, conduct real-time coaching, and serve as an additional resource for questions, concerns, and training needs.

Leveraging advanced practice providers in rural inpatient programs offers valuable advantages, including increased access to care, enhanced continuity of care, collaborative healthcare, expanded services, cost-effective care delivery, patient satisfaction, and flexibility. By supporting APPs with ample specialty-specific training and physician support, rural inpatient programs can provide more comprehensive, accessible, and patient-centered care to their communities.

Looking to expand the utilization of APPs at your hospital? Let us know.

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