University of Minnesota Psychiatric-Mental Health Nurse Practitioner Rural Rotation

Description

Between 2021 and 2023, five cohorts of doctoral students in the UMN School of Nursing psychiatric-mental health nurse practitioner program completed 40-hour rotations in rural communities across Minnesota. The program was designed to provide students with an understanding of the unique challenges faced by rural patients and mental health professionals, as well as the advantages and possibilities of rural practice. Program coordinators partnered with a wide range of local organizations to give students a broad sense of the rural mental health ecosystem. Local partners ranged from community mental health centers to rural law enforcement agencies.

The program was funded with a grant from the Minnesota Department of Health (MDH). Students were offered stipends to cover expenses related to travel and accommodations. The grant funding also supported the inclusion of an online rural health unit in the Doctor of Nursing Practice (DNP) curriculum, which students completed prior to their rotation. Program participation was mandatory for all students admitted during the grant period.

Services offered

The program consisted of the following elements:

• A three-module online educational unit to help students prepare for a clinical immersion experience in a rural community. Module topics focused on the strengths and challenges of rural areas, their populations, and rural healthcare.
• An immersive, 40-hour rotation in a rural Minnesota community with reflective assignments
• Qualitative evaluation and assessment with the students and rotation sites
• A financial incentive offered to students who chose to practice in a rural area after graduation

Local partners included:

• Community mental health centers
• Crisis intervention services
• Law enforcement agencies, offering ride-alongs and officer shadowing
• Acute short-term residential facilities
• Private practices

Results

Over the course of the grant period, 29 students completed rural rotations in communities across the state. Student feedback on the program was overwhelmingly positive, and several students noted that their experiences with law enforcement were particularly informative.

In their post-rotation survey responses, students said that the program had given them a deeper understanding of the following aspects of rural practice:

• Transportation is a common barrier for patients, and some may need to drive several hours to access services or refill a prescription
• Lack of internet connectivity may prevent some patients from utilizing telehealth services
• Rural health organizations may have a large service area covering multiple counties
• There may be fewer resources available in some rural counties, but there can also be a unique sense of teamwork and close collaboration among the organizations that do exist
• Maintaining strict boundaries with patients can be more difficult in small communities; for instance, a patient may be your child's teacher or coach, and it is common to run into patients around town

Some students live in rural areas and took jobs in their communities after graduation. Others who live in outlying suburbs of the Twin Cities chose to commute to rural communities to practice in a higher need area. Many other graduates voiced an openness to practicing in a rural area in the future as a result of their experience with the program.

Challenges

Coordinating with local partners in multiple communities across the state required a significant amount of time and organizational capacity. Some local organizations were initially reluctant to become involved due to the weeklong time commitment and the worry that students may only be coming to fulfill a requirement. However, it was helpful to think “outside of the box” and involve additional healthcare team members and community partners such as law enforcement agencies. After hosting their first student and experiencing the uniqueness of the rotation, local organizations were often eager to continue partnering with the program.

Securing ongoing funding for this program has been a challenge. Program coordinators are currently in the process of applying for additional grant funding to support future rotations.

Replication

It is important to visit the communities and partner sites in-person during the program planning phase. The strong relationships and high level of coordination needed in order to make this program work cannot be developed over video calls alone. The information and insights gained from these in-person visits can then be shared with students to better prepare them for the unique characteristics of the clinical site and community.

If possible, allow students to provide input regarding where they go for their rotation. The rotation experience does not need to be uniform and may involve different experiences in each community.

Offering stipends to students to cover program expenses is beneficial. Many students noted that this financial support was appreciated to help defray travel and lodging costs.

Contact Information

Barbara Peterson, PhD, PMHCNS-BC, APRN, FNAP, Clinical Professor & Psychiatric-Mental Health DNP Specialty Coordinator
University of Minnesota School of Nursing
UMN School of Nursing Psychiatric-Mental Health DNP Program
pete1389@umn.edu