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Rural and Underserved APRN Project

  • Need: To reduce the primary care provider shortage in rural Colorado.
  • Intervention: A "grow your own" initiative in Colorado recruits rural registered nurses and trains them to become advanced practice RNs.
  • Results: 81 RNs have participated in the Rural and Underserved APRN Project so far.


Promising (About evidence-level criteria)


The Rural and Underserved APRN Project in Colorado recruits registered nurses (RNs) from rural communities and supports them as they return to school to become advanced practice registered nurses. These APRNs agree to return to their communities and help reduce the state's primary care provider shortage.

Project coordinators identified the state's Health Professional Shortage Areas (HPSAs) and talked to nurses from locations like Federally Qualified Health Centers (FQHCs), Critical Access Hospitals (CAHs), public health departments, and schools. RNs participating in the project would receive financial support as well as employer and community support.

Colorado Center for Nursing Excellence logo

This project partners with Denver's Loretto Heights School of Nursing at Regis University, which is creating a rural/underserved APRN program. The Rural and Underserved APRN Project is funded in part by the Colorado Health Foundation and received a 2018 HRSA Advanced Nursing Education Workforce grant.

Services offered

In order to participate, RNs must be from a rural and/or underserved area and agree to serve in a rural/underserved area for 2 years for every year that they receive funding.

Participating APRN students receive:

  • Assistance in the application process
  • Assistance in clinical and job placement
  • Employer support like flexible scheduling
  • Monthly coaching
  • Stipends


The project had 40 open slots and over 200 applications in the initial cohort. At this time, 81 RNs have participated in the Rural and Underserved APRN Project. Currently, there are 23 graduates; 20 passed boards on the first try and have attained employment as providers in a rural/underserved area, while the other 3 have not taken boards yet. Fifteen more participants are scheduled to graduate in 2019.

Thirty-four RNs responded to the Nursing Community Apgar Questionnaire, whose results suggested that a project providing community, employer, and financial support helps students overcome barriers, can be self-sustaining, and helps ensure that participating communities have access to a primary care provider. Communities around the state as well as local facilities and nursing organizations strongly promoted the project.

Phase 1 of the study examined recruitment efforts, while Phase 2 will study graduation rates and Phase 3 will study retention rates after 5 years.

Johnson, I.M. (2017). A Rural "Grow Your Own" Strategy: Building Providers from the Local Workforce. Nursing Administration Quarterly, 41(4), 346-352. Article Abstract


Once funding was granted, the biggest challenge was helping the nurses get accepted to an accredited APRN program, as the competition is fierce. Project coordinators worked with a variety of APRN programs to institute holistic admission procedures. The nurses who have been admitted under this process have been very successful so far.

One barrier was the challenge of getting employment flexibility during the clinical placement phase of the education process. Organizations have been challenged to flex the nurses' schedules in order to allow the APRN students to attend the required clinical placement experiences. Project coordinators reminded employers that, once the nurse has completed the educational process, they will have an additional provider.


Project coordinators asked participating communities to match funds used to support the APRN students in order to make the project (and recruitment efforts) self-sustaining. It also helps communities remain invested in their resources: local nurses.

In addition, identify and collaborate with accredited APRN programs that are rural-friendly. This will help students in the application process.

Many states do not allow APRNs full practice authority and require them to practice under the supervision of a physician. This can be a barrier in areas without a physician.

Contact Information

Ingrid M. Johnson, Project Director
Colorado Center for Nursing Excellence
303.715.0343 Ext. 1021

Nurse practitioners and other advanced practice registered nurses
Recruitment and retention of health professionals

States served

Date added
December 12, 2017

Date updated or reviewed
January 2, 2019

Suggested citation: Rural Health Information Hub, 2019. Rural and Underserved APRN Project [online]. Rural Health Information Hub. Available at: [Accessed 14 June 2021]

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.