Rural and Underserved APRN Project
- Need: To reduce the primary care provider shortage in rural Colorado.
- Intervention: A "grow your own" initiative in Colorado recruited rural registered nurses and trained them to become advanced practice RNs.
- Results: 81 RNs participated in the Rural and Underserved APRN Project.
The Rural and Underserved APRN Project in Colorado
recruited registered nurses (RNs) from rural communities
and supported them as they returned to school to become
advanced practice registered nurses. These APRNs agreed
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 received financial support as well as employer
and community support.
This project partnered with Denver's
Loretto Heights School of Nursing at Regis
University. The Rural and Underserved APRN Project
was funded in part by the Colorado Health
Foundation and received a 2018 HRSA Advanced Nursing
Education Workforce grant.
In order to participate, RNs had to 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 received funding.
Participating APRN students received:
- Assistance in the application process
- Assistance in clinical and job placement
- Employer support like flexible scheduling
- Monthly coaching
The project had 40 open slots and over 200 applications
in the initial cohort. Eighty-one RNs participated in the
Rural and Underserved APRN Project.
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
Johnson, I.M. (2017). A Rural "Grow Your Own" Strategy:
Building Providers from the Local Workforce. Nursing
Administration Quarterly, 41(4), 346-352.
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
were admitted under this process have been very
One barrier was the challenge of getting employment
flexibility during the clinical placement phase of the
education process. Organizations were 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 helped 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.
Nurse practitioners and other advanced practice registered nurses
Recruitment and retention of health professionals
December 12, 2017
Date updated or reviewed
July 6, 2021
Suggested citation: Rural Health Information Hub,
Rural and Underserved APRN Project [online]. Rural Health Information Hub. Available at:
[Accessed 21 May 2022]
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.