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Rural Health Information Hub

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.


Promising (About evidence-level criteria)


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.

Colorado Center for Nursing Excellence logo

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.

Services offered

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
  • Stipends


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 the project.

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 were admitted under this process have been very successful.

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.

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
July 6, 2021

Suggested citation: Rural Health Information Hub, 2021. 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.