Expanding a primary care nurse practitioner fellowship to support rural and underserved pediatric patients in the United States

Early Abstract:

Context: A significant shortage of primary care and mental health providers currently exists in the United States (U.S.) and is predicted to worsen, emphasizing the imperative for mental health training and collaboration within primary care settings, especially in rural and underserved areas. In fact, the World Health Organization (2021) estimates over 18 million health care workers will be needed in rural areas in the U.S. by 2030. It is challenging for primary care providers (PCP) to work in rural areas of the U.S. due to limited healthcare resources, limited access to emergency, specialty and mental health services, and requirements for skills to manage patients with complex problems. A lack of healthcare professionals specializing in primary care and pediatric care, coupled with rising demand for mental health services in underserved and rural areas, necessitates innovative and sustainable solutions. Nurse practitioners (NPs) emerge as a key workforce with the potential to provide these comprehensive services, given their adaptability, scope of practice and potential interest in living and working in rural areas which offer increased independent, comprehensive practice opportunities and competitive salaries leading to greater satisfaction and retention.
Issue: Nurse practitioners have historically demonstrated unique strengths in providing primary care services, but traditional education and training in the U.S. does not include additional skills such as telehealth and oversight of patients with complex medical conditions, which are required for successful transition to a position in a rural health area. However, there is evidence that post-graduate fellowships enhance the knowledge, confidence and capabilities for graduate NPs and offer comprehensive training to address the needs of rural and underserved populations.
Lessons Learned: The state of Delaware has a population of 1,052,000 according to the 2024 U.S. Census Bureau with estimates of more than 80% of the population living in designated rural and underserved regions. A pediatric institution within this state recognizes the demand for both mental health and primary care services in providing a compelling backdrop for development of a postgraduate NP fellowship training program. We discuss the program's structure, didactic components, and overarching aims at addressing the needs of local communities. Emphasis is placed on mental health training within pediatric primary care, equipping NPs with the necessary skills to provide more holistic care. This paper outlines techniques employed to initiate a pediatric primary care fellowship for NPs interested in a career providing primary care in a rural or underserved region. A discussion related to the challenges of determining the long-term impact of the fellowship program on healthcare outcomes, workforce development, and improved access to pediatric primary care services in underserved areas is included. This approach serves as a potential model for other regions grappling with similar challenges, offering insights into effective strategies for addressing the shortage of pediatric primary care providers with a focus on mental health training.
Keywords: nurse practitioner, continuing medical education, mental health services, rural health, primary care nursing, fellowship.
Mesh Terms: Nursing Personnel, Pediatric Nurse Practitioner, Advanced Practice Nursing, Pediatric Nursing.