By Frances Parrish, College of Behavioral, Social and Health Sciences
Nurse practitioners in Appalachia are more isolated geographically and experience different hardships than those serving patients in more urban areas, but now these nurse professionals will have access to a new resource for professional development, continuing education and networking through an alliance based in the Clemson University School of Nursing.
The Appalachian American Alliance of Nurse Practitioners (AAANP) is a new initiative designed to act as a networking and educational resource for nurse practitioners who work in Appalachian areas. The AAANP is led by Anne Koci, a clinical professor within the School of Nursing, and supported by the Center for Research on Health Disparities (CRHD), which is housed within the School of Nursing. The AAANP is a part of the CRHD mission to create opportunities to eliminate health disparities through education, professional development and research.
Koci has experienced the benefit of an alliance such as the AAANP firsthand. A local network in Tennessee previously helped her stay committed to working in rural Appalachia, so she hopes this Alliance will do the same for others. After she graduated from Indiana University Northwest with her Family Nurse Practitioner certificate, she moved her family to rural east Tennessee to work in a small clinic in a town of 1,000 people. Her collaborating physician worked in a nearby town and came to her clinic for one half day per week to see her consults and review records.
“Classroom education never truly prepares you for the realities of practice,” Koci said. “The role change from RN to APRN, plus the autonomy and responsibilities of the role in the midst of professional isolation were nearly overwhelming.”
At that time, there was a nurse practitioner approximately every 30-50 miles in this area of east Tennessee and several formed a support network of local nurse practitioners for clinical and emotional support. Koci said it made all the difference in her career.
“I was incredibly fortunate to find myself a member of this network, and, because of it, I stayed. Without that network, I don’t know if I would have continued to practice in rural Appalachia due to the tremendous stressors and professional isolation. This experience is what makes me want to invest in this network,” Koci said. “I’ve been down the road that these nurse practitioners are on now, and I want them to be able to stand on my shoulders to see the future and go onward and upward.”
The Appalachian area ranges from northern Mississippi to southern New York and is home to more than 25 million people. It includes all of West Virginia and parts of 12 other states including South Carolina. According to the Appalachian Regional Commission, the region has less health care professionals in comparison to the United States as a whole. These providers include primary care physicians, mental health providers, specialty physicians and dentists. Social determinants of health such as lower incomes and higher poverty rates reflect worse living conditions in Appalachia in comparison to the nation as a whole. These conditions are some factors that contribute to health disparities.
This is the second initiative that the School of Nursing has created to impact rural health in Appalachian counties and lessen health disparities. In 2019, the School of Nursing received a grant from the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services, to increase the nurse practitioner workforce in six upstate South Carolina counties, all of which are considered Appalachian counties. Kathleen Valentine, director of the School of Nursing and chief academic nursing officer for Clemson University, said her faculty are working to eliminate health disparities in this region, through the work in this initiative, research and the AAANP.
“In these Appalachian areas, it can be difficult for patients to access medical attention or primary care, and at times health care providers can feel isolated,” Valentine said. “The AAANP and ANEW grant are two ways in which we can break down those barriers for patients and their health care providers while working toward our goal of eliminating health disparities in this region.”
This work by the School of Nursing helps advance the College of Behavioral, Social and Health Sciences’ (CBSHS) mission as well as the land-grant mission of Clemson University, said CBSHS Dean Leslie Hossfeld.
“The work that the School of Nursing is conducting is a prime example of our college’s mission to build people and communities,” Hossfeld said. “I believe the work they are doing is vitally important to these Appalachian counties, and I look forward to seeing the long-term positive impact in those communities.”
In rural areas, health care providers have less access to resources for training and networking, and the AAANP is how the School of Nursing is working to help fill that gap. To kick off the Alliance, the School of Nursing is hosting a virtual education series, which is free thanks to the generosity of Kaye Herth, a former School of Nursing director.
Beginning September 25, the series will feature a keynote address by Margaret Fitzgerald, who will speak on pharmacology and drug therapies. The series will feature other webinars on substance use disorder by Clemson School of Nursing faculty members Mary Ellen Wright and Lucia Gonzales as well as webinars addressing health disparities in Appalachia by Ora Strickland and Koci. There will also be a health disparities panel led by School of Nursing faculty member Stephanie Davis, School of Nursing staff member Michelle Taylor-Smith and the Greenville Free Medical Center Director Suzie Foley.
Koci said the goal of the education series as well as the Alliance, now and in the future, is to help provide Appalachian nurse practitioners with resources for clinical practice, professional development opportunities, professional advocacy support and networking opportunities.
“We hope to develop a collaboration with them in the field and see opportunities to assist nurse practitioners with their patients. We want to work with them to help develop research questions and support these nurse practitioners as they work to solve health care problems that face their community,” Koci said. “Our hope is that the AAANP will reflect a true partnership.”