Last summer, in the midst of a pandemic, four new fellows began a unique post-doctoral program for advanced practice nurses that would take them into Central and Western Kansas, far from the program’s headquarters at the University of Kansas School of Nursing.

The purpose of this innovative fellowship, funded by a 4-year, nearly $2 million grant from the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, is to provide a bridge for doctorally-prepared primary care nurses to gain additional skills focused on complex primary care practice in rural and underserved community–based settings, with additional mentoring, additional education and a peer group to support them.

“We believed that there was an opportunity, particularly for those practicing in rural areas, for us to provide the support and mentoring you don’t get in your first year of practice,” said Cara Busenhart, Ph.D., APRN-NM, CNM, director of the program and an associate professor in the KU School of Nursing. “While residencies are becoming more common for BSN-prepared nurses, our fellowship program is unique in that it is specifically directed at those who have completed the clinical doctorate, the DNP.”

The Doctor of Nursing practice is the highest clinical graduate degree in nursing. Other common abbreviations used to designate specialization indicate certification, such as FNP for family nurse practitioner or CNM for nurse midwife. And finally, APN or APRN refers to a role, that of advanced practice registered nurse, which refers to a nurse that has completed additional post-graduate education and training in the management of common health and illness conditions. Many of these individuals prescribe medications, manage complex care plans and coordinate health care teams, sometimes providing the only health care for miles in rural areas. The fellows in this program are typically described using all of these abbreviations.

The fellowship program has placements at four clinical sites: First Care Clinic in Hays; The University of Kansas Hays Medical Center in Hays; The University of Kansas Pawnee Valley Campus in Larned; and the Bob Wilson Memorial Hospital in Ulysses. Plans call for expansion to five fellows next year and six the next, so efforts are under way now to recruit additional sites.

Busenhart notes that in addition to mentors and onsite training, the fellows also are provided with a weekly didactic session via Zoom. Those sessions, facilitated by JoAnn M. Peterson, DNP, APRN, FNP, and a clinical assistant professor in the KU School of Nursing, bring the fellows together for additional education and relationship building, with each other and with members of the KU faculty.

The sessions begin with a set curriculum, but they also evolve to meet the fellows’ needs, which thus far have included more information about telehealth and an additional emphasis on women’s health. Peterson, who has a background as a nurse and educator in rural Kansas, serving in both Garden City and Dodge City, points out that there is additional pressure in rural areas, where a specialist or even a colleague may be hours away.

“Managing congestive heart failure in a primary care setting in a rural area far from the nearest cardiologist is certainly something that, while common for a nurse practitioner, can be daunting at first,” she said. “Sometimes health care providers can burn out really fast, especially with the isolation of long distances,” Peterson said. “This year-long support will help the fellows manage all of the intangible elements of practice, from managing their time in a busy clinic to self-care. And that translates into better patient care.”

The fellows also use their weekly sessions to meet and develop relationships with additional faculty members and health care providers.

“It’s important to build and maintain a network of people to contact with questions,” Peterson said. “As your career goes along, you’re always building those types of contacts. These sessions give them a jump start.”

‘I AM NOT ALONE IN THIS’

Erin Casey, DNP, APRN, FNP, is a fellow 410 miles away from KU Medical Center at the Bob Wilson Memorial Hospital in Ulysses. A graduate of Missouri State University for her doctorate in nursing practice, and a native of Springfield, Missouri where she completed her associate’s degree and bachelor’s degree at Southern Baptist University-Mercy College of Nursing, Casey’s fellowship is at a 26-bed hospital in a community of around 6,000 people. It’s a shorter drive to Denver than it is to Kansas City, and the nearest big city is Garden City, about an hour away. With technology though, Casey is connected to the three other fellows in the weekly session that brings everyone closer.

“As stressful as things can be as a new NP, I am always reminded on Thursday during didactic that I am not alone in this,” Casey said. “These sessions provide a great reminder that I have a support system in the form of my cohort and the fellowship leaders. This makes me increasingly grateful for this opportunity that many new NPs do not get.”

For Heather Holaday, DNP, APRN, FNP, every week is old-home week. Holaday is a fellow at The University of Kansas Pawnee Valley Campus in Larned, Kansas, where she attended elementary and high school. A graduate of Fort Hays State University with her DNP, Holaday earned her bachelor of science in nursing at Emporia State. Holaday is in Larned at a 22-bed, critical-access hospital that’s now part of the statewide University of Kansas Health System, 272 miles from the KU School of Nursing and in a town of less than 7,000 people. Chances are good that Holaday may know her patients, their parents or their children.

“Many people in this great community have supported me throughout my journey,” Holaday said. “I am extremely honored and blessed to serve the community that shaped me. I enjoy working with providers and staff to deliver exceptional care.”

Summar Anthony, DNP, APRN, FNP, who received both her DNP and her bachelor’s degree at Fort Hays, is a fellow at the First Care Clinic, a federally qualified and federally funded community health care center and outpatient clinic in Hays. The First Care Clinic provides a wide variety of services, including primary care, mental health and dentistry, regardless of patients’ ability to pay. Anthony is from Colby and Salina, Kansas.

Tam Chieu, DNP, APRN, AGPCNP, who graduated from KU with both her DNP and her bachelor’s degree, is a fellow and an adult gerontology primary care nurse practitioner at The University of Kansas Hays Medical Center in Hays. Also known as Hays Medical Center or HaysMed, the 207-bed, non-profit hospital provides a variety of advanced care for the western half of the state, including cardiac intensive care and cancer care. Chieu is from Kansas City, Kansas.

It’s not easy to launch a new fellowship, especially during a pandemic. For Laura Crystal, the fellowship and education coordinator in the KU School of Nursing office of academic affairs, it has meant numerous Zoom calls and canceled site visits. Though Crystal and Busenhart made it out to Hays, trips to other sites and to the consultant’s office in Connecticut had to be canceled due to the pandemic.

Crystal, who splits her time equally now between working on the fellowship program and working in the office of academic affairs, notes that the most challenging part of her role this year has been navigating a new program through the university and also coordinating with community partners.

“It was a year of firsts,” she said, noting that the prestigious HRSA grant requires the production of numerous reports and working with large amounts of data. “But the most rewarding part of the job is working with the fellows. You can see it every week. They are learning so much and becoming even better health care providers.”