APRNs Lead in Rural Health

APRNs Lead in Rural Health
By Eric Snyder, DNP, APRN-CNP

APRNs across the state of Ohio have faced varying levels of both challenge and success when it comes to integrating into a health systems’ organized medical staff structure, let alone in a leadership role. While some health systems are ahead of the curve and have collaborative practice pretty much figured out, others are trying to catch up.

I am an acute care NP and an OAAPN board member currently serving as the southeastern region director. My career in healthcare began 22 years ago as a nurse aide in rural Ohio and I am now the medical director of the hospitalist program and president-elect of the medical staff at Trinity Hospital Twin City (THTC) in Dennison Ohio. I was fortunate to be elected to this influential position by my physician, my APRN and PA colleagues and with support from the hospital’s medical staff.

I came to Trinity Twin City in 2016 after having several conversations with then CEO Joe Mitchell regarding changing up their hospitalist service line. THTC is a critical access hospital in rural eastern Ohio which is part of Trinity Health Systems of Steubenville. As with many rural health systems, there is difficulty in recruitment and retention of physicians in those areas and thus APRNs have risen to help meet those challenges.

A plan was proposed to utilize and staff the hospitalist program with the majority of providers being APRNs. We were able to continue to prove this model over several years as a real winner for rural inpatient care both for the organization and the community it serves.

While APRNs had a strong local presence in primary care at the facility as well as a high level of collaboration between the APRNs and the local physicians, the medical staff bylaws did not reflect this. I spent the first few years working with the medical staff and administration to update the bylaws with provider neutral language. Next, we advocated for not just allowing APRNs to attend medical staff meetings but to allow them a level of medical staff membership that would afford them an official voice through voting privileges on medical staff issues. This gave us a “seat at the table” to continue to showcase our leadership skills to the medical staff and administration.

Teresa Gagliardi, MSN, RN, the VP of Hospital Operations at THTC had this to say, “We at THTC have been fortunate in the recruitment of Advanced Practice Providers (APPs). These providers have a solid nursing and healthcare background and it shows in their delivery of patient care. They are intelligent, engaged and respected individuals. Their patients think very highly of them as shown through our patient satisfaction scores.” She also adds that “APP participation in various committees and projects provides another perspective in getting the work done. Healthcare is complex and our APPs are committed to keeping up to date on what is evidence based practice.” Eventually, I was able to help influence having the bylaws updated and became an active medical staff member. I continued to have conversations with administration and physician members of the medical staff and stayed engaged and enthusiastic about sharing ideas. I believe this did not go unnoticed as I was appointed chair of MSPIC (medical staff performance improvement committee) in 2018. As the 2019 medical staff executive committee appointments came up, I decided to put my hat in the ring as a newly active staff member. Through a balloted voting process I was elected by a group of our physician and APRN peers (with their newly acquired voting privileges) as president-elect of the hospital medical staff. According to Dr. Tim McKnight, MD, the immediate past president of THTC medical staff, “Our APRNs have excellent clinical skills. Eric’s humble interpersonal approach with the medical staff and proven leadership capacity has earned him the respect of his peers and is the reason he was elected to this leadership position.”

We as APRNs are working on the frontlines right along with our physician colleagues. We are all trying to do our part to provide good patient care together. The culture at our facility has been excellent in that all people who are engaged and interested in improving patient care delivery have an official voice and the ability to contribute. Ohio’s APRNs have a lot to offer organizations and their medical staffs. From large urban centers to rural critical access facilities, all healthcare providers who are engaged and motivated to make a difference should have the opportunity to share their knowledge and experience regardless of background or title. This diversity can only add value to the pursuit of quality patient care.