IU nursing students, community providers increase access to care in rural Indiana

A partnership between the Indiana University Bloomington School of Nursing (IUSON), the Center for Rural Engagement, Southern Indiana Community Health Care (SICHC), and several community partners is providing much needed clinical experience to nursing students and improving access to health care for residents in Orange and Martin counties.

Amy Todd has been a nurse for 20 years, and she’s become very familiar with Martin County’s health care. “Being a rural community, we do not have a lot of resources,” she says. The resources they do have in their county of approximately 10,200 people include one physician and three nurse practitioners, and a stand-alone urgent care clinic with one nurse practitioner. “Some residents use the urgent care nurse practitioner as their primary care provider.”

Other health resources like the once-a-week availability of an obstetrician or the mental health care option in a neighboring county are under-utilized by residents out of concerns of privacy and stigma.

Though the services they need exist in the state, to make use of them can often be difficult or impossible. “There is not enough of the proper resources available to the patient population locally,” she says. “Access to care is a problem. Many patients must travel 75 miles or farther for proper care for their complex diagnosis.”

“Patients in rural communities are no different than those in urban settings. They need post-stroke care, mental health services, complex therapies, hospice services, specialized providers, pain management, just to name a few, but those services are not found locally,” says Todd.

IUSON associate professor Mary Lynn Davis-Ajami agrees. “Access to specialized services [is] severely limited,” she says. Her past experience working as a nurse in a rural hospital in North Carolina showed her the different way health care is conducted outside of urban areas. “I learned about the strength and sense of community that supported the families and individuals living there,” she says. “The health care system had fewer physicians per capita and smaller facilities with fewer high tech diagnostic tools … Labs were often sent off rather than run in-house, resulting in some delays in getting results back the same day.”

“There is a lack of access to health care especially in rural Indiana, which communities identify as one of their greatest needs,” says Katherine Pope, a registered nurse and health liaison at the Center for Rural Engagement. A report on community health priorities put together by the center shows that 70 percent of the Indiana Uplands counties—which include Orange and Martin counties—have identified access to health care as a top community health need. “Screenings can address chronic disease, maternal health, and substance use, while increasing access to care.”

For these communities, having the IUSON students provide their services makes a big impact. “Our work complements the work of the tremendous health care providers in the surrounding counties, and our faculty work hard to have our classes fit in with the health care priorities and needs identified by those living in the regions we enter,” says Davis-Ajami. “Our presence supports the individuals, families, communities, and health systems in the region,” she says. “We add value in the health and wellbeing of our rural neighbors and provide young energy and idealism for our partners.”

“It shows the community that they matter,” says Todd. “When an organization, such as Indiana University, invests in the county, it inspires and empowers many residents to do more and be more.”

The clinics, beyond supplementing essential health care in these counties, present excellent learning opportunities for students of IUSON. “Not everyone is from a rural community and learning about what people do and don’t have access to is very important in health care,” says Britney Arce, a clinical assistant professor at IUSON. Arce teaches the community portion of the IUSON course that brings the students to rural counties.

IUSON emphasizes an education that exposes students to a variety of nursing skills and techniques. “The clinicals in Orange and Martin County very much align with our learning outcomes for students to be a critical thinker, culturally sensitive, a knowledgeable care coordinator, and an individual who understands the impact of health care policy, finance, and regulatory environments on care delivery,” says Arce.