The Changing Look of Nebraska Health Care: In rural Nebraska it’s hard to recruit and keep doctors in small towns. That leaves a gap for primary care. But in some communities it could be nurses who end up filling the need for health care.
Nurse practitioner Faylene Dancer sees patients in the lower level of a short brick building in Sutherland, a town of about 1,300 people in western Nebraska. The building, connected to a nursing home, used to be a hospital. Now, it’s home to the Family First Health Center, an independent practice Dancer started in 2011.
Without the clinic, Dancer says people would have make the 20 or 30-minute drive to see a doctor in Ogallala or North Platte.
“Which, sometimes it's not a big deal for people,” Dancer said. “But there (are) a lot of people who will not travel in the weather or they have a mobility problem.”
With a nurse practitioner in town, they don’t have to go anywhere. Sandy Conrad of Sutherland, one of Dancer’s patients, is glad to have someone to see without a doctor in town.
“When Faylene took over it was a blessing,” Conrad said. “There isn't anything that they can’t handle.”
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A nurse practitioner is a registered nurse who goes back to school for more medical training. Before they’re licensed they have to pass a board exam and have 2,000 hours of supervised practice.
After that a nurse practitioner can see patients, either in a doctor’s office or in their own clinic. Dancer says most people visit her for either minor or ongoing health problems.
“In one of my normal days I'll see half a dozen colds. I will see patients with multiple chronic illnesses - C.O.P.D., diabetes, asthma,” Dancer said.
She can make diagnoses, prescribe medications, and order tests or medical equipment. But when a case becomes complicated or critical, she calls a doctor for advice.
“We continue to be their home base,” Dancer said. “And then we have the specialist look at the part that we need help with.”
That position as a patient’s medical home base could become a big role for nurse practitioners in the health care industry. There’s a shortage of doctors, especially in primary care. A University of Nebraska Medical Center study in 2012 found the state needed over 1,600 more primary care doctors to keep up with demand from an aging population and Obamacare.
Nurse practitioners can help fill that gap, and a change in state law makes it more likely.
Faylene Dancer used to be required to have a contract with a consulting physician. It could cost thousands of dollars each year. This year Nebraska became the 20th state to give nurse practitioners authority to practice without that kind of agreement.
But even without that piece of paper, Dancer says she still works closely with doctors.
The new $19 million Health Sciences Education building at the University of Nebraska at Kearney is home to the college's growing nursing program, although advanced students mostly learn in the field. (Photo by Grant Gerlock, NET News)
Katelyn Messner of Ogallala and Melissa Studnicka of Henderson are nurse practitioner students at the University of Nebraska at Kearney. Both want to practice in the Kearney area after they graduate. (Photo by Grant Gerlock, NET News)
“In one day I may call the radiologist, the pain specialist, a cardiologist, pulmonology. We talk to everybody,” Dancer said.
Some doctors may be concerned about competition from nurse practitioners but Stephanie Burge, a nurse practitioner and part-time instructor at the University of Nebraska Medical Center College of Nursing in Kearney, Nebraska says her experience shows they’re more interested in collaboration.
“We still need doctors in rural areas without a doubt,” Burge said. “But there are challenges to getting physicians into rural areas.”
Medical degrees are expensive. Practicing in urban areas offers a quicker payoff, making it hard for rural towns to attract physicians.
“So absolutely nurse practitioners open the door for people to receive quality health care,” Burge said.
UNMC's nursing program is growing in Kearney, in part to meet the need for more nurse practitioners. There’s a new, $19 million building on campus. The college is hiring more instructors. The goal is to add 32 more nurse practitioners students to the program by 2020.
Student Katelyn Messner from Ogallala is feeling good about finding a job when she graduates next year.
“I have a friend that just graduated and he got a job very quickly and I think we've seen that in a lot of these small town areas that people are looking for quicker access to care,” Messner said.
A lot of the students in Kearney come from rural Nebraska and Steph Burge says many of them want to go back home to work, but she knows they could change their minds.
“Two years from now when they start really looking at the job market, salaries will be an issue,” Burge said. “I mean, they can make more money living in a more populated area.”
That could draw grads to Lincoln or Omaha where nurse practitioners can help doctors see more patients.
And even though there is less red tape for a nurse practitioner to set up an independent practice, it still comes with financial challenges. Faylene Dancer says her reimbursements are 15 percent less than normal rates because she doesn’t have a doctor on staff.
“It is an inhibition for nurse practitioners to open their own practice or do rural care because it is so hard to get reimbursement,” Dancer said.
Dancer does cosmetic skin treatments on the side to keep her bills paid and doors open. But in small-town Sutherland, being there counts for a lot.
CORRECTION: This story originally said Stephanie Burge was an instructor with the University of Nebraska at Kearney. She is an instructor at the University of Nebraska Medical Center College of Nursing located on the UNK campus. The college plans to add 32 more students across the 2-3 year program by 2020.