Many rural hospitals are adding advanced practice providers to their physician-led ER teams to help improve their emergency departments. Here’s an update on current challenges in rural ERs and how your specialized skills as an APP can help!

Nurse practitioners and physician assistants may have growing opportunities in
 rural emergency rooms. That&rsquo;s because many rural hospitals are adding
 advanced practice providers to their physician-led ER teams to help improve
 their emergency departments. Further, there are new federal, state, and local
 funding resources that may help rural health facilities and critical access
 hospitals hire more clinicians. If you&rsquo;re an APP who is considering
 practicing in a rural area, here&rsquo;s an update on current challenges in
 rural ERs and how your specialized skills can help.


<h3>Unique Challenges for Rural Emergency Departments</h3>


 Emergency departments in rural areas across the nation grapple with ongoing
 physician shortages, unpredictable patient volumes and increased COVID
 vulnerability. These issues can cause bottlenecks in small, rural emergency
 rooms, leading to less-than-satisfied patients and providers as well as
 inefficient services.



 Continuing physician shortage. Even in the best of
 times, rural health facilities struggle to attract and retain full-time
 doctors, including emergency medicine physicians. According to
 <a
 href="https://www.annemergmed.com/article/S0196-0644(20)30501-1/fulltext"
 target="_blank"
 >Annals of Emergency Medicine</a
 >, only 8% of emergency physicians practice in rural areas.



 Fluctuating patient loads. Patients have been either
 avoiding emergency departments due to social distancing or flooding EDs due to
 surges in COVID cases (<a
 href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7015a3.htm"
 target="_blank"
 >CDC MMWR</a
 >). Unfortunately, patient volumes have once again spiked due to the Delta
 variant.



 Patient vulnerability. Residents of rural areas
 appear to show increased susceptibility to serious infection or death from
 COVID-19, likely due to older age, lack of health insurance and underlying
 health problems (<a
 href="https://www.ers.usda.gov/amber-waves/2021/february/rural-residents-appear-to-be-more-vulnerable-to-serious-infection-or-death-from-coronavirus-covid-19/"
 target="_blank"
 >USDA Economic Research Service</a
 >).


<h2>APP Support as a Solution for Rural ER Challenges</h2>


 To overcome these challenges, some rural facilities are fortifying their
 physician-led ED teams with specialized APP support.



 Nurse practitioners and physician assistants who are trained in emergency
 medicine can alleviate pressures on ED physicians, help streamline services,
 and improve patient experience. APPs in the ER can perform rapid medical
 evaluations (RMEs) alongside triage to reduce the door-to-provider time and
 promptly initiate the medical workup. They can provide treatment, case
 management and follow-up care (in accordance with the level of practice
 autonomy designated by their state).



 April Hawthorne, Cross Country Locums Vice President of Recruitment, is seeing
 a growing trend in rural ERs hiring more APPs. Hawthorne says, &ldquo;When
 facilities expand their APP team, patients don&rsquo;t have to wait as long.
 APPs can perform an RME on patients, and those patients who don&rsquo;t need
 to see the EM physician directly can be safely treated by the APP, decreasing
 wait times. The PAs and NPs can order lab tests, read results, counsel,
 diagnose, treat and fully process the patients. If they need help, they can
 then contact the supervising physician. APPs can address the lower-acuity
 cases, streamlining services in the ER.&rdquo;



 &ldquo;As long as there is sound clinical judgment, proper protocols are in
 place, patient safety is top priority and the provider can consult the
 supervising physician, the doctor doesn&rsquo;t have to be there every step of
 the way.&rdquo;



 For these lower acuity patients, the APPs serve as the first point of contact
 for the patient after intake, can constantly monitor them during treatment,
 and can give discharge orders and follow-up care. Having multiple APPs
 available can help ensure a patient-centered approach, upholding care
 continuity, decreasing readmission rates, and possibly translating to
 increased HCAHPS scores.



 Varying autonomy of practice. When implementing this
 approach, rural health leaders and practitioners must follow state laws
 regarding autonomy of practice and supervision requirements. So depending on
 location and whether APPs are classified as independent, reduced, or
 restricted in practice, different arrangements will suit different facilities.



 In states where APPs have autonomy of practice, small rural hospitals (those
 that partner with larger facilities and typically transfer high acuity
 patients to those facilities) might choose to have APPs onsite to treat low
 acuity cases with remote access to the emergency medicine physician at the
 larger hospital. In certain high-acuity environments where onsite supervision
 may be required, the APP team can consult the onsite physician as needed. Some
 hospitals may choose to employ telehealth &mdash; using virtual health
 consults with the supervising physician and in-person services with the APP.



 Financial resources for building APP teams. Some
 hospitals have found that federal funding, as part of the COVID stimulus and
 relief, has helped build their APP teams in the face of increasing pressure
 from the pandemic. This relief may be an available resource to solve
 challenges with staffing and retention during this particularly challenging
 time or to cover other COVID-related costs, freeing other resources for
 hiring. This is great news for APPs who are seeking positions in rural ERs.



 If you want to learn more about how you can expand access to emergency care
 for patients as an APP in rural areas,
 <a href="https://www.crosscountrylocums.com/">search our available jobs</a> or
 <a href="https://www.crosscountrylocums.com/contact-us">get in touch</a> with
 a locums recruiter today.

More Job Opps for NPs and PAs as Rural Emergency Departments Build APP Teams