Connie White Delaney

Dean, University of Minnesota School of Nursing

Rural Minnesota communities have clearly struggled during the past 25 years to slow the migration of their promising young talent to urban centers. Changing agricultural policies, shifting economies and aging demographics have all worked to destabilize our small towns. Shrinking access to essential health care in rural Minnesota has been, for some rural residents, the final affront.

It takes just one family member with a chronic or serious illness — requiring long drives to appointments in unfamiliar cities through unpredictable Minnesota weather — to throw an entire family off balance. The dire and well-documented shortage of primary and specialty care professionals in rural Minnesota has triggered responses from policymakers ranging from loan forgiveness programs to innovations in telemedicine to health collaborations.

This month, however, we celebrate a long awaited change that could have the most tangible impact on access to quality care yet. On Jan. 1, Minnesota joins 18 other states in authorizing its most highly educated nurses to practice to the full extent of their education and training. Until now, nurse practitioners, nurse midwives, clinical nurse specialists and nurse anesthetists in Minnesota were required to maintain a collaborative agreement with a physician in order to practice.

This paper agreement has become a meaningless barrier for many advanced practice nurses serving patients in rural Minnesota.

Beth Good, RN, is a psychiatric mental health nurse practitioner who sees at least 14 patients per day in Mora and Cambridge, Minn., as part of a primary care clinic and larger mental health services collaborative. She earned a four-year degree in nursing, followed by three additional years of graduate school specializing in psychiatric mental health, and was educated to practice and prescribe medications for certain types of mental health issues. When her collaborating physician from Duluth decided to leave Minnesota years ago, her practice had to be abruptly suspended and her patients had to find other care or go without. It took Good three months, courting 15 different physicians, before she found a physician both willing and able to sign an agreement that would allow her to continue to practice psychiatric mental health nursing.

“I know when and how I should be working in partnership with other professionals in caring for my patients,” she said. “These requirements served as barriers that limited my ability to practice and disrupted care for my patients.”

Good told me that while some physicians were willing to sign her agreement, many were prohibited from doing so by their employers. Other physicians simply did not want to take on additional stress.

The amendment to the Minnesota Nurse Practice Act, which passed by overwhelmingmargins in the Minnesota Legislature in May 2014, empowers the most highly educated and specialized nurses (typically with seven years of undergraduate and graduate education) to practice anywhere in Minnesota, and provide consistent, convenient care, and referral services to patients.

While the new law impacts all advanced practice nurses statewide, residents in underserved and rural areas are likely to benefit most from board certified advanced nurses who are able to establish themselves locally with fewer restrictions.

As a nurse researcher who grew up in a rural Midwestern hamlet, I have both the scientific evidence and a wealth of personal anecdotes pointing to the health benefits of being part of a small rural community. The physical activity, clean air, connection to the natural environment and access to generations of supportive family and friends inherent in rural life provide an excellent foundation for young families.

Small towns are an important part of the history and fabric of Minnesota. The ingenuity shown in recent years to introduce new industries, new forms of tourism, technology and regional collaboration demonstrate our commitment to strengthening small towns for the future.

Vibrant health services are essential to maintaining and growing our small communities. Today we can add this 2015 change to nursing practice law to the “win column” for Minnesota’s rural communities.

Thanks to the Minnesota Legislature and Governor for supporting this amendment to the Minnesota Nurse Practices Act.

Connie White Delaney, RN, PhD, is dean and professor at the University of Minnesota School of Nursing. Beth Good is a psychiatric mental health nurse practitioner with Kanabec County Mental Health, First Light system and a graduate of the University of Minnesota’s Doctor of Nursing Practice program.