Practice locations of graduates of family physician residency and nurse practitioner programs: considerations within the context of institutional culture and curricular innovation through Titles VII and VIII.

BACKGROUND: Studies have described the aggregate results of federal funding for health professions education at the national level, but analysis of the long-term impact of institutional participation in these programs has been limited. PURPOSE: To describe and assess federally supported curricular innovations at East Tennessee State University designed to promote family medicine and nurse practitioner graduate interest in rural and underserved populations. METHODS: Descriptive analysis of a survey to determine practice locations of nurse practitioner graduates (1992-2002) and graduates of 3 family medicine residencies (1978-2002). Graduates' (N = 656) practice locations were documented using specific federal designations relating to health professions shortages and rurality. RESULTS: Overall, 83% of family medicine residency and 80% of nurse practitioner graduates selected practice locations in areas with medically underserved or health professions shortage designations; 48% of family physicians and 38% of nurse practitioners were in rural areas. CONCLUSIONS: Graduates who study in an educational setting with a mission-driven commitment to rural and community health and who participate in curricular activities designed to increase their experience with rural and underserved populations choose, in high numbers, to care for these populations in their professional practice.

Transition to community-based nursing curriculum: processes and outcomes.

As the health care delivery system evolves, nurse educators must prepare graduates who can meet the comprehensive health needs of communities in a variety of settings. This article describes one college's process of curricular change from a traditional to community-based format. The concepts that guided curriculum development and implementation are presented, along with the outcomes that have resulted from this change. Lessons learned as the curriculum was restructured are described.

Nurse-managed primary care: outcomes of a faculty practice network.

PURPOSE: To describe selected outcomes of nurse-managed primary care in a large faculty practice network (FPN) and to use guidelines proposed by the National Organization of Nurse Practitioner Faculties (NONPF) to evaluate those outcomes. DATA SOURCES: Mission and goals, nursing control, fiscal stability, health care outcomes, and faculty role integration were examined. CONCLUSIONS: Outcomes show that the FPN directly supports the mission and goals of the East Tennessee State University College of Nursing and is managed by nurse faculty members. The FPN uses earned revenue, grants, and contracts to maintain fiscal stability. Patients are highly satisfied with services, and external and internal audits find the quality of care to be excellent. Students are educated in the centers. Faculty members publish and present research and other scholarly work derived from the FPN. IMPLICATIONS FOR PRACTICE: This model demonstrates that faculty practice can work, can meet the evaluation components of guidelines of a major national organization, and can contribute to the improvement of health for vulnerable populations.

Faculty practice and health policy: implications for leaders in nursing education.

This article describes the effects of selected health policies at federal, state, local, and institutional levels on the Mountain City Extended Hours Health Center, a rural nursing faculty practice of the College of Nursing at East Tennessee State University. A description of the ways in which nurse leaders have influenced and shaped health policy through the clinic is also presented. Rural health clinic legislation, state policies on advanced nursing practice, local government decisions, and institutional policies are among those factors considered. Suggestions for nurse leaders to maximize success in achieving policy goals are presented.