1. International Rural Nursing Conference July 19, CAPT Debra Scott, USPHS Regional Nurse Consultant Health Resources and Services Administration Office of Regional Operations , Denver

2. Health Resources and Services Administration Improving health and health equity through access to quality services, a skilled health workforce and innovative programs

3. Today’s Discussion
HRSA Overview
HRSA Support for Rural Health
The Role of Nurses in Rural Health Care and Delivery System Reform
Questions/Discussion

4. Agency Objectives Increase Access to Quality Health Care and Services
Strengthen the Health Workforce
Build Healthy Communities
Improve Health Equity
Strengthen Program Operations

5. Office of the Administrator
Bureau of Health Workforce
Bureau of Primary Health Care
Federal Office of Rural Health
Policy
Healthcare Systems Bureau
HIV/AIDS Bureau
Maternal and Child Health
Bureau

6. HRSA Regional Offices

7. Bureau of Health Workforce (BHW)
Programs Include:
National Health Service Corps Scholarship and Loan Repayment
NURSE Corps Scholarship and Loan Repayment
Diversity Programs including Centers of Excellence and Scholarship for Disadvantaged Students
Inter-Professional Training
Behavioral Health Workforce Education and Training
Grants to health professions schools and training programs

8. Repayment Loan Program Program Scholarship
The National Health Service Corps (NHSC) provides financial support to providers in exchange for working at NHSC-approved sites.
Repayment
Loan
Program
Program
Scholarship

9. More than 9,000 NHSC primary care providers are working in communities with limited access to health care nationwide. For more Information:
Physician
Nurse Practitioner
Mental Health
Dentist
Physician Assistant
Nurse Midwife • 2%
2% • Dental Hygienist
25%
16%
14%
12%
29%

10. HRSA Nursing Resources
Advanced Nursing Education (ANE)
Advanced Education Nursing Traineeship (AENT)
Advanced Nursing Education Expansion (ANEE)
Faculty Development: Integrated Technology into Nursing Education and Practice (ITNEP)
Innovative Nurse Education Technologies (INET)
Nurse Anesthetist Traineeship (NAT)
Nurse Education, Practice, Quality and Retention (NEPQR)
Nurse Faculty Loan Program (NFLP)
Nurse Managed Health Clinics (NMHC)
Nursing Assistant and Home Health Aide (NAHHA)
Nursing Workforce Diversity (NWD)
Personal Home Care Aide State Training (PHCAST)

11. Bureau of Primary Health Care (BPHC)
Health Center Program grantees – Public and private non-profit health care organizations that meet certain criteria under section 330 of the PHS Act and receive funds under the Health Center Program.
Health Center Program look-alikes – Health centers that have been designated as meeting the requirements of a health center, but do not receive grant funding under the Health Center Program

12. Health Center Program
There are 1278 Health Center grantees nationally that serve almost 23 million patients in 2014.
Section 330 grant funds (up to $650,000/year) to offset the costs of uncompensated care and other key enabling services
Health Centers (CHCs) are not free clinics, but provide services on a sliding fee scale

13. Healthcare Systems Bureau (HSB)
Organ and Blood Stem Cell Transplantation Program
Poison Control Program
340B Drug Pricing Program
National Vaccine Injury Compensation Program
National Countermeasures Injury Program
Hill-Burton Program
National Hansen’s Disease Program

14. HIV/AIDS Bureau (HAB)
Ryan White HIV/AIDS Program works with cities, states, and local community-based organizations to provide a cohesive system of care for low- income people living with HIV who are uninsured or underinsured.

15. Maternal and Child Health Bureau (MCHB)
Title V Block Grants
Healthy Start Programs
Maternal, Infant, and Early Childhood Home Visiting Program
Family-to-Family Health Information Centers
Universal Newborn Hearing Screening
Traumatic Brain Injury
Emergency Medical Services for Children
Children with Autism and Epilepsy

16. Federal Office of Rural Health Policy (FORHP)
Supports and funds State Offices of Rural Health
Administers Outreach and Network Development grant programs
Funds and conducts research
Provides technical assistance
Oversees the University of North Dakota’s Rural Assistance Center
List of current grantees, sorted by state or type of grant program:

17. Federal Office of Rural Health Policy (FORHP)
Other Major Grant Programs:
Hospital – State
State Offices of Rural Health, Rural Hospital Flexibility Grant, Small Rural Hospital Improvement Programs
Telehealth
Licensure Portability, Telehealth Network, Telehealth Resource Center Grant Programs
Community Based
Rural Health Outreach, Rural Network development, Network Planning, Quality Improvement, Rural Workforce and Delta States Rural Development

18. Rural Health Information Hub
Online Library of funding opportunities and best practices
Specific State information and guides
Community Health Gateway with evidence based models and tool kits
Tools for Success
Publications and updates
Technical assistance on request.
Link:

19. HRSA Rural Resources
Rural Health Network Development Grant Program
Rural Health Network Development Planning Grant Program
Rural Health Information Technology Workforce Program
Rural Network Allied Health Training Program
Rural Training Track- Technical Assistance Cooperative Agreement
Small Health Care Provider Quality Improvement
Telehealth Network Grant Program
Rural Health Research Center Cooperative Agreement
Telehealth Resource Center Grant Program
Flex Rural Veterans Health Access Program
Licensure Portability Grant Program
Small Rural Hospital Improvement Grant Program (SHIP)

20. HRSA Rural Resources Currently funded projects include:
Black Lung Clinics Centers of Excellence
Black Lung/Coal Miner Clinics Program
Public Access to Defibrillation Demonstration Projects
Radiation Exposure Screening and Education Program
Rural Access to Emergency Devices
Rural Opioid Overdose Reversal Grant Program
Rural Benefits Counseling Program
Rural Health Care Coordination Network Partnership
Rural Health Care Services Outreach Grant Program

21. HRSA Health Promotion Resources
Health Literacy
Oral Health
Bright Futures Prevention & Health Promotion for Children,
Adolescents & Their Families (HRSA Grantee Web site)
Healthy Tomorrows Partnership for Children: Community- Based
Pediatrics (HRSA Grantee Web site)
National Adolescent Health Information Center (HRSA Grantee Web site)

22. Other HRSA Resources
Communities of Practice/Collaborative Learning Teams
 Culture, Language and Health Literacy
Smoking Cessation
How to Help Veterans & Their Families
Quality Resources:
Quality Improvement & Risk Management Training
Provider's Guide to Quality & Culture (HRSA-supported partner Web site)
Quality Improvement & Safety Net Providers

23. Find Funding Opportunities
Grants.gov (
HRSA Website (
HHS Forecast
.hrsa.gov/grants/
Register to get notifications when opportunities are available:
subscriptions.html

24. Grant Application Resources
The Department of Health and Human Services forecasts its planned grant opportunities:
HRSA funding opportunities:
Alternatively, use the Federal grants source:
Overview of the application process, from start to finish: antprocess.pdf

25. The Role of Rural Nurses in Health Care and Delivery System Reform

26. Benefits of the Affordable Care Act for Americans
Improving Quality and Lowering Health Care Costs
Free preventive care
Prescription discounts for seniors
Protection against health care fraud
Small Business Tax Credits
New Consumer Protections
Pre-existing conditions
Consumer Assistance
Access to Health Care 
Health Insurance Marketplace.

27. Benefits of Health Reform
Benefits for Women
Providing insurance options
Covering preventive services
Lowering costs
Young Adult Coverage
Coverage available to children up to age 26

28. Benefits of Health Reform
Strengthening Medicare
Yearly Wellness Visit
Many Free Preventive Services for some seniors with Medicare
Holding Insurance Companies Accountable
Insurers must justify any premium increase of 10% or more before the rate takes effect

29. Delivery System Reform
The Affordable Care Act is about more than affordable, quality coverage. It includes tools to build a health care system that puts patients at the center by…
Paying for Quality Care Changing how doctors and health care systems are paid, so they can focus on making people healthier.
Improving Health Care Improving how care is delivered, by encouraging better coordination and focusing on wellness and prevention.
Unlocking Data Unlocking health care data and putting it to work when and where doctors, individuals, and hospitals need it.

30. Health Systems Reform
CMS funds for health care innovation and Delivery System Reform
Payment Reform- Value Based Purchasing
National Prevention and Health Promotion Strategy.
Prevention and Public Health Fund supports initiatives and policies:
Improve community and clinical prevention
Funds for research and data collection
Increase primary care and public health professionals.
Mandatory funding for public health departments to supplement existing funding.
Funds to promote a community health approach to prevention and well-being.

31. Some Health Reform Concepts
Health (Medical) Home
Meaningful Use
Accountable Care Organizations
Value Based Purchasing
Quality Improvement Organizations
Care Transitions
Increasing use of Technology/EMRs

32. Rural Nursing and Health Reform
Health Reform goals have long been the
priorities of the nursing profession
With 3 million members, nursing profession is the largest segment of health care workforce
Critical role in increasing access to primary and preventive health services, while improving quality and controlling costs, especially in rural settings

33. Rural Nursing and Health Reform
Essential that nurses in all roles and settings assume a more active role in health reform
Participate in policy discussions
Assume leadership roles as decisions are made
Be involved in health care reform at the facility,
community, and statewide levels
As a profession we have an historical opportunity to play a key role in the transformation of an entire health care system
Rural nurses can and should assume a fundamental role in this transformation

34. Opportunities for Nurses with Health Reform
The Robert Wood Johnson Foundation (RWJF) and the IOM two- year initiative to assess and transform the nursing profession
The committee developed four key messages:
Nurses should practice to the full extent of their education and training.
Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression
Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States.
Effective workforce planning and policy making require better data collection and information infrastructure

35. Rural Nurses Have the Ideal Skill Set
Focus on prevention
Public education/ PH messages
Collaboration
Surveillance and data collection
Community outreach
Quality improvement processes
In depth knowledge of communities

36. Emerging Roles in Rural Settings
Care coordinator including population health management and tiered coordination.
Faculty team leader; moving inter-professional nursing education to community settings.
Informatics specialist-roles in design, data interpretation, and telehealth applications

37. Emerging Roles in Rural Settings
Nurse/family cooperative facilitator;
Virtual and in person health care to people where they live and work.
Primary care in community health settings.
Nurse Navigator and facilitator of transitions to care.

38. Emerging Roles in Rural Settings
Generate evidence and engage
in research.
Leadership at every level, and in all sectors.
Administrative, legislative, or policy decision making positions.

39. . “Today’s nurses are undereducated for demands of practice”
Carnegie Foundation Report*

40. 2014 HRSA FUNDED PROGRAM
# OF GRANTEES
FUNDING LEVEL
Nursing Workforce Diversity (NWD) 44
~ $14.7M
Nurse Education Practice Quality Retention- IPCP
(NEPQR-IPCP) 53
~$24.4M
Veterans to BSN (VBSN) 19
~ $5.8M
Advanced Nursing Education (ANE) 76
~ $25.1M
Advanced Nursing Education Expansion (ANEE) 26
~ $31.0M
Advanced Education Nursing Traineeship (AENT) 87
~ $28.6M
Nurse Anesthetist Training (NAT) 82
~ $2.7M
Nurse Faculty Loan Program (NFLP) 93
~ $23.2M

41. Great Time to Assess Your Career
Newly funded programs will required a
well trained nursing workforce.
Emerging opportunities in academic and
nursing leadership roles.
Need for increased skills and competencies.
Opportunities with new funding for public health and nursing workforce, and faculty training.

42. The Culture of Health Care
The demands on the health care workforce and resources will continue to increase and care will continue to become more complex.
Developing well-functioning teams becomes
a crucial need throughout the health care system.
National Center for Interprofessional Practice and Education provides resources, tools and best practices.

43. Interprofessional Practice
Health care teams can be created to respond more efficiently to care challenges, ensuring better patient outcomes, improved quality and lower costs.

44. Culture of Health Care
Health care reform provides an opportunity to develop a partnership culture.
Communication flows in many ways
All Profession’s contributions are valued
Successful Interprofessional Practice Models
Hierarchies of Actualization
Documented difference in outcomes in a healthcare culture of domination and partnership.

45. “May we hope that when we are all dead and gone, leaders will arise who have been personally experienced in the hard, practical work, the difficulties and the joys of organizing nursing reforms, and who will lead far beyond anything we have done.” Florence Nightingale
We have the opportunity to come together now and be the nurses that contribute to the reforms that will take place in our lifetime.

46. Questions?
Debra Scott, RN, MS, MA Captain, US Public Health Service Health Resources and Services Administration (HRSA) Office of Regional Operations in Denver Phone: Web: hrsa.gov/about/organization/bureaus/oro/ Twitter: twitter.com/HRSAgov Facebook: facebook.com/HHS.HRSA