Across the state of Alabama, with the closure of rural hospitals and the retirement of hometown physicians, rural communities face a lack of accessible medical care. Nurse practitioners are helping fill health care needs by providing primary and specialty care in rural and urban underresourced communities.
University of Alabama at Birmingham School of Nursing graduate Amber Pennington, MSN, FNP-C (MSN 2013), a family nurse practitioner, realized her dream of opening a primary-care clinic, Vernon Medical Center, on January 24, 2022. She wants to help fill health care needs in her rural Lamar County hometown of Vernon.
Pennington already knows many of the patients who will use her clinic, having previously worked in the area while completing her master's degree at UAB. During her preceptorship, Pennington witnessed the challenges of treating underresourced communities firsthand, but she also found a passion for rural health care.
“When I first became a nurse practitioner, I was in rural health care and I loved the one-on-one patient care,” Pennington said. “After my preceptorship, I did hospitalist work for several years at DCH in Tuscaloosa, but I missed the personal aspect of getting to know patients. With hospitalists care, you often lose touch with patients after they are gone. Not here in Vernon. Very few primary care physicians come and open family care practices in rural communities, especially in towns of only 2,000 people.”
There are 4.8 primary care physicians for every 10,000 people in Alabama, and 55 of the state's 67 counties are designated as rural, with 62 being designated as primary care shortage areas. And, in these rural counties the population continues to grow at a faster rate than urban areas, exacerbating the need for more health care providers. Nurse practitioners like Pennington are improving access to health care for all Alabamians by increasing the number of rural primary providers living and serving in these underresourced areas.
Support from all corners
While working in Tuscaloosa, an opportunity arose to take over an existing clinic in Vernon. After a few stops and starts, and the death of her best friend and fellow UABSON graduate Amber Hattaway, MSN (MSN 2017), with whom she was going to partner to open the clinic, her dream became a reality.
“Having previously worked in Lamar County, people were excited to have me come back and I was excited too, but I compare it to having a kid—you never feel like you are quite ready,” said Pennington. “For nurse practitioners, we are often left to believe that is for the doctors, the bigger guys. But, the town had a meeting and they led me in the direction to take that step saying 'we'll be here for you.' The owner of the building offered to prorate the lease for two months until the credentialing was done. Everyone understood that I had to start from scratch. I am so thankful for everyone that has helped.”
Pennington's journey to becoming a family nurse practitioner and opening her own clinic was challenging. Finances and living in a rural community made attending graduate nursing school difficult. However, Pennington was determined to become a student at UABSON and sought the advice of longtime family friend and Vernon native Patrick McNees, PhD, FAAN, retired Associate Dean from the UAB School of Health Professions and his partner, late UAB School of Nursing Associate Dean for Research and Scholarship Karen Meneses, PhD, RN, FAAN. Meneses was a renowned nurse scientist whose research on breast cancer survivorship is revered in medical communities globally. McNees and Meneses mentored and supported Pennington throughout her journey because they “believed in Amber,” said McNees. “The world changes because of people taking a risk and having the tenacity to not accept 'no' as the answer. I believe Amber has that tenacity.”
“Dr. Meneses cared about rural Alabama and she knew we were very underserved,” Pennington said. “The cancer rates, especially breast cancer rates, in Lamar County are just through the roof. In the fall of 2017, Dr. Meneses hosted a breast cancer awareness program in Vernon for free [with the support of the UABSON]. For them to [offer] that much support for our small town was so gracious.”
In honor of her mentorship and dedication to nursing, Pennington has dedicated the lobby of her center to the memory of Meneses and Hattaway. Hattaway was diagnosed with breast cancer in December 2019. She passed away in July of 2020. Pennington plans to hang portraits of both in the lobby.
Pennington credits much of her success to her education from the UABSON and local community support.
“I wouldn't be where I am today if it wasn't for UAB and the distance accessible master's program,” said Pennington. “I was married with young kids. It was amazing to be able to get a degree I could be proud of and also be able to participate in clinicals and bed labs while taking care of my family. In the future, I want to work closely with UAB and the schools of nursing in our area to get as many nurses to come through the clinic as I can. I think that new nurses would see this as an inspiration, that we can do it. We are going to have to if we want rural health care in Alabama.”
Developing Rural NPs
To help nurses like Pennington, the UAB School of Nursing has a targeted initiative, the Graduate Nursing Education Primary Care Scholars (GNEPCS), for current nurse practitioner students planning to provide primary care in one of Alabama's rural-designated counties upon graduation. Primary Care Scholars enroll in the same courses as their classmates but receive mentoring, individualized content relative to rural health issues, preceptorships with rural health providers, and other opportunities for professional and leadership development, with the end goal of after graduation, these nurse practitioners serve patients in rural communities.
