Giving Heart and Soul to a Rural Practice

Dr. Viva Tapper confers with a patient in her clinic on the Olympic Peninsula - Gretchen Harnack

By Sharon Griggins
How do you make room in a schedule that is already packed with patients? This is the continuing dilemma for Viva Tapper, PhD, ARNP. As one of few psychiatric nurse practitioners on the Olympic Peninsula, Tapper wishes she could find more hours to see the many local residents in need of care. For her, the rural nursing shortage is very real.

All over the country, hospitals, clinics, nursing homes and other medical facilities are scrambling to find staff. Especially urgent is the need for nurses with advanced degrees and clinical specialties. In rural America, already hard-pressed for medical services, the lack of highly-trained nurses means one more weak link in the health care system.

Finding nurses with advanced degrees who want to practice in rural settings like Washington's Olympic Peninsula is difficult. Although the most likely candidates are nurses who already live and work in the area, they usually must leave their community to obtain training. And once they have moved to an urban center to complete their degree, they tend not to return. But for Psychiatric Mental Health Nurse Practitioners (PMHNPs) like Viva Tapper in Port Townsend and Jan Kemmerer in Grays Harbor, working in a rural community fits their lifestyle and work ethic. Both find satisfaction practicing in small towns, despite the challenges of providing mental health services in an area with few resources or medical specialists.

Viva Tapper has lived in Port Townsend since the early 1970's, leaving only to complete her degrees from the UW. As a psychiatric nurse practitioner with prescriptive authority, Tapper manages a full caseload of patients who are referred to her from local physicians. Her services are in especially high demand because there are no psychiatrists in the area. Practicing in a small town suits the way Tapper likes to work.

Collaborating with doctors is easier. Knowing you are a valued member of the community feels good. "I like being independent and I knew I could do that more easily here than in an urban setting," says Tapper. "And I like being a member of this community, knowing the families of patients, knowing their situations."

Working in a rural area also takes a person who enjoys country living. Jan Kemmerer, a PMHNP who practices with Evergreen Counseling Services in Hoquiam, Washington, is just that kind of person. "I can't imagine working in an urban setting," she says. Having been raised in a rural community, Kemmerer enjoys living on a small farm with her five dogs, four horses and flock of poultry.

Kemmerer agrees with Tapper that nurse practitioners fill a huge gap in providing mental health services on the Peninsula. She also feels that they bring a certain touch to their work. " I think we focus more on the whole patient, not just the mental health piece," Kemmerer says. "I think we give more heart and soul to the practice. "

For her, the hardest part of working in a rural area is the lack of outside services to assist patients. "It's hard not having the resources that would be available in an urban area, things like an eating disorders clinic or grief support service," she says. "Often the closest services are just too far away to be practical."

Shortages of skilled nurses like Tapper and Kemmerer will undoubtedly continue in similar rural areas, but the UW School of Nursing is hoping that distance learning programs (see related article on facing page ) are helping to alleviate the problem. Associate Professor Mary Durand Thomas, PhD, director of the SON's PMHNP focal area offering distance support for students in Port Angeles and Olympia, hopes that it will help rural nurses remain within their own communities. "I think the program is definitely helping to get more trained specialists where there are particular needs," she says.

Viva Tapper is ready for more colleagues to join her. Ultimately, she would like to organize a group of PMHNPs to provide mental health services throughout the Olympic Peninsula. "This area is ideal for nurse practitioners," she says. "I think that people don't go into rural areas because they think they can't support themselves. But there are so many people here who need services, I don't think that's true."

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