Rural health care

Nurse practitioner Buzz Jeansonne is working to help close the primary care gap in central Louisiana. With a staff of six other nurse practitioners, he manages five rural clinics. On an average day, each clinic sees more than 40 patients.

“The clinics are located so we can serve the most people,” said Jeansonne. “Most patients don’t want to travel out of town to be seen because they don’t have transportation or money for gas. Still, some do travel 10 to 12 miles to get to one of our clinics."

A native of Cottonport, Jeansonne was approached in 2006 by a local family practice physician about taking over his two clinics. “He wanted to retire,” said Jeansonne. “He was my family physician growing up, so we already had a relationship. He said he was having difficulty finding a physician who was willing to move to a rural area and invest in a rural clinic. We struck an agreement, and he acted as my collaborating physician until he completely retired a year ago.”

Jeansonne said the working environment was less than ideal when he took over the clinics. “In the beginning, the hospitals would not recognize me as a provider,” he said. “They wouldn’t put my name on a patient’s lab work or radiology report. The hospital physicians would not even get on the phone with me when a patient needed admission. Since then I’ve had time to develop relationships with most of these physicians and they understand the vital role played by advanced practice registered nurses (APRN) in the continuum of care.”

Jeansonne cites the lack of interprofessional collaboration as one of the biggest challenges that faces a nurse practitioner who manages his or her own clinic. “We know that we are not physicians, but we need to collaborate with physicians just as they collaborate with each other,” he said.

“This does not mean that simply collaborating with one physician allows us the ability to achieve the best results for our patients. I collaborate weekly with a variety of specialists and other nurse practitioners. Practicing in a rural setting is best when there is respect and collaboration between all healthcare providers.”

Jeansonne believes all providers have a “referral threshold,” a level at which their patients would be better served by another provider. “Physicians, APRNs, physical therapists, RNs and other healthcare professionals – all of us are trained to recognize that threshold,” he said.

“We work to keep our patients healthy by following the national standards of care for prevention and maintenance of the many disease processes that affect our population. That’s the job of a nurse practitioner. ”

All Jeansonne’s clinics qualify as independent rural health clinics, a designation based on the lack of local access to primary care services. Payments for services are accepted through private and public insurance, and patients who self-pay are charged on a sliding scale according to their ability to pay.

The clinics provide all the services nurse practitioners are allowed to offer in Louisiana including physicals, diagnosing and treating acute illnesses and chronic conditions, analyzing X-ray reports and lab tests and prescribing most medications. In Louisiana, APRNs are prohibited from prescribing certain drugs such as those for weight loss and pain management. In addition, they may not admit patients to home health agencies and hospice. “This in particular hinders continuity of care for some patients,” said Jeansonne.

The Campaign for Action is working nationally to remove scope-of-practice barriers that prevent all APRNs from practicing to the full extent of their education and training. Some states have already changed the policies that hindered APRNs’ ability to provide the best and most efficient care by removing the requirement for collaborative practice agreements, giving APRNs admitting privileges at all health care facilities and allowing them to perform all tasks that are within the scope of their education and training.

Jeansonne hopes Louisiana policy makers will see what is happening across the country and work with the medical community to develop similar policies. “Let’s break through those barriers and work together to take care of the people in our state,” he said. “We all want the same thing – accessibility to healthcare and the best possible outcomes for our patients.”

Jeansonne sees a growing need for primary care healthcare providers in rural settings. “Community leaders in rural areas continue to contact us because they are unable to recruit physicians to serve their populations,” he said. “We are determined to do all we can to continue providing much-needed care for these communities.”

In the photo above, Nurse Practitioner Buzz Jeansonne stands in front of his clinic in Simmesport. Jeansonne also has family clinics located in Cottonport, Mansura, Montgomery and Elizabeth.