While common narratives today focus on the steady loss of healthcare options in the rural South, medical providers, doctors, and other practitioners are still working in these areas, making do with what they have. Recent changes to insurance and Medicaid have affected the financial viability of many rural operations, but those challenges lead to questions, such as: what can be done? what is being done? This essay, written by a nurse practitioner in South Carolina, explores some of her experiences with trying times and uncertain circumstances, effectively challenging common beliefs and current narratives.
The Rural Winds of Change:
Accepting the Risk
by Dr. Janet Lynne Douglass
Is this wind a light breeze or a raging hazard? Am I being blown into a “useless place,” or perhaps a better question is: “will I be useless” in this new place? Questions to be contemplated, answered, ignored, or do I step into the unknown and channel the energy of these uncertain winds to bring about change? I’m no anemologist, but I am a risk taker.
It was the early 2000s, I was a board-certified family nurse practitioner working at a university in South Carolina, holding the position of clinical assistant professor in the nursing college. I managed a small family practice for the college. I worked in a comfortable office in an upscale neighborhood with everything needed for success. The patients I cared for were insured, and delightful. Students, bright and eager to learn come for clinical experiences. The situation was comfortable. I had an established routine. I drove an hour to and from work daily from my home in a small town north of the university city.
Why the dilemma? In the late 2000s, an opportunity to join a federally qualified health center to establish a family practice in a very rural part of the county where I reside presented itself. In this remote rural, underserved area, the need for health care was evident, with poverty prevailing, transportation poor. Twenty miles from any healthcare facility, the practice site left a lot to be desired, an old mobile unit in a parking lot surrounded by wooded areas. Thus, my dilemma, do I stay comfortable where I am well established, or do I go? Have I become complacent in the world of academia, or do I have more to offer mankind by changing directions?
There would be consequences to this decision either way. The timing seemed a bit unfair. I was very happy at the university practice and loved the teaching aspect. So, like all seasoned decision-makers, I weighed the pros and cons. During the process, I determined that, just as the wind is defined as the movement of energy from one location to another, my passion for helping others blows just as strong. I must courageously accept the challenge. The driving force behind my decision was the chance to make a difference in my county by promoting health and advocating for those less fortunate.
The change took place slowly, with goodbye parties, colleagues saying all the things that made me doubt myself and my decision. I knew they meant well, but I stood firm in my decision, fighting feelings of panic and uncertainty.
Months later, in my “new place,” I discovered that the roof leaked, the floor sagged, water pressure was poor, and the internet was slow. There were wild animals in the woods surrounding the unit. On my first day there I saw a bobcat prowling at the edge of the woods. I tried to feel at home, but the patients were challenging. It was eye-opening to see the effects the lack of health care had over time on this community. Adults with untreated hypertension, kidney disease, diabetes, heart disease, obesity, as well as children with untreated asthma, allergies, diabetes, and lacking age-appropriate immunizations. The upside, however, was that the patients were kind, that they needed me, and that they made that very clear.
As time passed, I met a personal goal and earned my doctoral degree, but I had a homesick feeling. I missed my nurse practitioner students. Having left the university on good terms, I submitted a proposal for having students come to my rural site for their clinical experience. What better place to train than where the need is so great? These learning experiences could be so valuable. Also, I could use the help. The proposal was accepted, an affiliation agreement written, and soon I had my first student at the site. This was a great benefit to my patients, as well as to me.
This change was shaping into something positive, something with much potential, and I started to expand my ideas beyond the exam room. I offered health classes in the community at a local church. I grew vegetables in the office yard for patients to enjoy. The practice was becoming a vital part of the community.
As the practice thrived, it gained attention. A larger, progressive health entity took us in. A grant was written to fund a new building. A clinical site was established at the local elementary school to serve students. The practices still thrive today, sixteen years later, providing expert care for people of all ages in a previously underserved area.
Today, I am retired, confident and thankful that the wind blew me in the right direction, and importantly, that I accepted the challenge and took the risk.
Dr. Janet Lynne Douglass is a retired family nurse practitioner living in rural South Carolina. She received her undergraduate degree and her master’s degree in nursing from the University of South Carolina. She received her Doctorate in Nursing Practice from The George Washington University, where in 2020 she was named one of the College of Nursing’s ten most distinguished alumni for professional achievement, leadership, and expertise in patient care. She is a member of the American Nurses Association, the South Carolina Nurses Association, where she is active with the Coalition for Access to Care. In retirement she enjoys reading, creative writing, playing guitar, teaching guitar lessons, and outdoor adventures.
Lesson Plan: NH-MSF Lesson Plan Personal-Historical
Nobody's Home 