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When faced with change, Ruth Swenson leans on a simple but steadfast belief: things will work out. It鈥檚 a mindset that has shaped every chapter of her life.听

After more than a decade as a nurse on the med-surg floor at Huggins Hospital in Wolfeboro, New Hampshire, Swenson鈥檚 mentors encouraged her to consider becoming an advanced practice registered nurse (APRN). As she explored her options, a well-timed email about UNH鈥檚 helped make the next step clear. 听

Swenson's previous degrees and coursework allowed her to fast-track into UNH鈥檚 program. With ANEW support, Swenson, a mother of four, completed her clinical hours in the Huggins network near her home in Ossipee.听

鈥淭he ANEW grant was tremendous in allowing me to still be a wife and a mom, despite having a full-time schedule, and without having to work crazy hours or assume a ton of debt,鈥� Swenson says.听

Building a Stronger Workforce 听

ANEW provides funding for primary care family nurse practitioner and psychiatric mental health nurse practitioner students training in rural and underserved communities, helping nurses advance their education while serving where they live. At UNH, it is jointly administered and managed by the and the . UNH received its most recent four-year, $2.6 million federal ANEW grant in 2023, according to UNH ANEW Director Marcy Doyle. 听

鈥淭his particular grant has covered nearly $50,000 of education costs per student, which is huge,鈥� Doyle says. 鈥淥verall, the program has received $3 million, with $1.9 million going directly to students. But we also invest in practices, develop learning communities, support agencies doing critical work, and provide funding to area health education centers.鈥� 听

ANEW鈥檚 goal is to encourage nurses to advance their careers to build a stronger primary care network in New Hampshire. Since 2019, 57 graduates have completed the program, with many continuing to work in the state.听

With an aging primary care physician workforce, many rural and underserved areas are facing a gap in health care services. That gap is starting to be filled by APRNs like Swenson, who, after graduating from UNH, joined Ossipee Family Medicine and Alton Family Medicine, part of the Huggins Hospital primary care network, as a family nurse practitioner. 听

In nearly all rural regions, APRNs deliver the majority of primary care services, with physician assistants (PAs) contributing to a lesser extent, according to Danielle Hernandez, administrator of the NH Health Professions Data Center. Additionally, Hernandez says their strong local ties and younger workforce point to long-term stability, with about 70% having lived or worked in New Hampshire before licensure and nearly 40% entering the field in the past five years. 听

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Addressing Mental Health Needs 听

ANEW is also expanding New Hampshire鈥檚 mental health workforce. 听

Psychiatric nurse practitioners now provide 50% more mental health care services 听鈥� measured in FTEs 鈥� than psychiatrists in the state. Nearly 15% of APRNs practice in psychiatry, compared to just 4% of physicians, according to Hernandez.听

Still, access gaps remain: the National Alliance on Mental Illness that 91,000 New Hampshire residents lack access to mental health treatment. This statistic inspired Fionna Norman, a current Psychiatric Mental Health Nurse Practitioner (PMHNP) student in the ANEW program. Norman, who completed her Master鈥檚 of Science in Nursing at UNH, says her clinical rotations at acute psychiatric facilities motivated her to continue her education through ANEW and UNH鈥檚 Psychiatric Mental Health Nurse Practitioner program. 听

鈥淚 was blown away by the compassion the clinicians showed for patients facing extreme adversity and severe mental illness. They treated each person without judgment and genuinely cared about helping patients achieve a higher quality of life 鈥� mentally, spiritually, emotionally, physically, financially, and socially,鈥� Norman says. 鈥淎NEW aligned perfectly with what my passions are.鈥� 听

Norman鈥檚 next clinical rotations will include federally qualified integrated healthcare centers. Once she completes the program, Norman鈥檚 goal is to continue working with underserved New Hampshire communities and hopes to own her own practice someday. 听

鈥淭he ANEW program really is non-negotiable 鈥� not just for my own career path, but for our community and society as a whole,鈥� Norman says. 鈥淚t provides the support needed to have primary and mental health nurse practitioners in New Hampshire. If we want healthy, economically and socially stable communities, people need access to primary and mental health care.鈥澨�

The "Grow Your Own" Advantage 听

While ANEW is strengthening New Hampshire鈥檚 primary and mental health workforce, it is also changing the way nurses advance in their careers and how communities retain them. 听

One of the biggest obstacles preventing bedside nurses from pursuing further education has been the time and cost involved, says Kris van Bergen-Buteau, director of workforce development and public health programs at the North Country Health Consortium. 听

ANEW helps lower these barriers by providing funding, flexibility, and a strong preceptor network that allows nurses in northern New Hampshire to complete their clinical hours close to home while advancing their careers. This 鈥済row your own鈥� model offers significant advantages over traditional recruitment.听

鈥淩etention becomes easier from an employer perspective because we鈥檙e not worried that these folks will decide they don鈥檛 really like northern New Hampshire after living through one winter and move away 鈥� they鈥檙e already here. Their kids are in our schools. They already have housing,鈥� van Bergen-Buteau says. 鈥淎 lot of the recruitment barriers employers face in today鈥檚 workforce environment don鈥檛 exist when you鈥檙e growing your own workforce. ANEW allowed us to make that an even more powerful recruitment and retention model.鈥� 听

UNH also partners with Lamprey Health Care through its Nurse Practitioner Fellowship Program, which helps new NPs transition from school to practice in primary care. Paula Smith, director of the Southern New Hampshire Area Health Education Center, says ANEW and the fellowship program fit into a broader UNH partnership that also includes youth summer camps and nursing education.听

"We use a partnership model," Smith says. "The more brains you have, the better your potential outcomes can be." 听

Ensuring Sustainability 听

ANEW is essential because there are no permanent funding streams for the education of APRNs, according to Doyle. Unlike medical education, which has established funding streams, nursing education relies heavily on competitive grants. 听

鈥淲hen we don鈥檛 get this kind of funding and we don鈥檛 have a tax base, there鈥檚 a fiscal impact,鈥� Doyle says. 鈥淧eople won鈥檛 return to school, or they鈥檒l have to take on heavy loans.鈥� 听

Hernandez agrees, noting that funding needs to continue to sustain and build on the strides made in strengthening New Hampshire鈥檚 healthcare workforce. 听

"We don't need to reinvent the wheel. We know what鈥檚 evidence-based and what helps with recruitment and retention,鈥� Hernandez says. 鈥淲e've already established what works; we need to ensure its sustainability.鈥澨�