Publication Date


Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Susan McNiesh

Second Advisor

Lilo Fink

Third Advisor

Lawrence Turner


rural healthcare, access barriers, nurse practitioner


Persons living in rural areas designated as having primary care provider shortages often lack access to timely and appropriate levels of care, frequently forcing them to forego care, delay treatment, or seek care in an emergency department for non-urgent complaints. This qualitative study reviewed evidence-based research and data generated from two focus groups sessions to generate a body of distinctive knowledge of the barriers to primary healthcare access as perceived by members of this rural, medically-underserved area of northern California. The theme that was identified, through conventional qualitative content analysis, as most prevalent among subjects was the inability to schedule timely appointments with their primary care provider for unexpected minor illnesses or injuries: with average reported wait times for an appointment from one to three weeks, which was unacceptable to all participants. A secondary theme, endorsed by 100% of focus group participants, was the ability of a same-day, walk-in, immediate care clinic operated by a family nurse practitioner to meet the needs of patients unable to otherwise receive safe, timely, effective, efficient, equitable, and patient-centered health care. Implications for nursing practice include, through implementation of this type of practice model, the ability to offer improved quality of health care and cost effectiveness while providing a short-term solution to an otherwise complex and multi-layered health care systems challenge.


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