The Bureau of Labor Statistics (BLS) shows that the number of jobs for registered nurses and nurse practitioners is expected to increase faster than the average occupation between 2018 and 2028. Additional factors, such as the growing aging population and nurses retiring, have led to a nursing shortfall.
Rural communities are especially affected by the provider gap, as 63% of primary health shortages currently exist in rural communities, according to the Designated HPSA Quarterly Summary (PDF, 953 KB). As a result, these underserved communities may have difficulty accessing care.
To address the nursing shortage and bridge the gap in access to health care in rural areas, hospitals, health care centers, and community leaders are enacting initiatives to recruit and retain nursing talent.
Currently, the United States has the highest number of Americans over the age of 65 who require additional health care services than any other time in history. Additionally, many health conditions that were once terminal are now survivable for the long term.
The nurse workforce is also aging; there are approximately one million registered nurses (RNs) over the age of 50, meaning one-third of the workforce could be at retirement age in the next 10 to 15 years.
There are multiple barriers to entry for nursing in rural areas. As a result, recruitment and retention of nurses in these communities can be challenging compared to urban settings.
According to Lara D. Wilson, executive director of the Maryland Rural Health Association, salaries for rural health care professionals tend to be lower than their counterparts working in metropolitan facilities. This pay discrepancy can be a deterrent for recent nursing school graduates.
Colleges and universities that offer health care degrees, including nursing, are more often located in urban cities, leading students to leave rural areas and stay in close proximity to their alma mater after they graduate, according to a policy brief from the National Rural Health Association.
Lack of exposure
Because many nursing students are not exposed to rural health care during their schooling, they may not feel equipped to work in such an environment or think to explore the space at all, Wilson said.
How Does the Nursing Shortage Affect Patients in Rural Areas?
Nurses play a critical role in patient care. When teams are short staffed, it can affect their work performance and, by extension, patient outcomes.
According to a 2019 report on the challenges of filling nursing positions, a nursing staff shortage can lead to errors and higher morbidity and mortality rates.In hospitals with high patient-to-nurse ratios, nurses experience burnout and dissatisfaction, and the patients experience higher mortality and failure-to-rescue rates when compared to facilities with lower patient-to-nurse ratios.
Further, turnover of health care providers and nurses can interrupt the continuity of care in rural communities, Wilson said. For example, current initiatives to offer loan forgiveness to clinicians and nurses has led to a revolving door of care providers.
“The problem is that clinicians will come to repay their loans, and then when that’s done, they leave,” Wilson said.
Establishing long-term providers who are part of a care team and the broader community has become the focus for rural areas to establish a continuum of care and improve the health of rural residents.
How Can the Nursing Shortage Be Fixed?
To address the nursing shortage in rural areas, health organizations, hospitals, and other community stakeholders are looking for strategies to recruit and retain nurses who are the right fit for a rural environment.
Wilson said that one such strategy is to establish more residency programs for nurses in rural areas.
“If we can get nurses to do their residency in the rural communities, they can see how rewarding working and living in a rural community is,” Wilson said. “I think that’s our best bet at encouraging clinicians to come to the community.”
Similarly, rural health stakeholders are looking into how they can attract nursing professionals who have existing ties to rural communities. Distance learning, for example, presents the opportunity for more rural residents to pursue nursing school while remaining in their community.
As part of the Health Resources and Services Administration, the Federal Office of Rural Health Policy helps increase access to care for underserved populations and build health care capacity. Their website includes a variety of resources, including funding opportunities for rural health programs.
The National Association of Rural Health Clinics promotes rural health clinics as a means of improving and sustaining the availability of quality, cost-effective health care to patients in rural, medically underserved areas.
The National Center for Rural Health Works provides information to help local decision-makers in rural communities become proactive and involved in planning and supporting their local health systems. Their website includes toolkits and templates for community leaders, as well as a calendar of webinars and other learning opportunities.
The National Organization of State Offices of Rural Health assists State Offices of Rural Health in their efforts to improve health care. The organization’s directory allows users to search for the contact information of each state’s rural health office in the United States.
The National Rural Health Association’s mission is to provide leadership on rural health issues through advocacy, communications, education, and research. The organization’s website includes publications and information about advocacy. Members of the association have access to additional resources.
The National Rural Health Resource Center provides technical assistance, information, tools, and resources for the improvement of rural health care. The resource library is a great asset for individuals seeking actionable information for their community.
The Center for Rural Affairs advocates for the improvement of rural communities across a variety of issues. Their website includes a page on rural health that is regularly updated with news and resources related to the topic.