Rural Health Nursing

Would you describe yourself as a “jack of all trades'' when it comes to your nursing skills?  Do you enjoy job autonomy and advocating for vulnerable patients?  If you answered “yes”, then the nursing niche you have been looking for just may be rural nursing.  Read on to learn more about the vital role rural nurses play in isolated communities. 

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Rural Health Nursing

People living in rural areas have unique needs and face more obstacles in accessing healthcare than those living in urban areas.  According to the National Rural Health Association, rural areas tend to have higher numbers of older adults and people with chronic disabilities. Rural nurses have a vital role in the health of rural communities by bridging the gaps between the need for care and access to care.

Roles and Duties

People in isolated and small rural communities across the U.S. depend on nurses for healthcare.  In some rural areas, the nurse may be the first and only contact residents have with a healthcare provider.  Rural nurses are unique because they tend to be “generalists” with the ability to care for young to old.  Job roles vary depending on the healthcare setting and patients being served.  Here is a look at some of the duties a rural nurse may have:

  • Patient assessments
    • Physical, psychosocial and spiritual
  • Patient safety assessments (fall risk, violence, substance abuse, elder abuse, etc.)
  • Assessing basic needs (food, housing, income, resources, access to care)
  • Medical histories, including family
  • Developing and implementing plans of care
  • Evaluating treatment effectiveness and works with interdisciplinary team when changes are needed
  • Evaluating treatment goals and outcomes
  • Providing care coordination, referral and follow-up to vulnerable/high risk groups
  • Advocating for vulnerable individuals and populations
  • Providing education to patients and communities

Qualities of the Rural Nurse

Rural nursing is rewarding for many, but it’s not for everyone. Take a look at some of the qualities nurses need to work in underserved rural communities.

  • Ability to work independently with limited supplies and resources
  • Assessment skills in a variety of nursing areas
  • Enjoys the educator role
  • Awareness of the area’s community resources
  • Deep understanding of the community’s cultural norms and values
  • Creativity to find challenge solutions without a major medical center
  • Embrace innovative solutions, like telehealth that bridge the community to health services
  • Strong knowledge of pharmacology
  • Ability to manage and delegate
  • Excellent communication skills

Work Environment 

Rural nurses typically work in smaller settings, which may include:

  • Hospitals
  • Doctor’s office
  • Community clinic
  • Mobile health center
  • Telehealth center
  • Patients’ homes

Challenges

People living in rural areas are more likely to die from all 5 leading causes of death when compared to urban populations.  Rural residents often have unique characteristics that contribute to poorer health overall.  These characteristics include:

  • More older adults
  • Lower incomes
  • More chronic illness
  • Fewer with health insurance
  • Fewer jobs that offer health benefits
  • Less education
  • Higher hypertension and stroke rates
  • Higher suicide rates 
  • Limited mental health services
  • Fewer transportation options
  • Less access to health foods
  • Fewer opportunities for physical activity
  • Limited access to specialists and emergency care

Required Education

Rural healthcare employers hire all levels of nurses, including:

  • Licensed practical nurses
  • Registered nurses (associate and bachelor level)
  • Advanced practice nurses
  • Nurse practitioners

A growing number of colleges offer rural health concentrations as part of their advanced practice program.  Here are just a few examples:

University of California San Francisco

University of Illinois Chicago

East Carolina University

University of New Mexico

Certifications

There is no specific certification for rural nursing.  However, other common certifications bring value to the rural nurse and benefit the overall community.   Example certifications include:

  • Clinical Nurse Leader
  • Certified Hospice and Palliative Care Nurse
  • Certified Gerontology Primary Care Nurse Practitioner
  • Certified Wound and Ostomy Nurse
  • Certified Diabetes Educator
  • Certified Addictions Nurse

Professional Organizations and Associations

Check out the Rural Health Information Hub website for a detailed list (with links) of organizations and associations with an interest in improving rural health.  Here is a sneak peek at just a few:

Rural Nurse Association

Association of Clinicians for the Underserved (ACU)

National Association for Rural Mental Health

National Rural Health Association

Job Outlook

The COVID-19 pandemic has deepened an already critical nursing shortage, placing the demand for nurses on the front pages. The U.S. has the highest number of people over the age 65 than any other time in history.  Add to the shortage mix a third of the nursing workforce is expected to retire over the next 10-15 years.  The demand for rural nurses is dire and interested nurses can take advantage of incentives to address healthcare shortages in these communities.  For example, The National Rural Health Association’s Nurse Corp Loan Repayment Program pays up to 85% of unpaid nursing education debt for

  • Registered nurses
  • Advanced practice registered nurses
  • Nurse Faculty

So, what’s the catch?  If you receive a monetary award, you must work two years in either:

  • A Critical Shortage Facility
  • An eligible nursing school, as nurse faculty

Check out the Nurse Corps Loan Repayment Program Fact Sheet

Salary Outlook

Rural nurses typically earn less than nurses working in urban areas.  However, there are often other financial “perks” offered by rural employers to attract and retain nurses.  For example:

  • Tuition reimbursement 
  • Student loans
  • Education leaves
  • Cross-training
  • Guaranteed pay raises
  • Paid time off
  • Preceptor Programs
  • Sign-on bonuses

Rural healthcare facilities will be working harder to hire nurses as COVID-19 pushes the limit of available resources.

Let Us Hear from You

Are you a rural nurse?  Share what led you to work in rural communities and what are the challenges and rewards in your practice.

References
National Rural Health Association

Addressing the Rural Nursing Shortage

Preventing Chronic Diseases and Promoting Health in Rural Communities

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J.Adderton

About J.Adderton, BSN, MSN

(Columnist)

J.Adderton is a nurse with over 25 years experience. She obtained her MSN with a rural nursing and lives in a small rural community. "I find it refreshing to see how rural nurses are changing our community for the better" -J. Adderton

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Specializes in BSN, RN, CVRN-BC.

The challenges in access to health care are large the fault of our system which pays less for health care delivered in rural areas.  We have many nurses who drive in an hour or more because they can't find jobs that pay well in the surrounding smaller towns.  Why do they pay less?  Because they get reimbursed less.  This is a crisis largely of the system's creating.  Why?  Unless you grow you own groceries they are more expensive in the country.  Gasoline is more expensive in the country.  Is it a prejudice against people who don't live in the cities?  If you honestly want easier access to healthcare for people who live in the country then don't discriminate against them when it come to reimbursement.

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Specializes in Community health.

I would totally love this. At the moment I work in an FQHC in a very urban, poor, inner-city environment. The locale is different but the duties are similar— it is an underserved population, often with low health literacy and sometimes illiterate, few resources, and we have to patch together healthcare. 

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Specializes in Dialysis.

I live in a rural area in Indiana. The area is very saturated with nurses who have to drive to Indy, Louisville, and Cincy for that first job. The hospitals in the area I live know that there's a saturation and only take experienced nurses. The pay may be lower, but many view not driving an hour+ as a good tradeoff for $$$. Area nursing schools around pumping out hundreds of nurses every year, with the promise of tons of local jobs waiting...NOT, except some of the not so good LTCs. So, not every rural area needs nurses. That's a misconception that needs to stop. Every prospective student needs to take a good look at the job market in the area in which they wish to work, and get an accurate picture of job availability 

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Specializes in Mental health, substance abuse, geriatrics, PCU.

I worked at a very rural, very small hospital for a few years. In the community we were mocked as not being able to handle more than a papercut. We certainly weren't taking neurosurgery or nicu patients but we were the only hospital around for a pretty good distance so often complicated patients would come to us to be stabilized and transported to other facilities so you still got exposed to quite a bit. In addition to this, some patients requiring higher levels of care would refuse transfer due to the distance, lack of trust in other providers, etc. so our hospitalist would manage them there so once again there was exposure to more complex patients. Another cool thing about being in such a small hospital was that it was not uncommon to help out in other departments of the hospital during the shift when a particular area got busy, for instance you might be called from the floor to the ER, or to the ICU, the house supervisor had to be able to scrub in the OR if our single surgeon happened to be on call that night to come in for emergency surgeries. No pharmacist at night, so one time I had to mix my own TPN for a patient. If there were no ICU patients, and your patient became unstable then congratulations you are the ICU nurse until the on call nurse comes in to take over. Because of this you had to be really flexible. We got a lot of palliative and end of life patients due to lack of access to home hospice in the area. This was a plus for me because I really enjoy providing end of life care.

That said, there were some bad points as well. Lack of resources was a big one. Lack of access to an MD overnight was an issue at times, sure we had an on call, but sometimes you just need someone in a white coat to take a look at someone and most of the docs wouldn't come in no matter the situation and would just order to transfer them or let the ER doc attend the code blue when it came to that. Which leads to another issue, some of the medical management from the physicians was sub par and tolerated due to the fact that MD's are so hard to find for rural hospitals. It could also be hard to get your hours in, when census was low and the other departments were slow or have coverage, in that scenario you don't get to work. That really hurt financially, and the years I was there I had to maintain a second job in order to make sure I got my hours each week. My co-workers were good people, but they were not very tolerant or accepting people so that made it difficult to "fit in" while I was there.

Nowadays I live in a moderate sized city and left the rural world behind. I don't regret working there, in fact it was one of my favorite jobs. While medical care wasn't really great, the nursing care was on point and really superior to many other places I worked, our patients were spoiled rotten. I will admit it wasn't really a resume builder because no matter how you try market yourself, people in big facilities just tend to look down on the little house on the prairie hospitals. Interestingly enough, jobs openings aren't really plentiful there, since most the employees are locals and have been there generations, the turnover is quite low. As hoosier said not all rural areas are bleeding staff.

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Specializes in Cardiac.

Themoonismylantern’s story is very much like mine. We did have an on call surgery team, but to help out, we ICU nurses would recover post ops in the middle of the night as a favor to the PACU staff. In this 120 bed hospital, ICU nurses carried pharmacy keys in case a new admit in the night needed something stat. No access to narcs in the pharmacy because every unit had a narc cabinet and counts were done every shift... it was mostly abx-vancomycin, ancef, etc but we mixed them. Also mixed our own pressors from stock kept in the  ICU. I didn’t have problems fitting in at work, but felt like an outsider in the small town because I wasn’t a “lifer”—born lived died for generations there. 
I also moved to a larger community (actually live rural and commute 30 minutes to work in a small city 200 bed hospital) on the “edge of town”. Staff here drive over an hour to work at my hospital. I have also worked at the other medium size hospital half an hour the other direction, and a very rural hospital about 50 bed with a LTC attached that has 2-3 “ICU” beds that usually sends their criticals to us. There are lots of clinics-almost in every tiny town so seeing a doctor is not difficult for the residents. People expect to travel for anything more than check ups, although specialties also travel to small clinics to see patients in their communities. 
The concept of rural nursing is interesting, somewhat like parish nursing. 

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