Time to focus on rural nurse staffing

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Alexandra Wilson Pecci, for HealthLeaders Media, July 10, 2012

When nurses are in abundant supply, nurse leaders and hospitals tend feel a sense of relief. But nurse leaders are urged not take their staffing levels for granted, and perhaps nowhere is this more important than in rural areas, where healthcare provider recruitment is an even greater challenge.

An editorial in the most recent issue of the Online Journal of Rural Nursing and Health Care cites research predicting that "over the next several years this bubble of abundance of RNs will deflate if not burst." Translation: Nurse leaders need to be prepared.

"This time of a more abundant supply of RNs is a time for rural areas to strengthen the ranks of rural nurses," writes journal editor Pamela Stewart Fahs, DSN, RN.

Rural healthcare organizations would certainly feel a future nursing shortage more acutely than their urban counterparts. After all, rural organizations already have trouble recruiting providers away from big cities where every amenity—professional and personal—is available in favor of places that might be 20 miles away from the nearest grocery story.

That's why Fahs implores nurse leaders in her editorial to "use this time to reduce professional isolation, [and] provide training that assists both individual nurses and the organization in growth to provide the best possible health care."

Her sentiments echo those of Carol Brewer, PhD, RN, FAAN, and professor at the School of Nursing at the University at Buffalo, who told me earlier this year that leaders need to make theirs "the best place to work so when they look around, they're going to stay with you. You want to keep them. You don't want them to jump ship the minute the market heats up."

But Fahs goes a step further in her editorial: She also calls on nurse leaders to cultivate the next generation of rural nurses, and points to the Institute of Medicine's Future of Nursing report, which, she says, urges the use of residency programs "to assure a smooth transition from education to practice settings in rural environments."

In fact, a study in the same issue of the Online Journal of Rural Nursing and Health Care shows that rural rotations increase nursing students' interest in practicing in rural areas. Researchers from the West Virginia University School of Nursing examined pre- and post-rotation surveys completed by 248 senior level baccalaureate students and found that after a semester-long interdisciplinary rural rotation, 53.6% of students reported an increased interest in rural health.

Practicing in rural areas is different than practicing in urban ones, and not just because there isn't a Starbucks on every corner. Rural practice often brings with it isolation, a lack of resources, and even more pronounced health issues among patients.

For example, within parts of Appalachia—the rural West Virginia area where nursing students in this study did their rotations—the population has an excess of premature deaths from heart disease, all cancers, chronic obstructive pulmonary disease, diabetes, and motor vehicle accidents. Appalachian communities are also rife with poverty, lack health literacy, and generally have poorer access to healthcare.

Not only were nursing students more interested in rural health after completing their rotations; they were also more sensitive to the unique caregiving needs of the population in which they served. For example, students were more confident in many abilities, including recognizing cultural differences; community assessment; community participation; meeting the unique needs of rural patients; identifying barriers to care; and identifying the impact of socioeconomic status on health.

Also, 87.6% of the students rated the quality of the rotation as good, very good, or excellent.  Students who evaluated the quality of the rotation more favorably also identified smaller communities as future practice sites and were more likely to remain in West Virginia.

So will this lead to a more nurses practicing in rural West Virginia? Only time will tell. As the study authors write, "While this rural health rotation helped to change students' confidence in key areas of rural practice, it was not clear that it would change students' intent to practice in rural areas."
They say additional strategies may be needed such as include integrating rural theory and practice opportunities throughout the nursing curriculum and building linkages between university faculty and rural preceptors.

But one thing is certain: Rural nurse leaders need to pay attention to these kinds of issues today to ensure that rural patients are still well-cared for tomorrow.

Source: HealthLeaders Media