Nurses make up more than one out of two healthcare workers in rural areas. But with the increasing shortage of health workers in rural areas, nurses are increasingly becoming the only point of call to rural healthcare delivery for rural dwellers.
The role of nurses is becoming more critical in rural healthcare delivery, and this offers a different set of challenges and rewards for nurses.
Healthcare facilities in rural areas often lack the finances to hire a sufficient number of highly qualified healthcare professionals and procure the necessary medical supplies.
However, nurses can rise to the challenge to help fill the healthcare needs of underserved communities while also enjoying opportunities for career advancement and professional growth. For instance, nurses can take on new specialties to fill the shortage of specialists at a community health facility. This can be a win for all, with the nurse earning a pay raise while helping the facility fill its personnel needs at a lower cost compared to hiring external candidates.
In the following sections, we’ll take a closer look at the challenges and opportunities in rural healthcare delivery. We’ll also examine ways that nurses can make a difference here.
Impediments to healthcare delivery in rural areas
Rural America is home to about a quarter of the country’s population. The choice to live in the countryside is oftentimes deliberate – people just wanting to live closer to nature and enjoy a simpler lifestyle, away from the bustle and rigors of the city.
Healthcare delivery in rural areas is similar to that of urban areas in many regards, but it also comes with its unique challenges. These are outlined below.
A predominantly low-income population
Given their relatively sparse amount of economic activities, rural areas tend to be low-income areas. The US Department of Agriculture estimates that nearly 16% of rural dwellers live below the poverty line compared to about 11% in urban and suburban areas. Also, rural dwellers make up about a third of food stamp recipients.
Due to their low income, rural residents often lack adequate health insurance coverage and often struggle to afford proper care for their health challenges. Also, poverty often equates to poorer living standards, and this leads to increased vulnerability to health problems such as chronic diseases, mental illness, and lower life expectancy.
Healthcare facilities in rural areas often struggle to maintain high-quality healthcare delivery while remaining profitable. The National Institute of Health estimates that over 170 rural hospitals went out of business between 2005 and 2020.
When a community loses a healthcare facility, they lose doctors, nurses, specialists, health educators, and medical supplies. Residents often have no choice but to travel long distances to get medical attention.
Healthcare worker shortage
Besides the closure of hospitals, many other factors contribute to the chronic shortage of healthcare practitioners in rural communities. These factors are to blame for the disproportionate concentration of talent pools in urban areas.
The Health Resources and Services Administration (HRSA) classifies areas with a low concentration of healthcare workers as Health Provider Shortage Areas (HPSAs). More than 85 million Americans live in these areas. According to the HRSA’s recent records, HPSAs are heavily concentrated in rural regions.
Issues with work-life balance
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Compared to urban nurses, it’s far more crucial for them to learn and implement strategies for maintaining a healthy work-life balance because constant pressure from work is almost guaranteed for them.
A declining number of rural medical students
The capital flight and personnel shortage afflicting rural healthcare are also driven by the decline in medical students from rural areas. Rural healthcare workers are often students who grew up in rural areas and small communities.
According to the journal Health Affairs, medical students from small communities have been declining in their numbers over the last 15 years.
Waning interest in rural healthcare
A broader issue affecting rural healthcare is the steady decline in interest in rural healthcare among healthcare workers. A physician staffing company, Merritt Hawkins, polled final-year medical students in 2019, and found that only 1% were considering practicing in a rural community.
Lower health literacy
Rural dwellers are generally not as informed about maintaining good health as their urban counterparts, making them more vulnerable to health risks. Lower health literacy in rural communities has been linked to higher rates of COVID-19 infections, diabetes, chronic infections, heart problems, etc.
Major health issues in rural areas
All the above combine to prevent many rural dwellers from finding lasting solutions to their health challenges. The impact of these challenges is exacerbating especially for specific health issues, including:
Heart conditions are also far more prevalent in rural communities. As per the Centers for Disease Control and Prevention (CDC), the number of heart disease-related deaths in rural areas is 160 per 100,000, nearly 50% higher compared to deaths in urban areas, which was estimated at 114 per 100,000.
More than 75,000 Americans died of opioid overdose between 2020 and 2021, according to the Center for Disease Control. That’s nearly double the yearly figure recorded in 2015. A huge number of those deaths occurred in rural areas due to a lack of access to primary healthcare, overprescribing, and lower health literacy.
The near non-existence of mental health services in many rural communities means that depression and other mental health problems that can lead to suicide often go unchecked in these areas.
CDC records show that the suicide rate in rural communities is twice as high as that of urban areas, at 20.1 per 100,000.
The role of nurses in rural healthcare delivery
For a long time, nurses have been at the front and center of health delivery in most rural communities. There’s also a growing body of evidence suggesting that the work of nurses is becoming increasingly critical and they’re more likely to bring about better patient outcomes compared to other healthcare professionals.
The role of nurses is as important – and sometimes even more superior – to those of doctors and specialists in treating a wide range of health conditions across different types of facilities, from primary to secondary and specialist care facilities.
Here’s why in more explicit terms:
Compliance with medical guidelines
Studies suggest that nurses are much more patient and sensitive when handling patient care. They’re much more likely to follow through with evidence-based guidelines for treatment and care.
As a result, rural patients report being more satisfied with their health outcomes when placed directly under the care of nurses.
Deeper local knowledge
Rural nurses often stay in a community or healthcare facility for several years on end, and this allows them to cultivate a deep understanding of the peculiarities of the locality. They know individual patients by heart, they’ve mastered the intricacies of the norms and cultural traits of the community, and they’re familiar with the local speak and local dialect.
As such, they can communicate with patients at a deeper level, avoiding awkward questions or misunderstandings that limit interactions with patients.
A more holistic approach to patient care
Rural nurses are often skilled at cultivating relationships to foster better healthcare outcomes. They focus not just on treatment regimes and medications, but on the life of patients as a whole.
They understand how social determinants impact access to quality healthcare, and are often willing to go out of their way to ensure holistic care for their patients.
For instance, they can find better strategies for communicating with a patient’s family to assuage their anxieties and advocate for better health standards and health policies in a facility or community.
Working with family values and community spirit
Because they often spend a long period in one location, rural nurses are often regarded as family. They often meet their patients and fellow healthcare workers outside work – at church, school events, or community functions.
As such, they cultivate a deeper level of trust with patients, and this helps guarantee a greater level of patient satisfaction.
Filling specialty roles
While most rural nurses are generalists, many have heeded the call for more specialists in their facilities and undertaken specialized training. Many develop these specialties on the job, assisting specialists with their workload while picking up some critical specialization skills in the process.
Reducing wait times
Studies also show that rural nurses help in minimizing wait times for patients on appointments.
What’s more, they also help improve the outcomes of appointments. Studies show that patient consultations with nurses tend to be longer, suggesting a deeper and more thorough assessment. And the number of return visits is much higher, indicating that patients tend to be more compliant when working with nurses.
Tips for improving healthcare outcomes as a rural nurse
There are many moves currently underway to address the chronic shortage of rural healthcare workers. In some places, doctors and specialists are being incentivized with higher rates and bonuses.
But in places where there are no incentives, nurses have had to think out of the box to find innovative ways to improve rural healthcare delivery.
Education and certification only get the job half-done in delivering rural care. Nurses need to cultivate their critical thinking and problem-solving skills, coming up with ingenious ways to meet the care needs in their locality.
Advocating for improvements to rural healthcare delivery
As a rural nurse, you need to take advantage of every opportunity to advocate for better health standards. That includes educating patients about better health standards, participating in community events on healthcare, recommending healthcare improvements to community leaders and policymakers, and engaging with local and regional bodies in the healthcare industry.
Promoting health literacy
With better health literacy, rural dwellers can be better equipped to maintain healthy lifestyles and seek out medical help successfully when the need arises. Nurses advocating health literacy can help patients become more compliant with their doctor’s advice and follow through with processes involved in accessing certain types of care facilities.
Telemedicine has had a seismic impact on healthcare delivery, especially in rural areas. With almost everyone owning a smartphone these days, nurses can explore remote technologies in many ways to improve access to healthcare for patients.
They can use telemedicine to deliver healthcare services to patients’ homes, such as diagnosing health problems, offering counseling, and recommending and monitoring treatment plans for patients.
Obtaining a license for full practice
Nurses that are dedicated to a rural care facility can seek licenses for full practice to be able to operate at a much greater capacity.
More than half of the States in the US allow nurses to obtain authorization for full practice. With this, nurses can carry out patient examinations, diagnose illnesses, prescribe medication, and oversee the administration of treatment plans, all without the intervention of physicians.
Conclusion: rural nurse are bridge-builders for rural healthcare delivery
The decline in access to healthcare delivery for rural dwellers has been a perennial problem in many rural communities. A predominantly low-income population, difficulties with churning profits forcing rural care facilities out of business, and low standards of health and poor health literacy, all combine to create significant disparities between health delivery in rural areas and that of urban areas.
However, nurse practitioners are in a position to rise to the occasion. Nurses can help improve rural healthcare delivery in many ways, from reducing wait times for patients to helping fill the shortage of specialists, employing telemedicine to provide more convenient access to medical services, and advocating for ways to improve health and healthcare in underserved communities.