What to Know About Rural Nursing
Curious about rural nursing? Around 20% of Americans live in rural areas, where a hospital may be more than 30 minutes away, and the nearest specialty clinic could be over an hour. Nurses in these areas can build skills in trauma care, mental health nursing, pediatrics, oncology, and more, all in one setting.
There are vast disparities in care and health outcomes between patients who live in cities and those who live rurally. People in rural areas have:
- Higher rates of mortality.
- Higher rates of heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke.
- Higher rates of infant mortality.
- Less access to physical and mental healthcare.
- Less healthy food availability.
Nurses are crucial in these rural areas, where physicians are more scarce, and patients face critical barriers to healthcare. If you’re curious about moving to an area with wide-open spaces, learn more about the challenges and opportunities as a nurse in these locations.
What Is Rural Nursing and What Does a Rural Nurse Do?
Rural nurses work in geographically isolated areas with small populations that are more spread out. Often, the patients these nurses care for have limited access to healthcare services. Consequently, nurses may care for patients of all ages, health conditions, and levels of acuity.
Rural nurses may work in:
- Community hospitals
- Community health centers
- Family medicine and primary care
- Tribal health facilities
- Public or county health offices
- Home health
- Women’s health
The basic duties and job description of a rural nurse may be quite similar to those of a nurse in a metropolitan area. They still assess patients, implement nursing interventions, plan patient care, and educate. But since there are fewer specialty clinics in rural areas, a nurse might have to work with a broader knowledge base.
For example, a rural emergency department nurse may need to be comfortable caring for adult, pediatric, and neonatal populations, and may manage a trauma patient alongside a mental health patient in the same shift.
What’s It Like to Work in a Rural Hospital?
Nurses who work in rural hospitals deal with a unique set of issues and need excellent critical thinking and problem-solving skills. Rural working conditions for nurses include:
- Expanded specialty areas: Smaller facilities tend to combine units, so nurses may need a broader array of skills.
- Less physician access: Rural areas have fewer higher-level providers, with 68 physicians per 100,000 people compared to 80 in urban areas. In some areas, physicians may do video calls with patients or manage multiple patients remotely.
- Mid-level provider collaboration: While physicians may be in short supply, nurse practitioners (NPs) often fill in the gaps in rural settings, acting as primary care providers, emergency medicine providers, and more.
- More patient needs: Patients in these settings may be older, sicker, and more likely to experience chronic illnesses, requiring more nursing time and care.
- More accidents and injuries: Unintentional injuries and deaths are more common in rural areas, alongside drug overdoses. Nurses are likely to need emergency and trauma care skills.
- Barriers to compliance: Prescriptions may be harder to fill, and medical offices may be far away. Barriers like these mean that patients may appear noncompliant with medical recommendations.
- Patient transfers: Patients who require very specialized services, such as Extracorporeal Membrane Oxygenation (ECMO), are transferred to a higher level of care.
- Rural hospital closures: Many rural facilities face diminishing funding and even closures, creating job instability for staff.
Why Do Rural Areas Face Staffing Shortages?
Nurses are in short supply across the country, but staffing shortages are more extreme in rural areas, where only 16% of nurses work. Practically, nurses may not want to relocate to an area with fewer opportunities. And nurses who grow up in rural areas tend to move to cities for school, and may not choose to return to areas with fewer job options.
Rural work may not align with nurses’ career goals — a high-risk NICU nurse, for example, may struggle to find roles in their specialty in a small town. Nurses with families may find it’s difficult for their partners to find job opportunities, and schools for their children may be far away.
What about the turnover of existing rural nurses? When asked about what issues frustrate them or may cause them to leave a role, rural nurses had these chief complaints:
- Staffing inconsistency
- Fewer growth and learning opportunities
- Constraints around logistics and resources
What Does a Rural Nurse Make?
The average registered nurse salary is $98,430 per year, but nurses in rural areas tend to earn less than their urban counterparts. For example, one of the areas with the highest nurse income is New York City, where RNs earn an average of $115,650 per year. In a more rural part of the same state, such as the southwestern nonmetropolitan area, RNs earn an average of $85,900 per year. Your salary will also depend on your experience, level of responsibility, specialty, and more.
Benefits and Drawbacks of Rural Nursing
What might you like or dislike about working in a rural setting? While it may have challenges, living and working in these areas can have benefits as well:
| Benefits | Drawbacks |
|---|---|
| Potential to develop long-term bonds with patients in a tight-knit communityRural areas tend to have a lower cost of living
Potential for a higher level of autonomy, and building broader skills Loan forgiveness programs may be available in some high-need areas, and hospitals may offer bonuses for nurses who start a new role Many nurses prefer life at a slower pace, with more privacy and space to spread out |
Staffing may be inconsistent, leading to heavier patient loadsRural roles tend to pay less than urban ones
Less access to services and specialty providers can be frustrating Fewer specialty or advancement opportunities Rural life has the potential for isolation |
Ready to Serve Your Community?
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