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A Roadmap to Recruiting and Retaining Rural Nurses

June 2013

Nurses are often seen as the most prominent faces of healthcare by their patients. This is especially true in many rural areas where communities are often small and close-knit, and where healthcare providers can be harder to come by than in more populous settings. This makes addressing nursing shortages a high priority for rural healthcare facilities. In order to do that, nurse leaders are confronting many of the challenges that rural nurses face with a renewed focus on rural nurse education and staffing.

Many of these challenges begin with education and the transition from nursing school to the workforce. As students typically receive their education in cities or large communities, the realities of rural nursing can take a nurse by surprise when he or she begins at a hospital. A recent report by the Institute of Medicine, The Future of Nursing: Leading Change, Advancing Health, recognizes this issue, and calls for the increased implementation of nurse residency programs to help ease the transition from student to nurse in rural and medically underserved areas. These programs would give students additional rotation opportunities in rural areas, which would help increase student interest and give them insight into the unique health needs of rural populations.

Another prominent challenge facing rural nurses is a lack of resources in many communities, which can often result in professional isolation.

“In some cases, rural nurses may be the only healthcare provider on site in their community. In those situations, if you have an urgent problem, you can’t always refer to a specialist in a timely manner,” said Pamela Fahs, RN, DSN, president of the Rural Nurse Organization, and professor and Dr. G. Clifford and Florence B. Decker Endowed Chair of Rural Health Nursing at Binghamton University in Binghamton, N.Y. “Even finding the time to participate in continuing education courses can be an issue, as rural nurses sometimes find themselves in higher demand than their urban counterparts due to shortages of healthcare staff.”

To help address the problem of professional isolation, many nurse leaders are pushing for rural hospitals to become more involved in collaborative professional networks so that nurses can continue to learn and grow even in the face of geographical challenges.

“It is much more difficult for rural nurses to access nursing conferences and professional meetings since they typically take place in large cities,” said Fahs. “The Internet is helping, but healthcare facilities must continue to help nurses find resources for growth and development.”

According to a recent study by the Robert Wood Johnson Foundation, rural hospitals may be better able to ensure high-quality care if they maintain low nursing turnover and stable practice environments. This finding provides an enormous incentive for nurse leaders in underperforming rural hospitals to revisit their efforts to retain a high-quality staff. In fact, according to Fahs, a greater focus on rural nurse staffing has started to emerge in the past few years, with more universities integrating rural theory and practice opportunities throughout the nursing curriculum.

“Nurse leaders can play an important role in recruiting and retaining new nurses in the rural setting, as well as helping students better prepare for the transition. Their efforts can ultimately help reduce professional isolation in rural environments – a benefit for nurses, as well as healthcare facilities,” said Fahs. “If nurse leaders and rural hospitals work together to seize this opportunity, the rural nursing workforce will likely continue to grow and strengthen moving forward.”

The Rural Nurse Organization, a professional organization of healthcare providers dedicated to the specialized practice and unique challenges of rural nursing, continues to provide resources for rural nurses and is committed to using the Institute of Medicine’s report as a blueprint for future action in rural communities. To learn more about the Rural Nurse Organization, visit

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