Nursing is regarded as one of the most rewarding careers. Whether nurses practice in a rural or urban setting, they can expect to enhance the health and wellness of their community while forming long-lasting relationships with patients.
They are trusted authority figures who take care of the most important aspect of life – health.
Nursing skills are always in demand, and the kind of training they receive allows practitioners to move swiftly between settings and deliver top-quality patient care. In rural areas, they are a vital element in the healthcare system.
Rural nurses play a critical role in delivering healthcare to underserved communities in America. In many places, they are the first and sometimes only contact for people in need of medical care.
The recent pandemic highlighted a plight that was previously only known to industry insiders. While a lot of attention was paid to the availability of beds for critical patients and PPE, we did not get to hear much about how nurses were coping with the influx of critically ill patients.
By the time the worst of COVID-19 was winding down, many rural nurses were exhausted. Underserved communities were hit hard. Some lost their only nurse for miles.
For anyone considering a career in nursing, this opens up unique opportunities. With the right qualifications, they can easily get a job delivering nursing care to rural communities in America. Nurse practitioners in underserved areas face certain challenges, but the career is rewarding. Carson-Newman University offers an MSN-FNP program which will help you get into areas such as advanced health assessment, advanced pathophysiology and advanced pharmacology.
They can impact their patients’ lives in a way that is difficult to do within a city setting. They also operate with greater autonomy and often make decisions regarding patient care that they would have to defer if they were working in a city hospital. Compensation is also better for the rural nurse – they receive incentives to make up for serving in rural areas.
Your career in nursing can be off to a great start if you choose to work in an underserved community. However, it is important to be well-prepared for the challenges that you will face, especially in the early days.
What challenges come with nursing in underserved communities?
- A shortage of doctors
Just like there is a lack of nurses in rural communities, rural America also suffers from a shortage of doctors. In some places, the nearest doctor is half an hour or more away. There is only so much a nurse can do, and many times the care provided to critically ill patients is inadequate because there is not a doctor on site. Nurses must often rely on their wits.
They regularly find themselves doing more than they signed up for and hoping for the best. This is not ideal, especially in healthcare delivery.
- Delayed transportation leads to delayed care
In a 2010 paper titled ‘Transportation, Distance, and Health Care Utilization for Older Adults in Rural and Small Urban Areas’, the author points out that nearly 90% of those who can get themselves to a clinic or hospital in rural America have to rely on a family member or friend to drop them off and pick them up. Those who live alone, and families that do not have a driver among them, are more likely to miss appointments or be late. This often compounds disease.
In some rural communities, the nurses are proactive. Rather than wait for patients to come to them, they go out to patients’ homes to deliver important treatments and medications.
This, however, is at a cost. They must leave the practice and patients who come in while the nurse is out may opt to leave before they get treatment. Rural nurses are forced to do a careful balancing act. They must assess who needs care the most and how those patients can best be attended to.
- Today’s rural populations are older and sicker
Because of sporadic access to healthcare patients in underserved communities tend to be sicker than those in metro areas. A growing number of baby boomers now need elder care. Nursing staff in rural areas find themselves overwhelmed by the number of patients they have to care for and the extent of their symptoms.
- A shortage of ambulances and airlift helicopters
It is not unusual for people in rural America to die because the ambulance took too long to arrive. Many far-off communities have just one ambulance, and should a call come in when it is in use, the patient must wait their turn. This is not ideal, especially when you consider that many of them are quite ill and need to see a doctor immediately.
Airlift helicopters are also in short supply. Most rural practices rely on bigger city hospitals to send them air transportation when they need it, which can sometimes cost lives.
- A shortage of support staff
In some rural clinics, the nurse does it all. They greet patients when they arrive, do the preliminary examination, and then take them through to the doctor. The doctor may order basic tests, and the nurse collects blood and other samples. They may also be called upon to fill subscriptions.
These are tasks that ideally should be done by other medical personnel, but because they are not there, it falls on the nurse to do them.
- Poor literacy often compounds health issues
Unfortunately, literacy rates in underserved communities remain lower than in urban settings, and this has an impact on healthcare. Nurses can face an uphill battle when trying to convince patients to come in for much-needed treatment.
- Undiagnosed chronic illness
A patient may come in with a sore or an abscess, only for the attending nurse or doctor to discover a much more serious underlying illness for which they could have been successfully treated if they had come in earlier. This puts a strain on hospital resources and nurses.
- Mental health and substance abuse issues
These two issues plague many communities in rural America, and they can put a great strain on patient services. Patients can fall through the cracks while nurses are grappling to deal with those who suffer from addiction and poor mental health.
- A lack of funding
This can lead to a shortage of essential equipment and medications, and it directly affects how well nurses do their jobs. In some cases, patients must be referred to other hospitals because their local clinic lacks the right equipment for diagnosis.
Are there rewards to serving the underserved?
Despite facing all these challenges, many nurses who work in underserved communities report high levels of job satisfaction. They can deliver personalized care within small communities where they know everyone and where their services are much appreciated.
They get to understand patients’ needs and issues and can create treatment plans for each person. When their patients cannot come to the hospital or clinic they often go out to their homes for check-ups and deliver vital treatments.
This is different from nursing within a city setting, where an NP or FNP can attend to dozens of patients in a day and walk away from it all at the end of their shift. In a rural community, there is a sense of continuity, and nurses form special bonds with each patient.
Serving in these communities also provides a wealth of experience. Those who are new to the nursing profession find it especially useful to serve in rural communities. They very quickly get to understand the social determinants of health, which helps them design better treatment programs for their patients.
Rather than immerse themselves in medical theory, they know who their patients are and where they come from, and how this may impact their health.
They are also eager to empower patients to take control of their health. Instead of handing down treatments and diagnoses, nurses in rural clinics often discuss with patients how best to live their lives so that they are healthier in the future.
How can you meet the challenges of rural nursing?
If you are coming from the city to practice nursing in a rural setting you will undoubtedly find it stressful in the initial days. Where you had a full support staff, you now have to rely on yourself to get the work done. You may have to make do with the little available equipment, often referring patients to better-equipped facilities for more accurate diagnosis.
However, there are certain things you can do to help serve your community better:
- Some nurses practice where they grew up, so they understand the culture. If you are working in an entirely new community, it pays to take some time to understand the culture. Life in rural areas moves at a rather different pace than in urban areas. If, for example, someone misses an appointment or is late, it does not help to reprimand them. Rather, find out how you can help them be on time next time. In small communities, you may feel a loss of anonymity and privacy. Unfortunately, that is how life is in rural areas, and there is not much you can do about it.
- You will be an exceptional rural nurse if you are flexible. In many underserved communities, people work from dawn to dusk and can only see a doctor or nurse late in the day. If you insist that they come in when they are supposed to be working, you may lose them altogether. Rather, find out what timing is best for them, and abide by it.
- Build strong relationships with your patients. Work hard to get them to trust you. Remember, some of these people have not had access to proper medical care for years, and they prefer to do things their way. If you build good relationships with them, they will trust you and come to you whenever they need medical attention.
- In small communities, small things matter. Whatever you do will travel through the grapevine, and soon everyone will know. If you want to become an exceptional rural nurse, you should always be aware of the perceptions of the community.
- Take care of yourself – you may find yourself working extra hours, but you must take time off to look after your emotional and physical health. Find a few minutes each day to relax. Simple daily exercises like yoga and meditation are helpful for nurses. Exercise your mind to stay sharp and keep on top of advances in your field.
- Talk to the powers that be about equipping your facility and providing more funding. Oftentimes, rural nurses are hesitant to ask for what they need. It is your right to have the proper equipment and support staff, so talk to whoever is in charge about getting you what you need so you can do your job.
- Do not judge your patients – some of them have lived in a rural setting all their lives and do not know anything different. Others may not be as educated as you are used to. Whatever the case, your care should be free of judgment. Treat all your patients equally and be compassionate and empathetic.
- Encourage young people in the community to become healthcare providers. If you can get one or two young people to join the nursing profession every year and come back to help their local community, life will get easier with time.
- If you do not have experience handling mental health patients, it is time to get it. Many underserved communities have significant segments of the population that suffer from addiction.
- Keep in touch with your peers – when working far away from the city, the tendency is to lose contact with others in the profession. You will be a better nurse if you keep in touch with others to exchange ideas and information.
Nurse practitioners in underserved areas may find it difficult, especially in the initial days. Practicing in rural areas comes with challenges, but it is also rewarding. Not only do you get to develop personal relationships with those in your care, but you also work within a community that values and appreciates the services you provide. It is a difficult job, but it is also rewarding.