Nursing in Rural Areas: Challenges, Shortages & Solutions
This paper examines the multifaceted challenges facing nursing in rural areas of the United States and internationally. Drawing on studies from New Zealand, South Africa, Kenya, Thailand, Western Quebec, and rural America, it addresses workforce and employment issues, the knowledge and skills rural nurses must possess, policy interventions including financial and non-financial incentives, homecare nursing attitudes, rural health clinic efficiency, and threats to the future supply of rural registered nurses. The paper concludes with recommendations for education reform, preferential student recruitment, palliative care teams, and evidence-based best practices to recruit and retain nurses in rural settings.
- Introduction: Rural Nursing in Crisis: Scope of rural nurse shortage and its causes
- Workforce and Employment Issues: New Zealand survey on recruitment and retention gaps
- Knowledge, Skills, and Policy Interventions: Skills demands and financial incentive research
- Homecare Nurses and Rural Health Clinic Efficiency: Quebec homecare nurses and clinic productivity findings
- Attitudes Toward Rural Living and Working: South African nurses' views on rural work and life
- Threats to the Future Supply of Rural Nurses: Aging workforce and projected shortage beyond 2020
- Conclusion and Recommendations: Policy, education, and recruitment solutions proposed
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What makes this paper effective
- Synthesizes multiple international studies (New Zealand, South Africa, Kenya, Thailand, Canada, and the United States) to build a broad, comparative picture of rural nursing challenges.
- Moves logically from problem identification through evidence-based analysis to concrete, actionable recommendations, giving the paper a clear and purposeful structure.
- Grounds abstract workforce concerns in specific data points (e.g., mean nurse age, percentage living rurally, projected shortages exceeding one million by 2020), lending credibility to its arguments.
Key academic technique demonstrated
The paper demonstrates effective thematic synthesis — grouping findings from distinct studies under shared thematic headings (workforce, skills, policy, attitudes, supply threats) rather than summarizing each source in isolation. This allows disparate evidence to reinforce a unified argument about the severity and complexity of rural nursing shortages.
Structure breakdown
The paper opens with an introduction establishing the scope of rural nursing's crisis, followed by five body sections each addressing a distinct dimension of the problem. A conclusion recaps key findings before a recommendations section translates the evidence into practical policy and educational strategies. This intro–body–conclusion–recommendations format is well-suited to policy-oriented nursing research papers at the undergraduate level.
Introduction: Rural Nursing in Crisis
Rural nurses are particularly endangered by the current and worsening shortage in nursing. Rural nursing is already beset with issues that range from a lack of a clear professional practice system and the need for larger incentives for nurses to work in rural areas, to a general unwillingness among nurses to live in these areas and the foreseen depletion of the rural nursing supply. Possible solutions and approaches have been proposed, though no single or simple answer has emerged.
Approximately 20%, or 54 million U.S. residents, live in locations categorized as rural (Bushy, 2006). These residents are distributed across 80% of the nation's total land area. About 99 or fewer residents occupy every square mile in these areas, and they experience the shortage of nurses more acutely than residents in urban areas. Moreover, rural residents generally have lower annual incomes, less education, and poorer health status than their urban counterparts. Local health care providers cannot compete with the wages, start-up bonuses, and benefits offered by urban facilities. The situation is even more difficult in frontier areas where the population is smaller, particularly regarding wages. Financial constraints also limit educational opportunities in small hospitals, and an inadequate number of nurses hampers the recruitment of physicians, thereby restricting local residents' access to care. These residents must spend more to see specialty or even basic health care providers in urban areas for services that are not found or are inadequate in their communities (Bushy).
Nurses who consider working in rural areas need to understand the scope of nursing practice in those settings, the community's norms and behaviors, and the consequences of choosing to work there (Bushy, 2006). They need to recognize the necessity of new changes in education and existing systems, which require multi-dimensional strategies and partnerships among educators, researchers, rural communities, and policy makers. All of these partners are equally necessary to confront the challenges of rural nursing, and there is no single or simple solution to its inherent problems. The rewards, however, are great for those who remain dedicated, as long as they view the career realistically (Bushy). As one survey participant observed, "a rural nurse lives and breathes rural air… there is dust and dirt and mud and grit in her work" (Litchfield & Ross, 2000).
Workforce and Employment Issues
A national survey conducted among 84 nurses in New Zealand in 2000 identified workforce and employment issues in rural nursing practice (Litchfield & Ross, 2000). The mean age of the almost-entirely female respondents was 46.3. Almost half were in their 40s, and 30.6% were 50 years old or older. Most respondents were from New Zealand or Europe (89.4%). All held basic general nurse registration, but few had formal or specialty preparation in rural nursing or any of its components. Only 5.9% held a bachelor's degree. More than half lived in rural areas and made limited use of computer technology. Workforce issues identified included recruitment and retention, education, and career structure. Nurses' work was fragmented, and a lack of a clear professional practice system in the contemporary rural health service context was identified as a pressing concern that must be addressed (Litchfield & Ross).
References
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Litchfield, M., & Ross, J. (2000). The role of rural nurses: A national survey. Centre for Rural Health: New Zealand Ministry of Health. Retrieved from http://www.moh.gov.nz/moh.nsf/pagesmh/4992/$file/Role_Rural
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