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Competition to recruit registered nurses is fierce, especially experienced nurses. For rural healthcare facilities, competing for nurses is even more compressed due to the experience, the pay and now, Covid, too.

Experience. It is not unrealistic to believe that most nurses begin their nursing careers with aspirations to work in trauma, large hospitals, or teaching facilities. They want to continue their learning experiences through hands-on work in providing healthcare.  In the rural healthcare setting, hospital bed size is smaller and may even be critical access (25 beds), whereas urban hospital average bed size is larger (76 beds to 252 beds per hospital). The rural hospitals will triage patients needing a higher level of care to the closest urban hospital.

Additionally, since the rural area may only have one or maybe two hospitals, options for work may be more limited, having the nurse take work in a doctor’s office, clinic, or nursing home. This makes it a lure for nurses to be attracted to work in the urban areas for that hands-on experience. Is there career pathing available for these nurses to keep them in the rural areas?

And while there are nursing schools that provide the healthcare staff needed in rural communities, Covid has made it more difficult for nursing schools to properly prepare their nursing students. With healthcare facilities turned upside down frantically trying to take care of patients, vaccinate their staff and hire more people, nursing schools have had to be creative to complete clinical rotations, moving to virtual or other methods such as using “actors.” Some schools have even contemplated delaying graduation to afford nursing student’s clinical time. In the rural market, nursing schools are even more limited: by enrollment capacity, by availability of healthcare facilities options, by sim labs that may not be available, and the list continues. Additionally, faculty are in short supply. But in looking for solutions, could nursing students from rural schools be included in virtual classes of some of the larger schools? Could these students be used by some hospitals as ancillary support staff? We need to continue to be creative to make sure our rising nurses get the clinical preparation they need.

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Pay. In addition, pay for nurses working in rural areas is often less than offered in the urban healthcare setting, even before Covid. The financial status of rural hospitals greatly vary from urban hospitals due to a diversified payor mix rural hospitals tend to have an older patient population covered by CMS.

Healthcare labor costs increased 7.6% across the US last year, and rural hospitals in states like West Virginia need to spend significantly more money on travel nurses and staffing agencies to keep shifts covered.

To compete with more affluent, popular areas, “rural facilities and small community hospitals are needing to offer sign-on bonuses, relocation expenses, tuition reimbursement and even housing for far-flung staff,” according to an article in Nursesusa.org. “This is an expensive undertaking for hospitals that already run on tight financial margins, but the incentivizing of nursing staff is crucial to maintaining the delivery of needed services that bring in significant revenue.”

So can nurses be given alternate hours, more flexibility, alternative benefits, relocation, career pathing, etc. to attract them to work in rural areas that so desperately need them?

Covid-19. And then you layer on Covid. With healthcare being in short supply of nurses, the impact to the rural community has worsened. Even more competition is occurring, even state to state! Nurses are able to name their pay and assignment. And yet, rural healthcare facilities are in as much need as the rest. However, now may be the time to differentiate the benefit of working in a smaller, close knit community instead of an urban setting.

Rural hospitals and nursing schools must look beyond traditional ways of working and take advantage of different solutions. Creative staffing solutions such as international nurses can be invaluable, especially to a rural community, where the nurse is committed to the rural facility for a longer contract period, often then providing an opportunity for the hospital to hire the nurse directly.