As of 2022, rural areas were home to 43% of the global population. However, the healthcare landscape in these areas has been deteriorating. A report by Becker’s Hospital CFO revealed that since 2020, 36 rural hospitals in the United States have ceased operations and 700 are at risk of closing. This trend isn’t new; more hospitals have been closing than opening each year since 2011. The closure of these hospitals has left rural communities with limited healthcare options and longer travel times to access medical services. The situation is further complicated by a lack of public transportation. Workforce shortages, inadequate provider coverage, and delays in care due to a lack of specialty access further intensify these healthcare challenges. The difficulties faced by rural populations extend beyond these issues. A staggering 56% of the rural population lacks healthcare coverage, a figure significantly higher than the 22% of urban populations without coverage. Furthermore, healthcare costs in rural areas are higher due to increased insurance premiums and a limited number of insurance issuers participating in the health insurance marketplace. Layer in higher poverty rates, greater exposure to environmental hazards, and an increased incidence of older populations with more chronic conditions, and it is easy to see why there is a need to focus on innovative healthcare solutions to serve this population.
The nursing profession also faces many challenges. Significant changes from 2020 to 2022 have shifted the demographics of registered nurses (RNs) in the US, leading to a younger, less experienced workforce. In addition, the World Health Organization estimates that the number of nurses will decrease by almost 8 million worldwide by 2030. This change coincides with increased complexity of care due to patients being more critically ill and hospital stays becoming shorter. Data indicates a rise in patients with comorbid conditions and a decrease in hospital stay length. These factors have resulted in an “experience complexity gap,” a growing divide between the complexity of care and the experience of the nursing workforce. Addressing this gap requires concerted efforts to ensure the continued delivery of high-quality patient care.
What does this mean? Nurses working in rural healthcare face greater challenges, driving the need for innovative solutions to help them deliver quality care in these communities. The good news? Where there are challenges, there is often innovation. Limited resources drive healthcare providers to develop creative and innovative solutions that may not have been considered if resources were abundant. This also encourages collaboration, prioritization, and adaptation. In other words, while rural healthcare and the profession of nursing are currently experiencing significant challenges worldwide, these challenges drive opportunities for growth and the development of new solutions.
Take the Iowa Online Nurse Residency Program (IONRP), for example. This year-long online program is designed to support new nurses transitioning into the profession. It covers core professional competencies, personal well-being, and engagement in a professional experience, helping new graduate nurses (NGNs) cope with the demands of the healthcare environment. The program includes microlearning video content and audio podcasts that NGNs can conveniently access from their mobile devices. It covers a wide range of topics to provide additional support in applying to the practice environment, such as surviving the first year of nursing, developing solid habits and routines, being a safe clinician, and leading from the bedside. After completing the online content, NGNs participate in reflective journaling, a unique challenge, and a monthly cohort discussion to connect with other NGNs working in similar rural environments. They also connect with a residency coordinator from their organization to further apply the concepts to their unique role, review hands-on clinical skills and organizational policies, and be more integrated with the organization. Since its launch in August 2014, over 4,500 new graduates from critical access, rural, and urban acute and non-acute care facilities in multiple states in the United States have enrolled in the program. An examination of the outcomes of new-graduate residents completing the IONRP showed statistically significant improvements in confidence in communication with patients, families, and other healthcare providers, as well as in prioritization, organization skills, and leadership ability. Participants also reported fewer harmful safety practices and patient errors over time, validating the effectiveness of the nurse residency curriculum. The IONRP's use of innovative online methods has been proven to be as effective as traditional approaches, reaching nurses working in rural areas without the need for additional personnel or long commutes.
As a pioneer of online nurse residency program solutions, the IONRP provides evidence-based programming for nurses starting their careers in rural areas. It fosters a broader community of nurses nationwide in the US. Its focus on proactive personal well-being to enhance resilience is crucial for healthcare environments in rural settings, where access to mental health services is limited. By leveraging technology and evidence-based practices, the IONRP helps to ensure that rural nurses are supported during their transition into practice and capable of providing high-quality healthcare services while fostering a sense of connection and support among its participants. While this program is US-based, the overarching concepts could be adopted around the globe in rural settings.
Another unique solution originating from the rural state of Iowa is the establishment of a fully virtual Association for Nursing Professional Development (ANPD) Affiliate group for practice-based educators across the state. ANPD is a professional association that promotes the specialized practice of nursing professional development to enhance healthcare outcomes. Nursing professional development (NPD) practitioners play a crucial role in fostering the professional growth and development of nurses and other healthcare professionals, from novices to experts. They are responsible for designing, implementing, and evaluating onboarding and orientation programs, managing competencies, providing continuous professional development, facilitating role transitions, fostering academic practice partnerships, and conducting research, quality improvement, and evidence-based practice. NPD practitioners are essential to any healthcare organization as they ensure that those delivering direct patient care possess the knowledge, skills, and abilities necessary to provide high-quality patient care in an ever-changing healthcare landscape. In a rural state like Iowa, it can be challenging to participate in national organizations, but the ANPD's affiliate group demonstrates the power of innovation and collaboration by nurturing community and cooperation among professionals who are geographically closer to one another.
Like many rural states, several groups that supported practice-based educators in Iowa disbanded over the years for various reasons, including the rural nature of the state, which resulted in members having to travel long distances for in-person meetings. While many of ANPD's affiliate groups continue to hold face-to-face meetings, the lack of resources and the rural setting in Iowa prompted the founding members to adopt a different approach and establish a virtual affiliate group in Iowa. Each month, the group conducts virtual networking meetings to support the professional development of NPD practitioners across the state. These interactive sessions offer participants the opportunity to discuss current topics, gain insight into ANPD resources, and participate in breakout sessions focusing on the six core components of the NPD practice model. Continuous networking is also facilitated through a LinkedIn group and Microsoft Teams channels. In the two years since this group was established, its membership has grown to nearly 80 participants, demonstrating the immense need and value of the group.
Challenges faced by rural healthcare and the nursing profession are significant, but these challenges also present opportunities for innovative solutions and growth. The IONRP and Iowa ANPD Affiliate group are just two examples of leveraging innovation and technology to support nurses working in rural areas. By focusing on such innovative solutions and leveraging technology, it is possible to overcome challenges related to living in and working in a rural area, improve patient care, and support the development of a robust nursing workforce in rural areas. This not only benefits the nurses but also contributes to better healthcare outcomes for rural communities.
Nicole Weathers, MSN, RN, NPD-BC, is the director of Iowa Online Nurse Residency Program at the University of Iowa College of Nursing. She is a member of Sigma’s Gamma Chapter.
Linda Anders, DNP, MBA, RN, NPD-BC, FNP-BC, is the Nursing Education Programming Manager at Sigma. She is a member of Sigma’s Chi Rho Chapter.