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Rural Nursing – The Pros and Cons

A career in nursing can be exciting, rewarding, and challenging— especially in the area of rural nursing. Working in a small hospital or rural community means you will need to provide expert nursing care to young and old patients and their families in a variety of settings.

Rural nurses care for OB, pediatric, geriatric, surgical, and acutely ill patients in community hospitals or home settings.

As a home health rural nurse you may need to care for patients (who live 60 miles or more from the nearest hospital facility) who have diabetes, heart disease, kidney failure, asthma, cerebral palsy, or a pressure ulcer. Because many rural patients are poor, uninformed, or do not have access to medical care, they are more likely to suffer from co-morbidity than patients in urban areas.

For example, a patient with type 2 diabetes living in a rural area often has other conditions like a pressure ulcer, high blood pressure, or heart disease. Caring for patients with multiple medical conditions means rural nurses must be competent care providers with creative problem-solving skills.

rural nursing

Rural Nursing in the Foothills of the Appalachian Mountains

Many rural patients live alone in isolated areas and their nurse can sometimes be the only person they see that day. This is why it is important that rural nurses understand their role is much more than a patient care provider.

I asked Rachel Ballard, RNC-MN, BSN, who has been a rural nurse in the Appalachian Mountains for 10 years, about her experiences as a rural nurse.

She said, “I live in the foothills of the Appalachian Mountains—the poorest region of the U.S. We have the highest drug rates, heart disease, and diabetes numbers to boot. I think rural nursing takes a bit of ingenuity and tenacity. We have to go on when it looks bleak. Get creative when we don’t have things we need.”

When I asked Rachel about what it takes to be a rural nurse she said,

“It’s hard for me to tell you what it takes to be a rural nurse because I’ve always been one. I’ve only lived in a rural setting and only worked in one. I’m used to not having supplies or dealing with patients who have so many co-morbidities it’s almost impossible to treat them.”

Although rural nursing may not be for everyone, there are many positive things about caring for patients and their families in a rural area. Before deciding upon a work setting it’s always good to take a look at the pros and cons of that particular work setting.

Pros about Rural Nursing Include:

  • Job stability – Many rural areas need expert nurses to care for patients in their community.
  • Variety – As a rural nurse you get to care for a variety of patients.
  • Independence – Rural nurses are given a higher level of autonomy than nurses practicing in urban areas are given.
  • Creativity – Rural nurses never get bored of never being intellectual, physically, or emotionally challenged. They must use their creativity to overcome some of the limitations of working in a rural area with limited resources.
  • Connections – Rural nurses are intimately connected to their community and patients. They need to work together with other nurses and members of the community to get their patients and families the resources they need.
  • Teaching and educating – Rural nurses have an important role in educating members of the community about making healthy lifestyle choices, with a limited amount of resources.
  • Culturally competent care – Rural nurses must be sensitive to the culture of the members of the community where they work. Rachel said, “Here some women want to put an axe under the bed to cut labor pains or ask to bury the placenta at home. We must respect those wishes as any nurse would.”

Just like a career in urban nursing, working as a rural nurse can also be challenging. There are a variety of factors that impact the way nursing care is provided in the rural areas.

Cons of Rural Nursing Include:

  • General knowledge – Rural nurses are expected to care for patients with a variety of medical conditions. This means they develop general nursing skills instead of expert skills in one particular area. This can be both a positive and a negative element of rural nursing.
  • Flexibility – Rural nurses are expected to be flexible, float to different units on the hospital where they are needed, perform care without the resources they need or use assessment skills without technology because the technology they need is not available.
  • Inadequate staffing – Many rural areas do not employ an adequate number of nurses to care for the population of patients they are serving. This means rural nurses may need to carry a heavy load of patients. Rachel said, “We often don’t have enough staff and are forced to work with less than what we need.”
  • Inadequate resources – Because rural nurses tend to work in poor communities they tend to work in areas with scarce community resources. This means the rural nurses have to rely on their own ingenuity to fill in the gaps. According to Rachel, “You can’t get an ultrasound on the weekends and have to wait until Monday or be dying to have someone on call come in and perform one.”
  • Small community atmosphere – A small town atmosphere where everyone knows each other can be a problem for rural nurses. According to Rachel, “HIPPA [confidentiality] is a major concern because you see your patients or their families out in town and nurses often forget their boundaries and share too much information with them [members of the community].”

If you are a creative, genuine person who has the tenacity to work in a challenging area then you may want to consider a career in rural nursing. Rural nurses have job security, flexibility, and the ability to make a positive impact on the community where they live.