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When listening to stories about the nationwide nursing shortage, some of us might immediately think of urban hospitals as the overwhelmed facilities most acutely struggling to care for the citizens of densely populated metropolitan areas. There are approximately 20 million people in the larger New York City region, and Los Angeles and Houston have more than 12 million and 7 million, respectively. That’s certainly a lot of people to care for.

However, the reality is that the shortage of qualified nursing professionals is in no way confined to the cities. Rural communities are also suffering, and the need for action is paramount.

Rural Healthcare on the Edge

According to a May 2023 article in the journal Chief Healthcare Executive , 35% of the hospitals in the U.S. can be categorized as rural, and more than 600 are at risk of closure. The consequences could be severe in PennsylvaniaMissouri, and many other states with large rural populations, and anyone aware of the situation is justifiably concerned.

While urban hospitals can often choose to close units or shutter a percentage of beds due to plenty of nearby hospitals picking up the slack, many rural hospitals serve as a medical safety net for large geographic areas and can’t simply decrease capacity. If your hospital is an oasis in a medical desert, it’s a serious responsibility to remain open and accessible.

Meanwhile, recruiting doctors, nurses, and other professional staff to live and work in rural areas can be challenging, especially when younger clinicians are more likely to prefer to settle in urban centers offering more nightlife, professional opportunities, social outlets, and cultural amenities.

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At the same time, the American Association of Colleges of Nursing has reported that nursing school enrollment has fallen in recent years, with entry-level baccalaureate nursing programs losing 1.4% in 2022, MSN programs dropping 9.4% since 2021, and PhD programs shrinking by 4.1% from 2021 to 2022. With tens of thousands of qualified candidates turned away each year due to a lack of faculty and appropriate clinical training sites, this decreased nursing school capacity feeds directly into hobbled patient care capacity at urban and rural levels.

The Rural Health Information Hub (RHIhub) reports that the use of methamphetamine and tobacco is higher in rural adults than in their urban counterparts, and rural teens are much more likely than urban adolescents to abuse alcohol and drive while under the influence.

With overdose deaths disproportionately higher in rural areas, the repercussions of such dire statistics don’t bode well in areas already lacking sufficient healthcare resources, including clinician shortages and facilities at risk of being permanently shuttered.

Solutions Are Needed

Considering that 35% of American hospitals are in rural areas and that substance use disorders and other ills plague rural communities as much as, or more than, urban centers, action is needed to stem the tide.

Increasing nursing school capacity across the country is a prudent course of action to begin to solve the nursing shortage. And if we can find solutions to the astronomical debt (often more than $250,000 to $300,000) taken on by medical students while completing their studies and becoming physicians.

One thing that some rural communities may have going for them is significantly lower housing costs and a lower cost of living, something that newly debt-saddled physicians (and nurses) should take into consideration. Despite relatively lower salaries, rural living can counterbalance a more straightforward way of life and more affordability. Any way that we can mitigate rural workforce deficits is vital to consider.

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Tulane University suggests increased access to mobile health clinics, telehealth, and rural-urban collaborations that leverage the technology and capacity of healthcare systems in large population centers. Reliable broadband service is crucial to rural patients being able to make use of telehealth and app-based care solutions.

Infrastructure for healthcare-related transportation could be critical in some rural areas where elderly or poor residents face barriers of distance and cost when attending medical appointments. From oral health and preventive care to home health and hospice, patients can only receive care when it is accessible and affordable and has adequate staff to meet patients’ needs.

Urban, suburban, and rural health are all equally important in terms of the overall health of our society. Rural areas need nurses, physicians, and other allied professionals willing to dedicate themselves to the issues faced by those outside of major cities and towns. Advocacy, collaboration, and creative thinking are pillars upon which effective strategies can be built, and nurses can be at the forefront of how these deficits and challenges are thoughtfully addressed.

Keith Carlson
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