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Boom or Bust? Local nursing education in rural communities proving helpful in battling the nursing shortage

Across the country, the supply of nurses in rural hospitals is getting dangerously thin. Many don’t have enough staff to run their hospital, and their patients have nowhere else to turn.
But for one hospital in the mountains of rural Utah, the supply of nurses provided by Nightingale College’s distance education model is critical for weathering the storms of the highly-unstable oil-based economy.
The residents of Vernal, Duchesne, Roosevelt, and a peppering of smaller towns that fill the Uintah Basin rely heavily on the oil fields for their livelihoods, and with fluctuating gas prices, nothing is certain. The towns stagger through “boom” and “bust” phases every few years, causing dramatic rises and falls in population, business, and employment.
Before education advanced, hospital officials at Uintah Basin Medical Center in Roosevelt had to constantly adjust to the ebb and flow of nurses.
“In 2008, I couldn’t find a part-time RN nurse because the oil field was booming and their husbands were in the oil field making six-figure incomes,” says Bobby Richardson, Chief Nursing Officer at the facility. “Today, with the downturn in the oil field, those nurses are coming back because they need a job, you know? So, one of the things that we deal with in this micro-economy is that cyclical nature of our industry.”
After a few months, the sudden influx in nurses was usually followed by a similarly sudden downturn, and an exodus. The nurses followed their husbands to a new career, and left the hospital in dire straits.
In a bust phase, Angela Gordon, who manages Med/Surg in the hospital, lost 8 nurses in 8 weeks. The loss was devastating for such a small facility. “It was a struggle and they were not replaceable,” she says. “This area peaked about two years ago with growth that has never been seen before. Vernal, which is 30 miles away, was in the top 10 fastest growing cities in the nation. And then due to political changes...thousands and thousands of oil field workers lost their jobs...There’s a lot of empty houses in Vernal now.”
A few key nurses held down the fort during the bust phases. Those are the nurses that had family ties in the area, or in other words, the locals.
Brianne Bird, a young RN from the Basin, managed to stay employed because she attended Nightingale College. The school allows its students to do all the didactic work online and their clinicals in their local hospitals. Bird’s nursing degree keeps things stable when her husband’s oil work fluctuates.
“When I first started the program, I was dating my husband,” said Bird. “He was on an oil rig and they make quite a bit of money, upwards of 75 plus a year. We were used to having quite a bit. Then as the oil went down, it kind of changed and we were more struggling with it. You know we were having to really watch finances and things like that. And after I graduated and got certified and was able to get this job, our finances have kind of evened out and we are able to pay all our bills on time.”
The instability of the oil also affects the hospital’s finances, forcing them into a nursing shortage cycle. Now, with the help of Nightingale College, local career nurses like Bird help keep the hospital stable.
The hospital, like many others in rural communities, eventually had to resort to travel nurses. Travel nurses usually don’t show the level of care that local nurses do, because they have a short-term view within the facility. The executives agreed that local nurses provided better quality care, but they didn’t have any locals available.
Other workarounds like transferring nurses between departments and paying overtime were equally ineffective for them. There were too few replacement nurses graduating, and no nurses moving in. The hospital’s potential patients were driving hours to other facilities to ensure they received care. Their nurses were overworked. Their managers were working on the floor, and even the ambulance staff had to help out sometimes. Their nursing positions remained empty for months, without even a single application. An understaffing whirlpool was the result.
“The immediate problem is just immediate staffing,” said Richardson, the CNO. “On the employee’s side, if I’m short staffed, you’re working overtime and you get very tired very quickly that increases patient safety issues and outcomes and those kinds of things. And on the employers’ side, I’m paying premium pay.”
Roosevelt climbed out of the downward spiral by battling the nursing shortage with local nursing education. With the implementation of contemporary education models, that allow for schooling online and in local facilities, the capacity for nursing students is not limited by faculty or space in a classroom, nor do nursing students travel for hours to attend school.
Nightingale College’s model involves local community partners, hospitals like the one in Roosevelt, who join with the school to educate nurses in their communities. The hospitals donate the space, and the College provides the education, creating a steady stream of nurses into the hospitals.
Although Roosevelt now has a reliable source of nurses, hundreds of other rural communities are still caught in the rounds of the nursing shortage cycle. Across the country, there are close to 2 million open positions for nurses, according to the Bureau of Labor Statistics. That is a lot of hospitals in need, and there aren’t enough travel nurses to fill all the positions in rural communities. That’s why Nightingale’s long-term solution is education within those communities.
The people who will be involved long term are the locals. Chona Dart, Roosevelt’s emergency department manager, said that the hospital prefers to hire local nurses, “because they live here and are more invested in our community.”
Nightingale works hard to educate career nurses that will stay within their communities, because those nurses know best how to improve health in that area.

NRHA commissioned the above piece from Nightingale College, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog.

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