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Dear rural hospitals: Where are your nurses?

In the rural city of Panguitch, Utah, Garfield Memorial Hospital has nine acute beds (21 beds total), one labor room, and five full-time doctors. A generous estimate pinpoints the population of Panguitch at 1,665. That’s 333 people per doctor. Panguitch’s story is not new. In fact, hospitals, long-term care facilities, and other health care facilities nationwide have similar stories to share.
As a nursing school, Nightingale College noticed that something needs to change in health care, and we ask a simple question: Where are your nurses?
When our learners arrive with their clean scrubs, full coffee cups and smiling faces, it’s hard to imagine that just a few hundred miles away are hospitals like the one in Panguitch – so small and remote that they struggle to find a single applicant for an open health care position. These nursing shortages are common in both urban and rural communities.
Why is there a nursing shortage?
43_MRP5528.JPGThe nursing shortage has become a plague throughout the United States, and rural communities are hit harder than their urban counterparts. Advancement in nursing education is key to erasing the nursing shortage, yet health care facilities can be slow to adopt modern education models. Instead, officials choose to implement short-term workarounds like travel nurses and overtime that can sometimes compound the original problems.
The career outlook for registered nurses is phenomenal. In fact, according to the Bureau of Labor Statistics, the field is projected to grow 15 to 16 percent in the next ten years. According to the American Nurses Association, 1.13 million nurses will be needed by 2022, including 574,400 new nurses and 555,100 replacement nurses. Why then, with so many well-paying open positions that require a minimal two years of schooling, are people not flooding to enroll in nursing programs? Why are nursing positions staying open for months and nurses being run ragged with overtime and understaffed units?
Reasons for the bottleneck
The truth is there are people flooding to fill the programs, but nursing education is causing a major bottleneck. There are many reasons that nursing programs are not churning out nurses at a sufficient pace:
Some nursing programs only accept honor-level GPAs, leaving out others who want to fill the nursing need. Additionally, implementing policies that create large washout rates of people who would make great nurses is not helping decrease the nursing shortage. At Nightingale College, we’ve found that the best nurses are not always the best test takers, and we believe in giving people a second chance to become the nurses so many hospitals need.
Some nursing programs have a limited number of seats available, and others have waitlists of three years or longer. That’s not just a long time for an applicant to wait, but it’s also a long time for a hospital to wait for RNs to fill understaffed units.

Another problem with nursing education is the standard delivery modalities. It’s sometimes impossible for prospective nursing learners in rural areas to get educated because they don’t want to drive every day to attend a brick-and-mortar school in another city. Offering classes online includes more non-traditional students.

What results from the current nursing education system is a very small class of elite, urban graduates who are expected to fill a larger-than-life need across the country. And few of these graduates are interested in working in a rural area when they can be paid more and have more job choices in an urban area.
This outcome leaves rural hospitals in a sticky situation. You’re probably not getting enough nurse graduates, barely enough or not enough to keep up with your turnover, retirement, and relocation rates. With fewer resources, rural hospitals have to figure out ways to operate with fewer nurses. You may end up implementing ineffective workarounds like overtime, travel nurses, less qualified nurses such as LPNs, CNAs, and floater nurses. They may even be at risk of closing down units in the facility, requiring residents to travel farther to receive care. The educational emphasis becomes even more prevalent considering the Institute of Medicine’s recommendation that 80 percent of nurses nationwide hold a bachelor’s degree in nursing by 2020.
Long term, short-term fixes and workarounds have serious ethical implications, impacting both nurses and patient care. “Health care organizations must focus on factors that influence errors and operationalize strong corrective actions aimed at improving working conditions and eliminating all preventable injury, harm and death,” reports Ronald Wyatt, M.D, Joint Commission on Accreditation of Healthcare Organizations medical director.
Hospitals need to take the initiative to reverse the shortage and improve health outcomes. Those outcomes aren’t secret, and your clients know when they are not being cared for at the highest level. According to Sigma, 81 percent of Americans know there is a nursing shortage, and 65 percent believe it impacts the care they receive.
Removing the bottleneck by bringing nursing education into rural facilities is one way to eradicate the nursing shortage. By opening your facility for experiential learning opportunities and partnering with local nursing programs in rural areas, you can offer more people the chance to become a nurse and help mitigate some of your understaffing problems.
By opening your doors for experiential learning, you can help nursing education move away from traditional on-ground models and elitist mentalities. With blended-distance programs like those at Nightingale College, which offers education online with experiential learning in partner facilities, learners can become nurses in their rural hometowns and stay there. You need them in your town, instead of traveling to the city for their education and accepting a job hundreds of miles away.
As a nursing school, Nightingale College sees fully staffed units forming in rural communities where our learners graduate and become nurses. We witness the impact homegrown nurses make in their community. Uintah Basin Medical Center partnered with Nightingale, and after only two years was fully staffed with local RNs. Other hospitals remain unaware of modern nursing education models and continue to swirl in the shortage whirlpool. There is a better way.
Nightingale College nurses are reversing that shortage. Our learners are going home to work in rural places like Panguitch, Utah; Kemmerer, Wyo.; Declo, Idaho; and Ely, Nev. It is time to partner with nursing education to help you stay staffed, and it’s time we work together to unstop the bottle.

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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