Nurse Practitioners May Find Challenging Practice in Rural Areas

If you are looking for a challenging position as a nurse practitioner and aren’t convinced you want to work in an urban setting, consider practicing in a rural area. There is ample opportunity for challenging practice and the opportunity to serve many patients who need care. In fact, nearly 20 percent of Americans live in rural areas, yet only 10 percent of providers practice there. Over the past decade, the rural population has grown by approximately 30 percent, due in large part to retiring baby boomers who are moving out of cities. As hospitals close and the population ages, there has never been a better time to find stimulating, interesting work in rural America.

The fact that 87 rural hospitals have closed since 2010 is an indication of the urgent need for an increased number of nurse practitioners in rural areas. The National Conference of Legislatures has stated that advanced level practitioners can meet the primary needs of these populations, and improve the healthcare of rural Americans in three important ways:

1. Increases access: “…access to primary care increases when more nurse practitioners deliver those services. Nurses working as care coordinators and primary care clinicians can reduce hospitalization and rehospitalization rates for elderly patients.”
2. Improves quality of care: “A growing body of evidence indicates that the quality of care provided by nurse practitioners and physician assistants in the primary care setting is, in some aspects, comparable to that of physicians. In certain studies, for example, nurse practitioners were found to spend more time in consultation with patients and generate greater overall levels of patient satisfaction."
3. Reduces costs of care: “A2009 RAND study found that, in Massachusetts, visits to nurse practitioners and physicians assistants cost 20 percent to 35 percent less than visits to physicians.” Additionally, it has been proven time and again that preventive care reduces overall healthcare costs by avoiding costly adverse events caused by unmanaged chronic disease.

The need is dire

The National Rural Health report shows that rural populations tend to be in fair to poor health and are more apt to live in poverty. "Rural Americans tend to be older and less well insured, and chronic disease prevalence, infant and maternal morbidity, mental illness, environmental and occupational injuries, and obesity are higher in rural communities.” In addition, these areas "generally have fewer physicians, nurses, specialists, and other health care workforce, and small losses – such as a doctor who moves away or the retirement of a nurse – can have ‘far-reaching impact’”. The need for healthcare has never been higher and nurse practitioners can help to provide it.

A 2018 report by U.S.News & World Report showed startling statistics on the state of rural healthcare in America:  

• Across the country thereare more than 7,200 designated Health Professional Shortage Areas (HPSA) lacking adequate primary care
• 5 million people live in those areas
• Nearly 60 percent of the HPSA areas are in rural regions

Health Professional Shortage Areas are defined as those areas where there are shortages of clinicians providing primary care, dental and mental health services. It can be comprised of a geographic area, a specific population, and/or facility based. Some clinics that serve underserved populations also receive an HPSA designation. They include:

• Federally Qualified Health Centers (FQHCs) and FQHC Look-Alikes
• Indian Health Service and tribal clinics
• Rural Health Clinics (RHCs) – must complete a Certificate of Eligibility Form that certifies the RHC meets all NHSC site requirements

Many different types of care

Nurse practitioners interested in working in rural areas will find great need and great opportunity. As rural hospitals have closed, numerous clinics and community health centers have opened to try to fill the gaps in care. The National Health Service Corps has expanded across the nation. (Working for the NHSC offers opportunities for student loan repayment as well.) Despite this, rural areas remain desperately underserved.

Nurse practitioners can help to fill this gap. They can play an important role in expanding access to skilled care. They can provide population health services and specialized healthcare. For example, rural areas need disease prevention and chronic disease management. They need care for men and women at every stage of life from newborns to seniors.

The Commonwealth Fund identified two key issues in filling the healthcare gap in rural America:

1. Reshaping health care delivery. Healthcare workers should be deployed beyond the confines of traditional healthcare facilities. Rural healthcare organizations should consider the deployment of healthcare workers to support high risk patients in the community and support population health. Increasingly, clinicians should address social determinants of health like access to food and transportation as part of the holistic delivery of patient care.
2. Healthcare providers in rural communities should seek creative and collaborative partnerships with organizations and colleges in the area. This will expand limited resources and create joint efforts to leverage data and social services to serve the populations.

There are many untapped opportunities in rural areas for nurse practitioners who are looking for challenging, rewarding practices. It’s not for everyone, but for those who find a rural home, it may be the opportunity of a lifetime.