Those who are most interested in a rural healthcare practice are those who grew up in and prefer a rural setting.
With the need for rural practitioners critical, the most effective way for rural hospitals and health systems to adequately staff for nurses and nurse practitioners is to grow their own, says nurse educator and practicing clinician.
Michele Reisinger, DNP, APRN, FNP-C, should know. She is a Kansas native with a decades-long clinical practice as a family nurse practitioner in her hometown of Onaga, population about 700.
She also is an assistant professor of doctoral nursing at Washburn University School of Nursing in Topeka, Kansas, where she is the primary investigator on a Health Resources & Services Administration-funded $2.4 million, four-year grant focused on the education and preparation of rural nurse practitioners for practice in medically underserved communities.
The need for advanced practice nurses (APRNs) in rural areas is great, as hospitals close and the number of physicians declines. Nearly 80% of U.S. rural counties are medical deserts, with no access to healthcare services, according to the National Rural Health Association.
"I have students that live out in western Kansas and southwestern Kansas, and these students are being recruited heavily a year before they even graduate because those rural health clinics are having to staff with long-term locums who have been present for several months to a year because they don't have enough bodies to physically fill the positions that are there," Reisinger says.
The question is whether those APRNs will stay for the long term, she says.
"You can provide incentives, such as participation with tuition reimbursement," Reisinger says, "but often what we will find happens is those entities then put in the number of years they're required to pay back their tuition reimbursement and they don't often stay sustainably in the community."
For example, the National Health Service Corps Scholarship Program essentially removes a clinician’s educational debt once they’ve fulfilled an obligation of a particular number of years to a community.
"Sometimes it works, sometimes it doesn't," Reisinger says. "Sometimes those people stay for 10 or 15 years, sometimes they stay there for three years and move on, because they've got their educational debt paid off."
But that’s not for lack of trying on Reisinger and Washburn’s part to get them to stay.
The nursing school requires students’ rotations to include a certain number of hours in rural health settings to expose them to a practice of which they might not otherwise be familiar.
"The reason for that is twofold," Reisinger says. "One is to effectively prepare them educationally, but it’s also to generate interest because it's very difficult to recruit nurse practitioners to the rural areas, so this is also a workforce type of issue."
Coming back home
Those who are most interested in a rural healthcare practice are those who grew up in and prefer a rural setting, Reisinger notes.
"In my little corner of the world, we've recruited a lot of different ways, but what really works is you have to raise them in a rural community, send them away to get educated, and hope they migrate back to the rural community because they recognize the benefit of a rural community in raising their own children or have that piece of community attachment," she says.
"It's really hard to relocate a provider who has never experienced rural living or who doesn’t have a sense of community in a rural entity," she says.
That’s why hospitals or extended-care facilities are tending to recruit locals within their own communities.
"Rather than spending those additional funds outside and trying to recruit it, if you can recruit within and then bring them back, retention is much greater, at least in my experience," Reisinger says.
Better staffing, cost savings
Eastern Maine Community College’s nursing program in Bangor, Maine, collaborates with the region’s rural hospitals to provide nursing education for students who prefer to stick close to their communities.
Northern Light Mayo Hospital in Dover-Foxcroft, Maine, graduated six students in the class in 2020 and nearly all continued working there, according to The Hechinger Report, a national nonprofit newsroom that reports on education.
Not only did that help with staffing levels, but in the first nine months after the nursing students’ graduation, the hospital saved $360,000 in travel nursing costs, according to Hechinger.
Building a pipeline
Rural and underserved citizens of Colorado have gained access to healthcare providers through the Grow-Your-Own APRN Fellowship, an innovative model that builds an advanced practice (APRN) primary care workforce and pipeline for rural and underserved areas by recruiting and developing nurses already committed to their own rural community.
The program was developed by Ingrid Johnson, DNP, MPP, RN, FAAN, president and CEO at the Colorado Center For Nursing Excellence, who recruited rural BSN nurses to return to school, earn advanced practice degrees, and transition to practice as a rural primary care APRN. The fellowship provided financial support, individualized coaching, and leadership support.
“The model significantly reduces financial and continuity-of-care costs related to recruiting and turnover of providers that have no interest in living long-term in rural areas and often leave after loan-forgiveness obligations are met,” according to the center of excellence.
Johnson’s program, which has received national recognition, was published in Nursing Administration Quarterly.
“We've recruited a lot of different ways, but what really works is you have to raise them in a rural community, send them away to get educated, and hope they migrate back to the rural community.”
— Michele Reisinger, DNP, APRN, FNP-C, Washburn University School of Nursing
Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.
Even with loan-forgiveness incentives, most nurses leave rural practice after employment obligations are met.
Washburn University School of Nursing curriculum requires a certain number of hours in rural health settings to introduce students to rural practice.
The Grow-Your-Own APRN Fellowship in Colorado is successfully placing nurses in rural and underserved areas.