Facing the Challenges of Nursing: Serving Rural Populations

Nursing is the most trusted profession in the United States. Nurses walk alongside patients through their entire health care journey, practice in a wide range of specialties, and are advocates for quality patient care. And yet there are continued shortages across the industry. The Bureau of Labor Statistics (BLS) projects 15% growth in Registered Nurse (RN) employment from 2016 – 2026 and the need for 1.1 million additional nurses by 2022. 53% of US nurses are now over 50 and moving toward their retirement years – a dramatic shift from 30 years ago, when 54% of nurses were under 40. How did it get here and what can be done about it?

Nursing shortages stem from multiple factors, but one of the industry’s biggest challenges is availability of quality training for new nurses in post-secondary institutions. Challenges include finding faculty (nurses tend to make more doing nursing rather than teaching nursing), finding clinical rotations to apply didactic skills for future nurses, navigating the complexities of nursing program approval requirements (which vary by state), and the expense of educating nurses (start-up costs, simulation costs, clinical facilities, etc.). Providence recognized this challenge in the early-2000s and partnered with University of Providence (UP) to start an RN to BSN program in 2008. Last year, UP celebrated the 10-year anniversary of its first RN to BSN graduating class. Since this first cohort, they have graduated over 800 students. As of Spring 2020, UP now has 221 nursing students, which includes not only the RN to BSN program but also a Master of Science in Nursing, Nurse Educator and a pre-licensure BSN program with locations in Lewistown, Montana and Anchorage, Alaska.

The BSN program is unique because it has a focus on rural nursing, whereas most nursing schools are focused on urban healthcare. UP’s BSN program features a hybrid design with clinical training occurring on-site and coursework completed online, making the program more accessible than traditional programs and allowing the program to scale more quickly than others.

Above and beyond the overall shortage, there are dire nursing shortages in rural hospitals, where a skillful nurse who has generalized training can literally be the difference between life and death for a patient. After piloting the model in Lewistown, Montana in January 2019, UP opened a second site in Anchorage, Alaska in January 2020 and will expand to Medford, Oregon in 2021. Removing barriers for students, in addition to creating more locations where they can receive their education is directly helping meet the demand for more rural nurses who can serve populations where nursing shortages are most acute.

“Having made Alaska my home for almost 30 years, I’m thrilled to be in Alaska’s first cohort of UP’s new accelerated BSN program. Alaska needs nurses,” said Mary Kemper, a student currently enrolled in the Anchorage cohort. “Our small cohort of nine is getting the best of online learning from professors from across the country, along with many hours each week of expertly guided real-life clinicals at PAMC, a nationally recognized Magnet hospital. 

Mary is eager to help her community and said even though she doesn’t have a background in healthcare, she can see that by the end of the program, UP will have her ready to face the challenges of professional nursing, especially in rural and remote environments. 

“I hope to serve in my own city of Anchorage first -- what unit, I cannot guess. Eventually, I hope to gain skills to serve in smaller communities in Alaska and then in rural and urban communities throughout the West.”

In addition to training students through their existing higher education programs, UP is exploring innovative ways to meet rural students where they are. In 2019 the university received a $441K grant from USDA Rural Development to roll-out a distance learning system “to deliver advanced classes and educate nurses and nursing students in rural Montana”, including rural Montana high schools and the Salish Kootenai College on the Flathead Reservation. Deb Burton, the vice president of the School of Health Professions for the University of Providence stated that the grant “provides an unprecedented opportunity to deliver the highest quality academic clinical education to rural and place-bound students in our state, and to build a future Montana nursing workforce that mirrors the population: rural students, Native American students, and students who plan to stay and practice in our most rural communities.” The USDA projects that this work will reach six Montana counties, serve over 850 secondary students and 20 tribal college students.

The nursing shortage is only projected to increase. University of Providence is actively working to decrease the shortage, especially in rural areas where the need is the greatest. By expanding the BSN program to rural areas, providing a hybrid model that works with students’ schedules, and meeting rural and place-bound students where they are, UP is removing barriers to education and helping to ensure that the next generation of nurses is poised to provide compassionate, quality care for patients at any point in their healthcare journey.


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