By Susan Kreimer, MS, contributor
Oct. 16, 2009 - Among the many priorities in modern health care, a movement is underway to boost the number of rural nurses and enhance health outcomes in underserved communities. Some universities are offering special online degree programs or nurse residency training to accomplish these goals.
The demand for nurses in rural areas greatly outstrips the supply, said JoAnn Klaassen, RN, MN, JD, director of the University of Missouri-Kansas City School of Nursing’s Rural Nurse Initiative, launched in January 2009.
A $1.75 million grant from the federal Health Resources and Services Administration (HRSA) made this initiative possible. Aiming to increase the number of baccalaureate-level nurses in outlying areas, the university will provide laptops and high-speed Internet service to rural nurses who enroll in the school’s RN-to-BSN program.
“Rural nurses often have little to no reliable Internet access to be able to complete traditional online programs,” Klaassen said. “Furthermore, in the majority of online programs, rural nurses must learn in isolation, find clinical preceptors or travel to clinical sites.”
Although statistics on rural nurse shortages are limited, these hospitals take 60 percent longer than urban counterparts to fill nurse vacancies, according to the National Rural Health Association in Kansas City.
“As we move into health care reform – and the need for a more holistic and bigger-picture approach to how we deal with community health – it’s going to be vital to have these more highly trained professionals in rural communities,” said Barach Slabach, the association’s senior vice president and a former 22-year hospital administrator in rural Centreville, Mississippi.
Some studies indicate that nurses residing in rural areas often commute to urban workplaces paying higher wages. In 2004, the American Academy of Colleges of Nursing estimated that 63 percent of rural nurses in central regions did not have bachelor’s degrees, Klaassen said.
The three-year HRSA grant enables the Kansas City school to offer its RN-to-BSN program to nurses in rural and remote areas. Weekly courses take place in a virtual classroom. All sessions are archived for later viewing or podcasting to accommodate work schedules.
Klaassen added, “We have redesigned curricular elements of our current program to integrate rural nursing concepts, and we carefully design our online practicum groups with both urban and rural nurses to maximize collaboration and resources.”
The school is in the process of live streaming activities from its onsite simulation lab, so that distance learners can watch and participate in debriefing sessions. Urban medical centers also supply the school with nursing experts as needed.
“Faculty are carefully screened for online education expertise and are expected to be supportive and actively involved with students,” Klaassen said. “Live technology support is provided on a round-the-clock basis.”
The Idaho State University School of Nursing in Pocatello is also hoping to address rural nurse shortages. In 2008, the school received federal aid from HRSA to fund the Northwest Rural Nurse Residency, which began serving nurses in January 2009. The three-year HRSA grant expands upon an earlier one that created the first distance education rural nurse residency.
Working with partners in several states, the school of nursing is providing nurses with a rural generalist residency. Telemedicine and rich media classes help new rural nurses transition their skills from novice to proficient levels. Course content elevates patient care quality and nurse confidence.
“The residency focuses on crisis assessment and management,” said Deana L. Molinari, PhD, RN, CNE, an associate professor at Idaho State. “New graduates take seven core classes and choose from about 100 electives to gain the skills they need for their job description. They also work with a preceptor for 104 hours during the first four months.”
Graduates are employed before they enter the residency. They come from many states, including Oregon, Alaska, Washington, Idaho, Montana, Wyoming, Nevada, Oklahoma, Minnesota and Nebraska.
“The ‘residency-in-a-box’ idea provides small organizations with the power to offer quality programs similar to those found in urban centers, but focused on the type of practice found in rural centers,” Molinari said. “Rural nursing is a specialty and is hurting more than urban nursing.”
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