Retention and Recruitment in Rural Nursing

With the increase in vacant nursing roles across the nation, recruiting and retaining talent in nursing has become progressively more important — especially for community and rural health facilities.

Recruiting and healthcare professionals are vital to rural areas. The loss of even one nurse in these settings can affect healthcare delivery for an entire community. Ineffective recruitment and retention can limit access to basic healthcare services for thousands of patients who are spread out over hundreds of miles or cannot travel outside of their area for care.

The looming nursing shortage continues to be a challenge for many healthcare settings — particularly rural nursing. A study on the registered nurse (RN) workforce found that the number of working RNs decreased by 100,000 from 2020 to 2021, and this number is expected to significantly grow by 2030.

The American Association of Colleges of Nursing (AACN) cites many contributing factors to this, including nurse faculty shortages, increased burnout from the COVID-19 pandemic, and nurse retirement. As large numbers of nurses leave the bedside, it is critical to find recruiting and retention solutions to mitigate the effects of this shortage on rural healthcare settings.

Gaps in healthcare

Gaps in the healthcare workforce caused by both doctor and nurse shortages disproportionately affect residents in rural areas. These communities represent 14 percent of the U.S. population, and these areas have a much smaller share of doctors and nurses compared to urban areas.

According to the National Association of Community Health Centers (NACHC), over 30 million patients were served by community health centers in 2021. While these patient numbers are impressive, in many cases, these facilities are the only healthcare provider for hundreds of miles. The loss of adequate staffing can force patients to travel even further to receive healthcare services or go without care altogether.

Barriers to recruitment and retention of rural nurses

Nurses are the group most impacted by workforce loss in rural healthcare. Many reasons can be attributed to this. However, pandemic stress and competition from other employers were the most common reasons for staff departures, according to the NACHC. Barriers like these affect recruitment and retention in rural nursing and can be discouraging for nurses looking for long-term positions.

Nurses in these remote settings frequently care for more complex patient populations than residents of urban locations. Patients living in remote areas experience several disparities when it comes to health status, such as a higher incidence of disease and disability, lower life expectancies, and increased mortality rates. Compared with those living in urban areas, patients in rural settings have higher rates of chronic illness, are in poorer overall health, and are also older and have lower income.

Certain risk factors contribute to these disparities, including geographic isolation, higher rates of health risk behaviors, limited job opportunities, and lower socio-economic status. These same disparities can also make these healthcare settings seem less attractive to healthcare professionals. These recruitment challenges underscore the need for robust retention strategies.

Recruiting and retaining rural nurses

When it comes to the recruitment and retention of nursing professionals, some rural and community health centers do not use a long-term view despite stiff competition for a limited supply of healthcare professionals in other communities. Desperate to provide care to patients in need, many organizations jump right into the recruitment process without considering the current retention rates, cost of staff turnover, and benefits of staff retention.

Recruiting nurses is a short-term solution that involves identifying the workforce need, key attributes required for the open positions, and potential employees who fit the need. However, retention requires a more long-term view, focusing on how employees relate to their work, the people in the organization, and the patients they’re caring for.

Community and rural health facilities face special challenges when it comes to maintaining an adequate nursing workforce. These challenges, including fewer resources, geographic isolation, and workplace safety, can have a profound impact on attracting nurses into these health settings. But by considering the aspects that can entice nurses into rural healthcare environments like more autonomy, sense of connectedness, and mentorship, you can create thoughtful recruitment and retention strategies.

Recruiting qualified and interested nursing professionals and helping them acclimate to an area and facility are costly endeavors. Finding a nurse suited to the local area in which they will work can also be a lengthy process. Leaving a position unfilled for any length of time can cause tremendous gaps in care. Successful recruitment and retention can minimize the duration and number of vacant positions, while saving money, improving quality of care, and ensuring the provision of healthcare services in the community.

Strategies to improve retention

Efficiently recruiting and retaining nurses is essential for smaller communities, but many of these healthcare organizations are at a loss when it comes to retention.

Some ideas to improve nurse retention in these types of healthcare settings are:

  • Teamwork: Studies have shown that teamwork can enhance job satisfaction of nursing staff. In remote settings, teams are often small with staff from different specialties or disciplines. Nurses, especially in rural health, need support not just from leadership but their colleagues as well. By implementing team activities, such as meaningful team recognition or organized events, you can increase engagement and boost the morale and functionality of the team.
  • Supportive leadership: Nurse leaders and managers face challenges of their own in rural healthcare environments, including time away from the facility and traveling far distances. However, supportive leadership can influence retention in rural nursing. One study showed that when organizations invest in supportive and effective nurse leadership, there was higher retention and job satisfaction among nursing staff. In smaller communities, supportive leaders foster accountability, cultivate leadership skills, and encourage growth. In these settings, this can appear as mentoring, staff sitting in on management meetings, or learning a new task.
  • Mentorships: Mentorships provide opportunities for support and connection to nurses working in remote areas. Whether a nurse is new or seasoned, mentorships ease workplace transitions, build community relationships, and further develop communication skills. Because these partnerships offer a different level of support (personal and professional) for rural nurses, they can have a positive impact on recruitment and retention in remote areas.
  • Education and student placement: A study on retention of healthcare professionals found that the selection of students from rural backgrounds increased retention. This survey also revealed that when current healthcare staff had organizational support to pursue education, including flexible schedules, paid tuition or tuition reimbursement, or academic courses tailored to their specialty, there was lower turnover.

Final thoughts

Strong retention rates can reduce the need for frequent recruitment, and properly planned recruitment strategies can improve retention rates. Implementing a proactive and strategic approach can help community and rural health facilities recruit and retain the personnel they need to provide adequate care to the patients they serve.