Addressing the Rural Nursing Shortage

The Bureau of Labor Statistics (BLS) shows that the number of jobs for registered nurses and nurse practitioners is expected to increase faster than the average occupation between 2018 and 2028. Additional factors, such as the growing aging population and nurses retiring, have led to a nursing shortfall. 

Rural communities are especially affected by the provider gap, as 63% of primary health shortages currently exist in rural communities, according to the Designated HPSA Quarterly Summary (PDF, 953 KB). As a result, these underserved communities may have difficulty accessing care.

To address the nursing shortage and bridge the gap in access to health care in rural areas, hospitals, health care centers, and community leaders are enacting initiatives to recruit and retain nursing talent.

Why Is There a Nursing Shortage?

In addition to the rapid growth in jobs for nurses, additional factors contribute to the current shortage. According to a 2019 report on the challenges of filling nursing positions, the aging population plays a significant role.

Currently, the United States has the highest number of Americans over the age of 65 who require additional health care services than any other time in history. Additionally, many health conditions that were once terminal are now survivable for the long term.

The nurse workforce is also aging; there are approximately one million registered nurses (RNs) over the age of 50, meaning one-third of the workforce could be at retirement age in the next 10 to 15 years.

In rural health care settings, these issues are compounded by the maldistribution of incoming health care professionals, which disproportionately affect remote communities, according to the Designated HPSA Quarterly Summary (PDF, 953 KB).

Additionally, rural areas tend to have higher populations of older adults and individuals with chronic conditions, increasing the need for care, according to a policy brief from the National Rural Health Association (PDF, 242 KB).

As a result of the shortage, health care professionals are at higher risk for burnout, according to a 2019 report on the challenges of filling nursing positions. The staffing shortfall puts additional pressure on health care professionals, especially in rural communities, leading to longer hours and more stress. If not properly addressed, the strain on the workforce caused by the shortage can lead to nurse burnout and higher turnover rates.

Barriers for Rural Nursing

There are multiple barriers to entry for nursing in rural areas. As a result, recruitment and retention of nurses in these communities can be challenging compared to urban settings.


According to Lara D. Wilson, executive director of the Maryland Rural Health Association, salaries for rural health care professionals tend to be lower than their counterparts working in metropolitan facilities. This pay discrepancy can be a deterrent for recent nursing school graduates.


Colleges and universities that offer health care degrees, including nursing, are more often located in urban cities, leading students to leave rural areas and stay in close proximity to their alma mater after they graduate, according to a policy brief from the National Rural Health Association.


Because many nursing students are not exposed to rural health care during their schooling, they may not feel equipped to work in such an environment or think to explore the space at all, Wilson said.


While there are ample job opportunities for nurses and other health care professionals in rural areas, their life partners who work outside of health care may struggle to find employment. The policy brief from the National Rural Health Association notes that this can make it difficult for nurses to relocate to a rural setting (PDF, 242 KB).

How Does the Nursing Shortage Affect Patients in Rural Areas?

Nurses play a critical role in patient care. When teams are short staffed, it can affect their work performance and, by extension, patient outcomes. 

According to a 2019 report on the challenges of filling nursing positions, a nursing staff shortage can lead to errors and higher morbidity and mortality rates.In hospitals with high patient-to-nurse ratios, nurses experience burnout and dissatisfaction, and the patients experience higher mortality and failure-to-rescue rates when compared to facilities with lower patient-to-nurse ratios.

Further, turnover of health care providers and nurses can interrupt the continuity of care in rural communities, Wilson said. For example, current initiatives to offer loan forgiveness to clinicians and nurses has led to a revolving door of care providers.    

“The problem is that clinicians will come to repay their loans, and then when that’s done, they leave,” Wilson said.

Establishing long-term providers who are part of a care team and the broader community has become the focus for rural areas to establish a continuum of care and improve the health of rural residents.

How Can the Nursing Shortage Be Fixed?

To address the nursing shortage in rural areas, health organizations, hospitals, and other community stakeholders are looking for strategies to recruit and retain nurses who are the right fit for a rural environment.

Wilson said that one such strategy is to establish more residency programs for nurses in rural areas.

“If we can get nurses to do their residency in the rural communities, they can see how rewarding working and living in a rural community is,” Wilson said. “I think that’s our best bet at encouraging clinicians to come to the community.”

Similarly, rural health stakeholders are looking into how they can attract nursing professionals who have existing ties to rural communities. Distance learning, for example, presents the opportunity for more rural residents to pursue nursing school while remaining in their community. 

2019 report on the challenges of filling nursing positions additionally highlighted the importance of providing continuing education and room for growth for nurses so they can feel empowered in their work and avoid burnout.

Why Choose Rural Nursing?

While living and working in a rural environment is not the right fit for everyone, many nurses may find it to be a rewarding experience. Rural nursing may be worth exploring if: 


According to a survey of Nurse Practitioners (NPs), individuals working in rural facilities more often reported they were fully using their skills, satisfied with their work, and planning on staying in their jobs despite working more hours and seeing more patients.


Because residents in this area are typically underserved, rural nursing can be fulfilling to professionals who want to provide individualized care to people who need it, according to the National Organization of State Offices of Rural Health.


Rural nurses are instrumental in implementing new technologies like telehealth to bridge the gap in access to care, Wilson said. For example, nurses can be trained to help facilitate synchronous telehealth sessions. While an outside provider conducts a video call with the patient, the nurse uses equipment to examine the patient, enabling assessment, diagnosis, and treatment.

Resources to Get Involved

Centers for Disease Control and Prevention: About Rural Health

This resource page provides information on rural health, including statistics on health disparities, challenges faced by rural communities, and what can be done to improve rural health care systems. 

Federal Office of Rural Health Policy

As part of the Health Resources and Services Administration, the Federal Office of Rural Health Policy helps increase access to care for underserved populations and build health care capacity. Their website includes a variety of resources, including funding opportunities for rural health programs.

National Association of Rural Health Clinics

The National Association of Rural Health Clinics promotes rural health clinics as a means of improving and sustaining the availability of quality, cost-effective health care to patients in rural, medically underserved areas. 

National Center for Rural Health Works

The National Center for Rural Health Works provides information to help local decision-makers in rural communities become proactive and involved in planning and supporting their local health systems. Their website includes toolkits and templates for community leaders, as well as a calendar of webinars and other learning opportunities. 

National Organization of State Offices of Rural Health: State by State Directory

The National Organization of State Offices of Rural Health assists State Offices of Rural Health in their efforts to improve health care. The organization’s directory allows users to search for the contact information of each state’s rural health office in the United States.

National Rural Health Association

The National Rural Health Association’s mission is to provide leadership on rural health issues through advocacy, communications, education, and research. The organization’s website includes publications and information about advocacy. Members of the association have access to additional resources. 

National Rural Health Resource Center

The National Rural Health Resource Center provides technical assistance, information, tools, and resources for the improvement of rural health care. The resource library is a great asset for individuals seeking actionable information for their community. 

Online Journal of Rural Nursing and Health Care

Published by the Rural Nurse Organization, this journal includes peer-reviewed articles on topics related to rural nursing and rural health care.

Center for Rural Affairs: Rural Health

The Center for Rural Affairs advocates for the improvement of rural communities across a variety of issues. Their website includes a page on rural health that is regularly updated with news and resources related to the topic. 

Rural Health Information Hub: Rural Healthcare Workforce

As a resource provided by the U.S. Department of Health and Human Services, this website includes an online library, access to data, toolkits for rural community leaders, and more.

Rural Health Research Gateway

The Rural Health Research Gateway provides easy and timely access to research conducted by the Rural Health Research Centers, funded by the Federal Office of Rural Health Policy.