Industry Trends Impacting Rural Nursing Part 1

According to the United States Census Bureau, about 60 million people, or one in five Americans, live in rural America. In general, rural areas are sparsely populated, have low housing density, and are far from urban centers. While urban areas make up only 3 percent of the entire land area of the country, they are home to more than 80 percent of the population. Conversely, 97 percent of the country’s land mass is rural but is home to just 19.3 percent of the total population.

According to data from, as of January 2020 the United States had:

  • 1,355 Critical Access Hospitals
  • 4,478 Rural Health Clinics
  • 3,896 Federally Qualified Health Centers located outside of Urbanized Areas
  • 1,095 short term hospitals located outside of Urbanized Areas

Rural nursing is not immune to industry changes. HealthTechS3 conducted a virtual focus group with nine nursing leaders who work in rural settings to get their insight on four industry changes. Part 1 includes COVID-19 and rural hospital closures and Part 2 will include tele-health and rural nursing shortages.


Rural areas of the U.S. have so far avoided the worst of the ongoing COVID-19 pandemic. However, many health experts predict a “second wave” of COVID-19 could have a big impact on the nation’s rural populations. Indeed, recent outbreaks in meat-processing facilities and prisons, which are typically found in rural areas, may be a sign that rural hospitals will experience a surge of COVID-19 cases in late summer and early fall.

Many rural hospitals may, in fact, be better prepared if a second wave of COVID-19 occurs since they have had longer to prepare than some of their urban counterparts before the pandemic hit. 

Lisa Barr, Quality/Nursing Supervisor Manager at Heart of the Rockies Regional Medical Center, noted that, like many other rural hospitals, they had ample time to prepare.

“We started the first week in March, as the outbreak hit the U.S.,” Barr said. “We started daily incident command meetings, implemented a labor pool, cross-trained staff, constructed a negative air pressure room in the ICU, planned to open inpatients’ beds in our same-day surgery, and many other strategies so that we were ready.” 

Cheryl Tennberg, Regional Chief Nurse Executive, and Sherry Lauer, Regional Chief Quality Officer for Hawaii Health Systems Kauai Region, agree that rural hospitals have had more time to prepare and train staff. However, they also expressed concern that a rural hospital could become overwhelmed very quickly if there was a surge of COVID-19 patients due to a lack of ventilators or PPE equipment. 

Sarah Cordtz, who was until recently the Coordinator of Quality Assurance/Risk Management at Trinity Hospital/Mountain Communities Healthcare District, pointed out that chronic staffing shortages are worsened in the event of a surge. She said that without other floors, departments, or sister hospitals to pull from, providing appropriate care to such large numbers could be difficult. She also noted that many rural hospitals rely on a large percentage of nursing staff being new grads or travel nurses, and this can also bring more challenges.

Cordtz added that even though there may be more challenges, rural nurses are great teachers, used to making do with limited resources and finding ways to get things done.

Sara McPeak, Chief Nursing Officer at Carlinville Area Hospital and David Harrison, Vice President of Patient Care Services at Hillsboro Area Hospital, added that rural hospitals have an advantage because they are smaller, which makes communication of new practices and nurse involvement easier.

Rural Hospital Closures

A February 2020 report from the Chartis Center for Rural Health suggests 2019 was the worst year for rural hospital closures in a decade, with 19 rural hospitals shuttering. Today, 453 of the 1,844 rural hospitals still operating in the U.S.—approximately one in four—show signs of being vulnerable to closure in the near future.

Although there are many aspects of a closure that are not under the control of an individual nurse, Faith Jones, Director of Care Coordination and Lean Consulting for HealthTechS3, noted that nurses need to understand how the practice of nursing contributes to the financial bottom line, not just in salary dollars but in patient outcomes and reimbursement.

“Being a good steward of the resources is caring for the community,” Jones said.

McPeak noted that nurses can work in many different practice areas, including tele-nurse programs, home health, public health, and provider clinics. She also noted that becoming a nurse practitioner may be an option to consider for some nurses, especially given the need in rural communities for more providers. Several nurse leaders commented that pursuing a BSN or MSN also increases job opportunities. 

Looking for a new position in the wake of a hospital closure can be daunting, especially if you don’t want to travel outside of your community. The following are some of the suggestions offered by nurse leaders:

  1. Keep certifications current, even if not required by your organization.
  2. Take advantage of continuing education opportunities.
  3. Be open to retrain and expand knowledge—learn how to wear many hats.
  4. Create a support network that supports you in your growth and development with open and honest communication.
  5. When applying for a new position, highlight your skill set. Don’t just include the positions you have held on the application or your resume, but highlight the ability to prioritize, multi-task, and respond to quickly changing situations, all of which are hallmarks of rural nursing.

Stay tuned for “Industry Trends Impacting Rural Nursing: Part II”, where we’ll explore the role of tele-health and the impact of rural nursing shortages on the industry.