Regional Resource: More than a Bandage: Long-term Efforts to Solve the Rural Nursing Crisis

NURSES ARE A CRUCIAL, YET SOMETIMES OVERLOOKED GROUP IN THE HEALTHCARE SECTOR. Numerous studies confirm that having more nurses in a hospital improves patient outcomes. Despite the vital role nurses play (or perhaps because of it), the United States is experiencing a shortage of registered nurses (RNs). The 2018 National Sample Survey of Registered Nurses (NSSRN), conducted every 10 years, found that the average age of an RN in the United States was 50 – meaning many nurses will reach retirement age in the next 10 years. Even before the COVID-19 pandemic, the Bureau of Labor Statistics (BLS) reported that the U.S. would need nearly 200,000 new registered nurses to enter the workforce annually to match the pace of retirements and rising health care demand. Some experts believe that the RN shortage will include the entire nation by 2030, with the South and the West as the hardest-hit regions. Complicating matters, it is often difficult to recruit and retain healthcare professionals in rural areas as salaries are often higher in urban areas.

According to the NSSRN, there were approximately 3.9 million RNs in the United States in 2018. This count includes persons who are trained as registered nurses but are not currently employed as one. In the South, Missouri and West Virginia have the highest number of registered nurses per capita, with 15.1 and 14.8 nurses per 1,000 residents respectively. South Carolina and Texas had the lowest ratio at 7.9 and 9.6, respectively. Tennessee and Mississippi have the highest percentage of actively employed RNs at 88.9 percent and 87.7 percent, respectively. The national average is 12 registered nurses per 1,000 residents.

Nursing shortages are particularly acute in rural areas, which tend to have patients who are older,
sicker, and poorer than their urban counterparts.
A 2021 survey of 130 rural hospital leaders conducted
by the Chartis Group found that nearly all respondents (98.5 percent) were short-staffed. A similar number of respondents (96.2 percent) said that nursing was the hardest position to fill. Due to workforce shortages, nearly half of respondents reported turning patients away and 27 percent had suspended some services.

The nation will need hundreds of thousands of new nurses to enter the workforce in the coming years.
To meet this demand, nursing schools are seeking to expand capacity and hospitals are hoping to lure nurses out of retirement. Beyond this, state policies also can play a role in mitigating the rural nursing shortage.

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