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How to Overcome Obstacles as an NP in Rural Areas

People living in rural areas often face healthcare challenges

People living in rural areas often face healthcare challenges

Nurse practitioners (NPs) are likely to serve a pivotal role in the nation’s healthcare system going forward. Not only do they provide a viable alternative to physician care, but they are also a key element of the plan to combat the looming health care provider shortage, much of which is projected to occur in rural areas. Students who choose to complete a Master of Science in Nursing — Family Nurse Practitioner program (MSN - FNP) — may be well-positioned to assume this role. Rural nursing can be challenging though, with several obstacles to overcome.

NPs and Physician Shortages

Less than 10 percent of all physicians choose to practice in rural locations. As a result, there were about 6,100 primary care health professional shortage areas, or HPSAs, in the United States as of 2014. These are often rural areas, designated as HPSAs when the primary care health professionals to resident ratio exceeds one in 3,500. Some rural areas are eventually left with no local healthcare providers or services when physicians retire or gravitate toward urban settings.

Barring any significant changes in the delivery of primary care, this disproportionate distribution of physicians is expected to result in an even more substantial physician shortage by 2020. Some entities, like the Health Resources and Services Administration (HRSA), have predicted that the shortage may exceed 20,000 physicians. Overall population growth, longer lifespans and the aging Baby Boomer demographic also may affect the shortage.

NPs have been identified as one way to at least partially remedy these rural provider shortfalls. With job growth for primary care NPs expected to increase by 30 percent through 2020, they are projected to play a pivotal role in healthcare going forward, particularly in underserved rural areas.

More Chronically Ill Patients

While NPs may provide one possible solution to the shortage, rural nursing comes with its own set of challenges. Prior to the Affordable Care Act, many rural residents were uninsured or underinsured, increasing the likelihood that preventive and even critical care was delayed or skipped altogether.In addition, because there have been an inadequate number of healthcare providers in these areas — for decades on end in some cases — residents typically have different and more complex medical needs than their urban counterparts. Since many of these rural areas rely heavily on agriculture, for example, cancer tends to occur more frequently due to an increased exposure to harmful farming chemicals. Teen pregnancy rates, preventable hospital stays and deaths related to heart disease are often elevated as well. A rise in chronic diseases such as diabetes, COPD and obesity have also been noted.

Inadequate Transportation and Delayed Care

The limited number of healthcare providers and lack of healthcare insurance are not the only reasons care may be postponed. Residents may also forgo care when traveling presents an issue. The closest healthcare services may be in the next town or county, which can be many miles away. Since rural areas often have higher levels of poverty, residents may not have access to a vehicle or cannot afford the gas. These areas are also less likely to have a well-coordinated public transportation network, leaving residents to rely on friends or family members for transportation. Various levels of illness or disability may prevent others from driving as well.

When transportation becomes an issue, the likelihood of delayed care may rise. In 2010, the Federal Transit Administration sponsored a research study titled “Transportation, Distance, and Health Care Utilization for Older Adults in Rural and Small Urban Areas.” The study found that of those respondents who were unable to drive to appointments themselves, 87 percent relied on a friend or family member for transportation. These types of arrangements were found to be less than ideal. Residents who lived alone or in households without a driver were more likely to miss or delay appointments. By delaying important preventive examinations, the complexity of the disease structure within rural communities is significantly compounded.

NPs Filling the Void

All of these factors complicate rural nursing and pose obstacles for nurse practitioners. NPs typically act as an extension of their supervising physician. However, in rural settings, they may be the sole healthcare provider, or they may be expected to assume the role of a physician. They must be able to work independently with minimal supervision, support and resources. The sheer number of patients they encounter may force them to quickly evaluate and treat, while referring others to larger facilities for more comprehensive care. In some rural healthcare clinics, it is not uncommon to treat 200 or more patients per day.

Those numbers could easily increase now that insurance coverage has been expanded. NPs serving these areas should be prepared to encounter a multitude of chronic and complex health conditions. Nurses who successfully complete an MSN - FNP program may find that working in these locations can be rewarding while also filling a vital role in the healthcare system.

Up to the Challenge

The healthcare resources available to residents in rural areas are often inadequate. The looming primary care physician shortage may only exacerbate the situation. Nurse practitioners have an opportunity to fill that gap and provide much needed care. Although rural nursing can be challenging, NPs have the potential to provide care where there otherwise may be none.

Learn more about the University of Texas at Arlington’s online Family Nurse Practitioner program.


Mattson, J. (2010, December). Transportation, Distance, and Health Care Utilization for Older Adults in Rural and Small Urban Areas. Retrieved from

Projecting the Supply and Demand for Primary Care Practitioners Through 2020. (2013, November). Retrieved from

Rural Health Concerns. (2016, June 01). Retrieved from

Rural Health Disparities. (2014, October 31). Retrieved from

Social Determinants of Health for Rural People. (2015, June 09). Retrieved from

Vestal, C. (2012, December 06). In Many Communities, Nurse Practitioners Fill An Important Void. Retrieved June 16, 2016, from

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