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How to Overcome Obstacles as an NP in Rural Areas


UTA NP Rural Challenges

People living in rural areas often face healthcare challenges

Nurse practitioners (NPs) will 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 healthcare provider shortages, many of which exist in rural areas.

Students who choose to complete a Master of Science in Nursing (MSN) degree program with a nurse practitioner specialization will be well positioned to assume this important role in increasing access to care. For the busy working nurse, The University of Texas at Arlington (UTA) offers several online MSN programs, including a number of NP specializations:

Nurses who pursue one of these NP specializations can embark on a rewarding career, help address healthcare provider shortages and meet specific healthcare needs in rural areas. But rural nursing can be challenging, with several obstacles to overcome.

NPs and Physician Shortages

The COVID-19 pandemic exacerbated existing healthcare provider shortages in rural areas, with many physicians and nurses leaving their jobs due to stress, burnout and retirement. Roughly 15% of the U.S. population lives in rural areas. But less than 10% of all physicians choose to practice in rural locations. As a result, there are 8,519 primary care health professional shortage areas (HPSAs) in the U.S. as of November 2023, according to the Health Resources and Services Administration (HRSA).

A disproportionate number of these HPSAs are in rural areas. In fact, about 65% of rural areas currently have a shortage of primary care providers. 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 unequal distribution of physicians is expected to result in an even more substantial physician shortage. The National Center for Health Workforce Analysis (NCHWA) projects an overall shortage of nearly 140,000 physicians through 2036, including a shortage of 68,020 primary care physicians. Moreover, NCHWA projects a 56% shortage of physicians in nonmetro areas in 2036, compared to a 6% shortage in metro areas. Population growth, longer lifespans and the aging Baby Boomer demographic also may affect the shortage.

These numbers are daunting, but solutions may be on the horizon. NPs have been identified as one way to partially remedy these rural provider shortfalls. With employment of NPs expected to increase by 45% through 2032, 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, as highlighted by organizations and governmental agencies like the Centers for Disease Control and Prevention (CDC). 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 — partially because there have been an inadequate number of healthcare providers in these areas — 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 and persistent 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, inequities in access to care increase and the likelihood of delayed care may rise. By delaying important preventive examinations, the complexity of the disease structure within rural communities is significantly compounded.

NPs Filling the Void

All these factors complicate rural nursing and pose obstacles for healthcare providers, including 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.

NPs serving these areas should be prepared to encounter a multitude of chronic and complex health conditions. Nurses who successfully complete specialized NP MSN programs, like those offered online by UTA, can gain the knowledge and skills they need to address complex health conditions and provide primary or acute care to different age groups.

Plus, the knowledge and skills needed to work independently will become increasingly vital as more states adopt full-practice authority regulations for NPs, broadening the scope of NP practice, especially in high-need rural areas. Working in these locations can be rewarding, and nurses who take on these critical roles help fill a long-standing gap 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 only exacerbates 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 UTA’s online MSN programs as well as the MSN in Gerontology and MSN in Pediatric Care NP specialization options.

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