Rural nursing presents challenges, rewards

Providing comprehensive health care can be a daunting task for nurses serving nearly 60 million people living in rural America.

"If you are the nurse on the floor, you are the respiratory therapist, the IV person and the wound care specialist," said Carmen Fees, director of nursing at the Philip Health Services. Philip is located 80 miles east of Rapid City--home of Mount Rushmore--and 80 miles southwest of South Dakota's capital city, Pierre. The town's population in 2012 was 780, with an average age of nearly 52.

Affiliated with the Rapid City Regional Hospital, Philip Health Services has an 18-bed hospital and 30-bed nursing home. More than half of the hospital patients are waiting for a long-term care bed, and nursing home beds are filled as soon as one is available, Fees explains. The two facilities share nurses.

In this rural setting, Fee pointed out, "You get to run the whole show." That attracts some nurses, but frightens others, especially those fresh out of nursing school.

Through a three-year, $1.09 million grant from the U.S. Department of Health and Human Services, the South Dakota State University College of Nursing has developed a program to better prepare nurses to work in rural settings.

Associate professor Lois Tschetter; Nancy Fahrenwald, dean and former associate dean for research; instructor and project Paula Lubeck and 10 faculty members in mental health, pediatrics and medical surgical nursing have been working on the Simulation, Informatics and Technology Enhancement project since 2011.

Rural nursing presents challenges, rewards
"It's a different type of nursing," said Linda Young, nursing specialist at the South Dakota Board of Nursing. "Every one of the states has a rural nature to it, and all deal with these same rural issues."

Nurses in these communities have to know all aspects of health care, project director Tschetter explained. A pregnant woman may come into the rural hospital emergency room in labor and the nurse must simultaneously provide emotional support to the patient and her family as well as collect assessment data and communicate with the physician regarding a plan for care.

Simulations re-create rural scenarios
Through the grant, the SDSU research team built a simulation lab in which nursing students can learn the wide of range of skills they will need, according to Tschetter.

Instructors have developed simulations to mimic situations students could encounter and implemented them into the curriculum, Tschetter explained. One setting might be a rural clinic, another in a rural hospital and a third in a large acute-care setting.

Someone comes into a small 20-bed hospital, for instance, and the nurse will have to use telemedicine to call providers at a large health-care institution where experts can provide guidance on how to care for this patient, Tschetter explained. Nursing students work through the scenarios using the lab mannequins, review the videotape with their instructors and then discuss what went well and how they can do better in the future.

"Students can have experiences that they wouldn't get to be a part of in the hospital," Tschetter said. "And it's safe; no one gets hurt."

Young sees this type of training as extremely beneficial to new graduate nurses: "To give them additional education and training opportunities while still under the wing of experienced licensed nurses will give them the confidence and competency they need."

Curriculum to help rural health care nationwide
More recently, the simulations have involved pharmacy students, adding the collaboration emphasized nationally, Tschetter pointed out. With future funding, the researcher hopes to add students from nutrition and social work to the scenarios.

"We think our rural focus is unique and something we want to pull together, write about and make available to other schools," Tschetter explained. SDSU has implemented this curriculum in Brookings, Sioux Falls, Rapid City and Aberdeen.

As part of the grant, Tschetter and her team will share what they've learned with other nursing schools so they can develop programs specifically geared to rural health care. "We can help them get that rural focus for their students," Tschetter said.

Though the responsibilities of rural nurses are great, the work can be extremely rewarding.

"If you come to small facility and build your skill set, you'll be able to work anywhere," Fees added. "Just one person with enthusiasm, positive attitude and a skill set can make a huge difference here."