How to Become a Rural Nurse

60 million Americans—nearly 20 percent of the population—live in rural locations. Numerous impediments face rural residents seeking healthcare, including:

• Proximity to healthcare facilities
• Shortage of healthcare professionals
• Ability to schedule timely appointments
• Cost of healthcare services
• Inadequate health insurance plans

As a result, approximately one in four rural Americans reports forgoing necessary healthcare treatment in the past few years. That rate holds true even for those with health insurance (24 percent skipped treatment because they could not find a provider who took their insurance), although it’s even higher for the uninsured (nearly 50 percent).

Only about 11 percent of American physicians practice in rural settings, meaning the rural patient:doctor ratio is more than double its urban counterpart. These medical professionals often serve vast geographic regions requiring significant travel, further reducing the time available to treat patients.

Healthcare services for America’s rural populations are clearly insufficient; more healthcare professionals are needed in the nation’s remote locations. Rural nurses can help alleviate this problem by assuming some of the burden for patient care currently shouldered by medical doctors. The need for registered nurses in rural practices is great, but the need for nurse practitioners—particularly in the 22 mostly rural states where they enjoy full practice authority—is even greater.

If you’re considering becoming a rural nurse, here’s an added enticement for a career in this field: many governmental and nonprofit agencies offer incentive programs for rural nurses. You can begin working as a rural nurse with as little as an associate’s degree, or you can earn a master’s and become a nurse practitioner. No matter which you choose, you’ll be helping an underserved community. In this article on how to become a rural nurse, we discuss:

• What is a rural nurse?
• Rural nurse income
• Educational commitment to become a rural nurse
• Certifications for rural nurses
• Resources for becoming a rural nurse
• Pros and cons of becoming a rural nurse

What is a rural nurse?

“Rural nursing” is not a defined specialization like orthopedic nursing or rehabiltation nursing. There are no certifications for rural nursing, and very few academic programs offer specializations—or even individual courses—dedicated to practicing medicine in rural settings.

Becoming a rural nurse simply means working in a rural environment. As a rural nurse, you may work in any of the following settings:

• Hospital
• Doctor’s office
• Community clinic
• Mobile health center
• Patients’ homes

Rural nurses are more likely than their urban and suburban peers to work at small facilities. As a result, they typically enjoy more responsibility and experience less supervision, a situation many regard as beneficial. They are also more likely to see a broader range of problems. When you operate the only healthcare facility in a 50-mile radius, you do not specialize: you see whatever ails people, from Alzheimer’s to the Zika virus.

The skills required to be an effective rural nurse include:

• Evaluation and diagnosis
• Family medicine
• Critical care skills
• Knowledge of pharmaceuticals
• Teaching
• Physical therapy
• Patient management
• Staff management
• Business management
• Flexibility and adaptability

What specialty nurses are most needed in rural areas?

Because of the acute shortage of medical doctors in rural areas, the need is greatest for nurse practitioners (NPs). NPs—who hold either a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP)—are trained to diagnose conditions, conduct exams, order and interpret tests, and prescribe medications. They can perform most of the tasks performed by primary care physicians.

In 22 states—including most of the mountain states, many Midwestern states, and parts of New England—NPs enjoy full practice authority, meaning they can work autonomously (i.e., without the supervision of a medical doctor). Especially in rural areas, nurse practitioners (and physician assistants, who are similarly trained and empowered) provide primary care to many of the area’s patients.

Another specialization in demand in rural areas is travel nursing. Travel nurses work on short contracts, typically relocating for each new assignment. Because they go where nurses are needed, they may end up being offered positions in rural settings. The benefits of travel nursing include:

• Higher pay (usually)
• The opportunity to see different parts of the world
• Greater diversity of work experience

The downsides include:

• Relative lack of job security
• More complicated tax status (as a travel nurse, you’ll likely be self-employed)
• No paid vacation or other benefits
• Working with a travel nurse agency

Rural nurse income

Rural nurse pay is all over the board. Ziprecruiter reports that the median salary for rural nurses is $70,242. However, its data also show that the single-largest income group in this profession falls within the $27,000 to $39,499 range (nearly one in four rural nurses fall into this category). One in ten earns even less.

The most significant factor in determining income is whether the nurse is a registered nurse or a nurse practitioner. The latter, because of their extended training and responsibilities, earn significantly more than the former. Location, employer, and years of experience all also factor into salary calculations.

Educational commitment to become a rural nurse

Rural medical employers hire nurses at all levels: licensed practical nurses (LPN), registered nurses, advanced practice nurses, and nurse practitioners. Educational requirements vary according to role.

LPNs typically hold an associate degree in nursing. Earning that degree and passing the NCLEX-PN are the primary qualifications to become an LPN. LPNs handle a lot of the grunt work of nursing, including:

• Assisting patients in using the toilet
• Bathing patients
• Lifting patients and assist them in moving
• Changing dressings
• Inserting catheters

To become a registered nurse, you will need at least an Associate Degree in Nursing (ADN) or Associate of Science in Nursing (ASN), two-year degrees typically awarded by community colleges. Most employers prefer RN candidates to hold the Bachelor of Science in Nursing (BSN), and the profession is definitely trending toward requiring RNs to have a BSN. That said, the severe shortage of rural nurses improves the likelihood that qualified ADNs will be considered for rural RN positions.

You will need a Master of Science in Nursing to become a nurse practitioner, a role in which you may be able to administer most primary care services. A few MSN programs specify a curricular focus on medicine for underserved rural populations. They include:

• Bluefield College
• Duke University
• Northern Arizona University
• Purdue University (- Main Campus)
• University of North Carolina at Pembroke (offers a rural case manager specialization)
• West Virginia University

Finally, if you are most interested in conducting research into rural healthcare, consider pursuing a PhD in nursing at the Decker College of Nursing and Health Sciences at Binghamton University. The program focuses on research that will “improve the delivery of healthcare for rural and other vulnerable populations.”

Certifications for rural nurses

There are no certifications specific to rural nursing. Many different certifications can be applied to rural nursing, however. Among the more common certifications held by rural nurses are:

• Clinical Nurse Leader, a master’s-level certification indicating preparedness to assume leadership of an interdisciplinary healthcare team.
• Rural nursing typically involves work with pediatric patients. The entry-level Pediatric Nursing Certification (RN-BC) from the American Nurses Credentialing Center or the four pediatric certifications offered by the Pediatric Nursing Certification Board will bolster your resume.
• The American Nurses Credentialing Center offers three certifications in gerontology; other organizations certifying expertise in geriatrics include the American Academy of Nurse Practitioners and the American Association of Critical Care Nurses. Seniors constitute 18 percent of rural population (as opposed to 12 percent of urban population), so you’ll be seeing a significant number of older patients as a rural nurse.
• The Family Nurse Practitioner (FNP) certification is an excellent generalist certification for NPs because it covers all phases of the life cycle.

Resources for becoming a rural nurse

• The Rural Nurse Organization (RNO) represents and advocates for rural nurses and the quality of rural healthcare across the United States. Its website includes an online journal, articles about rural nursing, links to grant and scholarship opportunities, and event announcements (such as the biennial International Rural Nursing Conference, held in 2020 in Greeley, CO).
• The Rural Health Information Hub is aptly named. The site is a gateway to white papers, articles, journals, datasets, case studies, online classes, and analytical tools. If you have any interest at all in rural medicine, set aside a few hours to get lost in this rabbit hole.
• The National Rural Health Association (NRHA) advocates for improved healthcare practices and funding in rural America. It organizes events, presents programs, and publishes journals, articles, and press releases. Another rabbit hole. The NRHA website also provides links to state-level rural heath associations.

Pros and cons of becoming a rural nurse

So, should you become a rural nurse? The best way to answer that question is to weigh the pros and cons of the profession.

Pros of becoming a rural nurse

• Familiarity with patients: As a rural nurse, you will see patients more frequently and get to know them better. Many nurses enjoy building relationships with patients; rural medicine promotes such relationships.
• Greater autonomy: Rural healthcare facilities tend to have fewer staff members, so each employee must take on more responsibility. In rural settings, nurse practitioners frequently serve as the primary healthcare provider to their patients.
• Pastoral living: If you love green grass and clean air, rural life should suit you. All those beautiful twinkling lights up in the sky, the ones you never saw in the city? They’re called stars. Enjoy.

Cons of becoming a rural nurse

• Isolation: The flip side of the green grass, clean air, and stars is the relative lack of people to share them with. You won’t find yourself in many crowds. You’ll have a harder time shopping for groceries, clothing, and gifts. Your Internet connection may not be especially robust. You might well find yourself in a place where people joke, “Well, it’s not the middle of nowhere, but you can see it from here.”
• Fewer opportunities to specialize: The reduced personnel of rural healthcare facilities means everyone has to be a generalist. In a city, it might make sense to develop a specialization in oncology or physical therapy. In rural practice, there may not be enough traffic to justify it.
• Poverty: The poverty rate in rural America is 16.4 percent. That’s 3 percent greater than the urban poverty rate and 4.6 percent higher than the national poverty rate. You will likely encounter poverty and its many ramifications—economic, social, and medical—regularly as a rural nurse.

So why become a rural nurse? We’ll give the final word to Marie Riemer, a rural nurse at Sanford Health. “I love working in the community that I was born and raised in. … For families to be able to come in, young or old, and see familiar faces, nurses they know, providers they trust, all other disciplines that are familiar to them—it is so beneficial.” In the end, she says, “It’s very rewarding taking care of all of the generations that have shaped this community.”

(Last Updated on February 26, 2024)

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