Beginning Specialty Growth in Rural Nursing?

By Tori Hamilton RN, IBCLC

Rural Healthcare: Anything But Boring

Many nursing students or newly graduated nurses do not consider rural nursing–joining a smaller community critical access hospitals during their career. There are CAHs which need nurses in every region in the U.S. and Canada. Common misperceptions and beliefs that rural nursing is boring or less impressive than specializing in a larger population center has resulted in an impending staffing crisis. Experienced Baby-Boomer nurses in the rural setting are quickly reaching retirement age and there is a growing shortage of primary care providers.1

Rural nursing allows nursing students and newly graduated nurses freedom to explore different specialties and to gain a multitude of skill sets.

Gaining Broad Experience Across the Lifespan and Across Settings

For the past eight years, I have worked on the med/surg/obstetrics floor at our nearby rural hospital. Our client load consists of people aged from newborn to elderly. Every shift has a new host of challenges and achievements. It is not uncommon to spend the same day helping a new mother birth her baby and consoling family members after their loved one has passed. Rural nurses have a responsibility to provide care to clients of all ages and health conditions, resulting in them taking on an “expert generalist” role.5

It is incredible to consider the options afforded by a single nursing degree, and rural nursing is a valuable starting point. Unfortunately, many nursing students feel unprepared when they leave nursing school, and are unsure which path to choose moving forward. Rural nursing allows access to patients with a wide array of health conditions, ages, and settings–geriatrics, obstetrics, acute care, and mental health. Rural nurses see it all.

Rural Nursing Helps New Nurses Hone Their Skills

Not only do rural nurses specialize in multiple areas, they also develop a broader skill set. We cannot rely on support staff to help us provide quality care. Rural nurses perform all of our patient’s personal care, feeding, assessments, IV starts, medication administration, transporting, and rounding.

During crises the entire nursing team in our small hospital pulls together, whether it be a Code Blue in ICU or ER, a Code Pink in labor and delivery or a Code White on the psychiatric floor.

When a baby is born unresponsive in the middle of the night, that baby relies on rural nurses to receive positive pressure ventilation, chest compressions and other necessary resuscitative efforts.

Rural nursing provides nursing students with the experiences and skills needed to work in all area of nursing. The increased autonomy rural nursing has imparts critical thinking skills, time management and prioritizing tasks to the newly graduated nurse. Studies show that clinical placements in rural settings can enhance preparedness for nursing practice and increase understanding of rural communities and the health issues involved.8 I am hopeful that colleges will begin to recognize that rural nursing is a “goldmine” for varied experiences for nursing students and begin partnering with rural practice settings within their catchment area.

However, it is also important to recognize the financial constraints nursing students are in, and support should be provided to those students interested in obtaining clinical experience in the rural setting.6

Nursing students who have rural ties are more likely to have an interest in practicing in rural communities, so fostering programs to help nursing students complete clinical placements in their rural home towns may be the most beneficial program for both the rural community and nursing students.7

Educational Pathways & Tuition Reimbursement

If you are a newly graduated nurse and are unsure what area you want to specialize in or want to become an expert generalist, I encourage you to apply to rural hospitals. You may even find that there are additional incentives involved. For example, here in Ontario, we have the Tuition Support Program. I was reimbursed for four years worth of tuition costs in exchange for four years of service in an eligible underserved community, which so happened to be my home town.

Expertise About Health Disparities

While I am grateful that policy-makers are starting to take notice to the complexities communities like mine have with accessing health care, there is much work that needs to be done to limit the impact the limiting health services has on rural communities in comparison to its urban and suburban counterparts. Considerable differences continue to exist in health care access due to cultural and financial constraints, limited availability of services and public transport, and inability to retain physicians.3

There's a lot going on in rural nursing. In the United States, a focus on improving rural health as a means to increase quality has been a focus of recent public policy. The Medicare Rural Hospital Flexibility Program has federal funding to do just that. In 2017, the College of Family Physicians of Canada led a task force and provided recommendations for funding and next steps "to improve healthcare for rural Canadians" and improve the economy overall.

I am hopeful that technology such as telemedicine will help bridge the gap. It is well-known that healthcare disparities between rural and urban mothers include breastfeeding rates and access to IBCLCs.2 My small town has limited supports available to new mothers, and have felt the effects of this first-hand while raising my three children. I am hoping to offer virtual lactation consulting services for new moms across Canada who otherwise would not have access to breastfeeding support. It is important that nurses continue to think outside the box and embrace change in order to meet the health care needs of their community as well as the world at large.

More Than Just a Job–A Way of Life

As a new nurse in a rural hospital, you quickly recognize the immense power that your hands yield and the responsibility that you have to your patients and co-workers. Studies show that new nurses in rural settings do have a higher rate of burnout and anxiety in their first 18 monthsdue to the complex and ever-changing landscape of our role and the financial constraints that rural health care endures.4

It takes a strong-willed individual who is driven to succeed and to make a difference to become a rural nurse.

As difficult as it may be, the impact that a rural nurse makes on his or her community is remarkable. Luckily, the team of nurses you work day after day will become as close as family. They help you through the difficult times, and laugh with you with the dark humor only nurses can appreciate. In rural health, the interdisciplinary team includes neighbors, friends and family members–a tight-knit community, each person bringing something valuable to the team.

Guest Blogger Bio

Tori Hamilton is a Registered Nurse, International Board Certified Lactation Consultant and La Leche League Leader. She owns a motherhood website, works at a rural hospital in Med-Surg/Obstetrics and is a consulting OB Subject Matter Expert for Higher Learning Technologies. She spends her free time with her husband and three young kids in Ontario, Canada. You can find her lactation services and blog at


  1. Buerhaus, P. I., Skinner, L. E., Auerbach, D. I., Staiger, D. O. (2017). State of the registered nurse workforce as a new era of health reform emerges. Nursing Economics, 35(5): 229-237.
  2. Demirci, J., Kotzias, V., Bogen, D. L., Ray, K. N., & Uscher-Pines, L. (2018). Telelactation via mobile app: Perspectives of rural mothers, their care providers, and lactation consultants. Telemedicine and e-Health. Retrieved from
  3. Douthit, N., Dwolatzky, T., & Biswas, S. (2015). Exposing some important barriers to health care access in rural USA. Public Health, 129(6): 611-620.
  4. Duchscher, J. B. (2008). A process of becoming: The stages of new nursing graduate professional role transition. Journal of Continuing Education in Nursing, 39(10): 441-450.
  5. Knight, K., Kenny, A., & Endacott, R. (2016). From expert generalists to ambiguity masters: Using ambiguity tolerance theory to redefine the practice of rural nurses. Journal of Clinical Nursing, 25(11): 1757-1765.
  6. Neill, J. & Taylor, K. (2002). Undergraduate nursing students’ clinical experiences in rural and remote areas: Recruitment implications. Australian Journal of Rural Health, 10: 239-243.
  7. Playford, D., Larson, A. & Wheatland, B. (2006). Going country: Rural student placement factors associated with future rural employment in nursing and allied health. Australian Journal of Rural Health, 14: 14-19.
  8. Webster, S., Lopez, V., Allnut, J., Clague, L., Jones, D. & Bennett, P. (2010). Undergraduate nursing students' experiences in a rural clinical placement. Australian Journal of Rural Health, 18: 194-198.