Sustaining the Rural Health Nursing Workforce
Pipeline: The Role of Nursing Education Programs
Sarah Gallups, PhD, MPH, RN
Erica Newfield, DNP, RN, PHNA-BC; and Jolisa Watson, MSN, CRNP, NP-C
The evidence is clear that nurses play a critical role in improving access to care for vulnerable
rural populations. Equally important are efforts to recruit and retain nurses in rural healthcare
settings (Martin et al., 2024). Research has identified several factors that influence nurses'
decisions to enter and remain in rural practice, including job satisfaction, workplace
environment, scope of practice, and the availability of support resources. Significant barriers to
retention include high nurse-to-patient ratios and limited skill diversity among nursing staff.
To better understand the rural nursing workforce, Martin et al. (2024) analyzed data from the
National Council of State Boards of Nursing's 2022 National Nursing Workforce Survey. Their
findings revealed that 27% of both urban and rural registered nurses (RNs) plan to leave the
profession or retire by 2027. These projections highlight the urgent need for nursing education
programs to help strengthen the rural nursing workforce. Several evidence-based strategies can
support this effort.
1. Expand Rural Clinical Partnerships
Strengthening partnerships between nursing education programs and rural healthcare
organizations can increase opportunities for rural clinical placements and preceptor recruitment.
Collaborations with community hospitals, clinics, and other healthcare facilities allow students to
gain firsthand experience in rural practice environments. Students who complete clinical training
in rural settings are more likely to return to these communities after graduation. Such
experiences also foster greater interest, commitment, and passion for serving underserved
populations (Rusaanes et al., 2024).
2. Integrate Rural Health Content into Nursing Curricula
Including rural health concepts throughout nursing curricula helps prepare graduates to meet the
unique needs of rural populations. Exposure to the culture, health challenges, and social
determinants affecting rural communities enhances students' understanding of these populations
and may help reduce bias toward rural residents (Rusaanes et al., 2024).
3. Incorporate Rural-Focused Interprofessional Education
Rural healthcare delivery depends heavily on teamwork and collaboration. Integrating
interprofessional education (IPE) experiences that reflect rural practice settings can help students
develop skills in communication, role clarification, and collaborative care. Because rural
healthcare teams often work with limited resources and face unique patient challenges, IPE
prepares students to navigate real-world scenarios while providing holistic, patient-centered care
(Van Der Wege, 2024).
4. Recruit Students from Rural Communities
Targeted recruitment of students from rural communities is another effective strategy for
strengthening the rural nursing workforce. Nursing programs can support these efforts through
outreach events, healthcare career fairs, high school health sciences programs, and scholarship
opportunities for students interested in rural practice. Students with rural backgrounds are often
more likely to practice in rural areas after graduation (Witt et al., 2025).
5. Support and Strengthen Community College Nursing Programs
Community college nursing programs play a vital role in addressing rural workforce shortages.
Many of these institutions are in rural and healthcare provider shortage areas, making nursing
education more accessible to residents. These programs provide students with exposure to rural
healthcare environments and help strengthen the local workforce. Additionally, partnerships with
four-year institutions that offer RN-to-BSN and joint enrollment pathways enable nurses to
advance their education while remaining in their communities (George, 2021).
Conclusion
Given the substantial healthcare needs of rural communities and persistent workforce shortages,
nursing education programs have an essential role in developing and sustaining the rural nursing
workforce. Although addressing these challenges requires a multifaceted approach beyond
nursing education alone, academic-practice partnerships represent a promising strategy. The
University of Washington School of Nursing's Premera Rural Nursing Health Initiative provides
one example. This initiative partners with rural clinical sites across 21 counties to offer clinical
placements for Doctor of Nursing Practice students and postgraduate fellowships, with many
participants remaining in rural communities after program completion (Rural Health Information
Hub, 2024). Such partnerships demonstrate how nursing education programs can expand rural
clinical learning opportunities while strengthening recruitment and retention of nurses in
underserved communities.
References
George, K. (2021). Building health equity and community capital: Community college RN to BSN
programs addressing rural health professional shortages. Alliance for Research on Regional
Colleges. https://cdn.prod.website-
files.com/5fd3cd8b31d72c5133b17425/6170680e2f102d5561922db5_21-ARRC-Geo-Cap-
Health-whitepaper-web.pdf
Martin, B., Reid, M., & O’Hara, C. (2024). A detailed examination of the rural registered nurse and
Licensed Practical Nurse/licensed vocational nurse populations: Evidence to support holistic
workforce planning. Journal of Nursing Regulation, 15(1), 56–64.
https://doi.org/10.1016/s2155-8256(24)00029-2
Rural Health Information Hub. (2024). Premera Rural Nursing Health Initiative at the University of
Washington [online]. https://www.ruralhealthinfo.org/project-examples/1131
Rusaanes, V., Eide, H., Brembo, E. A., Gladhus, L., Oswald, B. M., & Heyn, L. G. (2024). Educating
nursing students for sustainable future rural health-care services: An umbrella review.
International Journal of Nursing Studies, 151, 104688.
https://doi.org/10.1016/j.ijnurstu.2023.104688
Van Der Wege, M. (2024). Interprofessional Education in the rural setting: Challenges and solutions.
Teaching and Learning in Nursing, 19(3), 246–248. https://doi.org/10.1016/j.teln.2024.03.013
Witte, L., Caloudas, A., Arredondo, K., Touchett, H., Paterson-Roberts, A., Watts, B. V., Vincenti, M.,
& Sutherland, B. (2025). Strengthening rural health care: A scoping review of nurse recruitment
and retention strategies. Medical Care, 64(1S), S18-S25.
https://doi.org/10.1097/MLR.0000000000002202
