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Rural Healthcare Improvement

Access is Not the Only Issue

Posted by Shanna S. RN, BSN on December 4, 2013

If you read my previous article on Improving Rural Access to Care, you know that I was recently struck by the difficulties many rural patients face when attempting to access healthcare. The situation was brought to light when my grandmother was forced to travel hundreds of miles over the course of three days, in order to receive a diagnosis regarding severe, persistent abdominal pain. She is not alone. According to Reuters five million rural residents live in healthcare shortage areas, where there are less than 33 primary care physicians for each 100,000 residents (2011). This means that there are millions of others who face situations similar to hers.

Thanks to a well-designed, multidisciplinary practice, my grandmother was seen by an Advanced Practice Registered Nurse who provides primary care in her rural area. The Nurse Practitioner attended to her needs, yet was unable to make a definitive diagnosis, based on the lack of simple medical technology. There was no ultrasound available at the facility where my grandmother was seen, so she returned home, then traveled hundreds of miles the next day, to a different healthcare facility, to be assessed with ultrasound.

The fact that it was so difficult to find both a primary care provider (PCP) and an ultrasound machine in the same location is almost shocking, especially considering that annual healthcare expenditures in the U.S. are anticipated to reach $2.9 trillion in 2013.

$2.9 trillion? That could buy hundreds of thousands of ultrasound machines!



What Other Issues Affect Rural Health?

Despite the amount of healthcare dollars spent annually, there are still hospitals in the U.S. that lack basic medical technology. There are rural clinics that do not have Registered Nurses on staff. There are budget cuts and nursing shortages and facilities that still use paper charts and pens to document patients' progress. If you've never practiced in a rural area, this may seem a bit unbelievable. For me, it is hard to fathom, and even harder to accept.

How can it be that ultrasound, first used to diagnose gallstones in 1948, could be unavailable in any healthcare facility today? How, in the United States, in the year 2013, does a lack of decades old equipment even exist?

Access to care is obviously not the only factor affecting rural residents. Some rural healthcare facilities are lacking the basic infrastructure, healthcare workforce, durable medical equipment, and even the supplies and medications that are necessary for meeting patients' needs. Access to facilities and providers are some of the first barriers to optimal care. Once access is achieved, the issues of healthcare quality, safety and effectiveness then become the factors to consider. Any discussion of rural health disparities and how to correct them must include all of the above factors, and more.

What Needs to Be Done?

Like most aspects of healthcare in the twenty-first century, much of the issue comes down to funding.Thankfully, there are several organizations, federal agencies, and leaders, including nurses, who are dedicated to obtaining and distributing funds for the purpose of improving rural health.

Just as there are nursing scholarships and loan repayment programs available for those nurses who practice in rural areas, there is also general funding available for rural health improvement projects in most states. Nearly every state currently has an office of rural health that works to secure funding for workforce development, research, technology and infrastructure development in under-populated areas.

In Nebraska, where my grandmother sought treatment, the Rural Nebraska Healthcare Network (RNHN) was recently awarded a $19 million grant to fund an infrastructure project that will bring enhanced telecommunication abilities to the hospital where she was seen. The RNHN funding will be used in a pilot program to install long distance fiber-optic cable systems throughout rural Nebraska areas. The enhanced communication infrastructure will enable the efficient exchange of electronic medical records, including diagnostic tests and results in real time. It will also allow care providers to access educational offerings, teleconference across the state, and monitor patients from distant locations.

Infrastructure projects like this, which is sponsored by the Universal Service Administrative Company, can significantly improve the quality of care rural residents receive. Improving communication between healthcare providers is essential to developing the multidisciplinary teamwork that is so essential for high quality patient outcomes. Without infrastructure, communication suffers, especially when time is of the essence, as is so often the case in healthcare.

There are countless other initiatives currently being implemented by the dozens of rural health agencies nationwide. Many of the projects focus on raising basic awareness of the issues rural residents and providers face. Some, like the Oregon Rural Healthcare Quality Network (ORHQN) believe that bringing providers, facilities and communities together to focus on what matters most to patients and the public is the key to improvement.

How Can Nurses Help?

I believe communication and awareness are essential first steps. A problem must first be identified and understood if it is to be solved, and there must be open dialogue between all parties involved. That is why I am writing this article. I am aware of the issues rural patients and providers face, and I want you to be aware of them too, so together, we can do something about it.

As nurses and healthcare professionals, we are tasked with improving public health, simply by nature of our profession. We are also given a unique voice with which we can raise a call to action. Our patients, families, and communities listen to what we have to say. Nurses are consistently rated as the most honest and ethical profession year after year, revealing the public's trust in each of us as individuals, and in our profession as a whole.


Photo Credit: NRHA

As such, we have the ability to affect healthcare in a beneficial way, and in ways that go beyond our efforts at patient care. We, as nurses, can choose to inform the public, our communities, our leaders and ourselves about what can be done to improve rural health. We can begin to do this by simply drawing attention to the situation.

Just as the body spikes a fever to alert all systems to an infectious agent, we must raise the call to the issues that threaten the health of our nation.

By arming yourself with information about the issues in your own location, and the steps that are being taken to correct disparities in rural health, you become a more educated nurse. As nurses, we must have a degree of concern for public health, regardless of our individual practice settings. Even if you practice in a heavily populated area, there is likely some place in your state that is considered rural, and there are likely real and recognized improvements that can be made there.

Together, as a profession of well-educated nurses, we can help make those improvements come to fruition. We can share strategies, funding sources, research initiatives, and organizational delivery models that work for rural patients and providers. We can help improve the level of care being provided in our nation's most remote areas, simply by letting others know what is happening, and determining what needs to improve.

An educated nurse is a powerful thing, and can incite change in both small and large ways. Take the time today to think about what you can do to improve the health of our rural communities. Think of my grandmother...think of your own grandmother, and then do what you can to provide them both with access to safe and effective healthcare.

For more information about efforts to improve rural health, please visit the Office of Rural Health Policy.

For an extensive list of funding opportunities for rural health, please visit the United States Department of Agriculture, National Agricultural Library's Rural Information Center.