What Is a Rural Nurse?

nurse visits elder patient in casual setting
nurse visits elder patient in casual setting

Rural Nurse at a glance

Where you’ll work: Rural hospitals, clinics, public health departments, home health, hospice and palliative care and social services organizations.

What you’ll do: Provide care in rural locations that may have limited access to comprehensive healthcare.

Minimum degree required: ADN or BSN to earn your RN license is all you need to get started as a rural nurse.

Who it’s a good fit for: Since there are less staff in rural settings, nurses tend to perform a greater breadth of care rather than specialize. You’ll also likely get to form closer relationships with patients because there are fewer people to treat.

Job perks: You get to be an integral part of the community and see the impact you make. Rural locations also tend to have a lower cost of living than urban or suburban areas.

Opportunities if you pursue a higher degree or certification: Having a more advanced nursing degree like a BSN or MSN could make you an incredibly valuable asset in a rural location, where it can be more difficult to access higher education opportunities.

Median annual salary: $77,600

Unlike other types of nurses, rural nurses are defined by where they work, not their specialty. In fact, they can be considered on the opposite end of the spectrum from specialized nurses because they need to be generalists.

“In a rural area, nurses deal with whatever and whoever comes through the door,” says Dayle Sharp, PhD, DNP, MPH, FNP-BC, APRN, president-elect of the Rural Nurse Organization. “You may help deliver a baby at 9 a.m. and help someone die at 11 a.m.”

There is no specific rural nursing certification, and you can join this field with an associate degree and a registered nurse (RN) license. Since rural communities typically have fewer medical resources, “you have to be creative,” Sharp says. You’ll need problem-solving skills, a willingness to get to know people on a personal level, and flexibility to thrive as a rural nurse.

What Do Rural Nurses Do?

“There are definitely differences between rural nursing and nursing in an urban area or major medical center,” Sharp says. Nurses in cities or suburban towns typically focus on one department, such as orthopedics or labor and delivery. They may work with other specialists, such as phlebotomists or IV teams, instead of performing those tasks themselves. In addition, patients come to them.

Rural nursing is different in these ways:

  • Rural nurses are generalists. “You’re not taking care of one type of person or one type of specialty. You do it all,” Sharp says.
  • Rural nurses likely know their patients. “You’re taking care of your neighbors, friends, even family members,” Sharp adds.
  • Rural nurses may take medical care to patients. It’s not uncommon for rural nurses to make house calls. Patients may ask medical questions when you bump into each other, like in line at the grocery store.
  • Rural nurses know patients’ circumstances. “When you get to know them, you have a better understanding of their socioeconomic situation, family, what’s available for resources,” Sharp says. You’ll be able to tailor medical advice so they’re realistically able to follow it.

A Day in the Life: Rural Nurse

“Rural nurses don’t do the same thing over and over; they do a little bit of everything,” Sharp explains. You’ll work in isolated areas in facilities with small numbers of staff, requiring you to perform duties that might be taken on by specialists in more populated areas. The variety gives nurses the chance to practice all the skills learned in nursing school. What’s more, you may take on more responsibility than RNs typically do in urban settings.

For example, it may take an on-call doctor awhile to arrive to the hospital, which means the nurses already there do whatever is needed. They may end up stabilizing a trauma patient before they are transferred to a better equipped hospital, for instance. “Rural nurses are so well trained and so are ready for emergencies,” Sharp says.

Where You’ll Work

Rural nurses can work in different settings. These are the workplaces you might consider:

  • Rural Hospitals: These medical centers may be the only hospital for hundreds of miles. Nurses here may float between intensive care, the emergency room, and the operating room.
  • Clinics: Rural nurses assist with more routine care at clinics. They may assist specialists who rotate in periodically, too.
  • Public Health Departments: Rural nurses may organize public health campaigns (such as vaccinations efforts), education events, or screening events (such as vision or mammograms).
  • Home Health: In some cases, it is not feasible for patients to come to a clinic. Rural nurses may go to them.
  • Hospice and Palliative Care: Sharp says that people in rural communities are more likely to care for aging and ill family members at home rather than in a long-term care facility. In these instances, nurses travel to patients’ homes.
  • Social Services Organizations: Rural nurses may work with safety net organizations such as WIC (Women, Infants, and Children) or Meals on Wheels.

What Education Do I Need?

Typically, rural nurses are RNs. Roughly 4 out of 5 rural nurses have an Associate Degree in Nursing (ADN), with the remainder holding bachelor’s degrees. In some cases, rural hospitals pay for your education so you can bring additional expertise to the job.

Some rural nurses decide to use their undergraduate education and license as an RN as a launching pad to pursue additional education, earning a BSN or a Master of Science in Nursing degree. Those who choose the post-graduate route may consider becoming a nurse practitioner or clinical nurse specialist. You may also work as a nurse educator. These three advanced practice registered nursing (APRN) positions typically involve more responsibility and can position you for leadership opportunities. Salaries are also typically higher for these advanced nurses.

Is Rural Nursing Right for Me?

“Unless you’re from an urban area, you might not know about the opportunities in rural nursing,” Sharp says. She wants to change that.

Rural nursing isn’t for everybody, though. These are the personality traits and skills you need to succeed as a rural nurse:

  • People skills: “You need to take the time to form a connection, understand family ties, and get to know your patients,” Sharp says. Rural nursing often operates at a slower pace so providers and patients can get to know each other.
  • Flexibility: “You have to be willing to walk into work not knowing what you’ll have to do next,” Sharp says. Many rural healthcare facilities have limited practitioners, so rural nurses see patients who might otherwise see specialists in urban or suburban settings.
  • Creativity: Sharp explains that one of the benefits of rural nursing is how well you know your patients, allowing you to better understand what care and treatment will work for them. That might mean you approach situations in different ways than a textbook would suggest. “One day, I walked into a patient’s home, they had no running water, and the electricity ran off a car battery,” Sharp remembers. “You have to ask yourself, ‘How am I going to get done what needs to get done with the materials I have?'”
  • Openness: There is no anonymity for rural nurses, Sharp explains. You know your patients, and your patients know you. That transparency means patients might come through for you, too. “It’s a two-way street,” Sharp adds. “If anything happened to me or my family, they’d be right there to help.”
  • Teamwork: Rural nurses rely on their fellow rural nurses to help patients—and each other, Sharp says. “There’s always somebody there who has your back.”

Licenses and Certifications

Currently, there is no specific certification for rural nursing. A RN license is all you need to begin your career.

For those who want to pursue a career in rural public health, it can be a good idea to earn a bachelor’s degree and, eventually, earn a Certified Public Health (CPH) credential from the National Board of Public Health Examiners.

Salary

The U.S. Bureau of Labor Statistics doesn’t track the pay of rural nurses specifically, but they do track that of RNs as a whole. Registered nurses earn a median salary of $77,600, according to the BLS.

Registered Nurses

National data

Median Salary: $77,600

Projected job growth: 6.2%

10th Percentile: $59,450

25th Percentile: $61,790

75th Percentile: $97,580

90th Percentile: $120,250

Projected job growth: 6.2%

State data

State Median Salary Bottom 10% Top 10%
Alaska $99,110 $77,450 $127,020
Alabama $60,510 $47,390 $78,670
Arkansas $61,530 $47,510 $79,440
Arizona $78,260 $60,750 $100,200
California $125,340 $78,070 $165,620
Colorado $78,070 $60,550 $100,870
Connecticut $83,860 $61,470 $110,580
District of Columbia $95,220 $62,700 $129,670
Delaware $75,380 $59,900 $99,780
Florida $75,000 $49,680 $95,630
Georgia $75,040 $58,400 $98,410
Hawaii $111,070 $75,380 $129,670
Iowa $61,790 $48,290 $79,260
Idaho $75,560 $59,640 $98,030
Illinois $77,580 $59,640 $100,650
Indiana $62,400 $48,400 $90,260
Kansas $61,790 $47,630 $79,360
Kentucky $62,480 $48,000 $82,410
Louisiana $64,450 $48,920 $94,360
Massachusetts $94,960 $61,180 $151,310
Maryland $78,350 $60,420 $101,650
Maine $75,040 $59,640 $98,780
Michigan $76,710 $60,120 $98,510
Minnesota $79,100 $60,850 $101,610
Missouri $61,920 $47,350 $94,690
Mississippi $60,790 $47,210 $78,670
Montana $75,000 $60,320 $97,260
North Carolina $72,220 $51,420 $95,360
North Dakota $73,250 $59,810 $95,360
Nebraska $64,000 $55,040 $84,910
New Hampshire $77,230 $59,900 $99,580
New Jersey $94,690 $70,920 $117,990
New Mexico $78,340 $60,320 $98,660
Nevada $79,360 $61,790 $119,530
New York $96,170 $61,260 $127,080
Ohio $74,080 $59,540 $94,690
Oklahoma $62,170 $47,960 $79,940
Oregon $99,410 $76,180 $127,680
Pennsylvania $76,940 $59,640 $98,680
Rhode Island $78,900 $61,340 $101,650
South Carolina $72,650 $47,860 $86,820
South Dakota $60,550 $47,470 $77,360
Tennessee $62,390 $48,190 $81,950
Texas $77,320 $59,780 $99,070
Utah $75,000 $59,640 $95,160
Virginia $76,900 $59,170 $100,990
Vermont $75,380 $59,640 $98,030
Washington $96,980 $74,070 $127,320
Wisconsin $76,560 $60,060 $98,970
West Virginia $62,390 $47,450 $87,440
Wyoming $75,000 $59,650 $98,140

Source: U.S. Bureau of Labor Statistics (BLS) 2021 median salary; projected job growth through 2031. Actual salaries vary depending on location, level of education, years of experience, work environment, and other factors. Salaries may differ even more for those who are self-employed or work part time.

“Rural nurses get lower pay than those in an urban or suburban setting,” Sharp says. “This is mostly because healthcare facilities there don’t have as much money and have to do more with less.” As a result, advanced degrees or certifications don’t always translate into raises.

That said, living expenses are typically lower in rural areas. That means that the difference in salary between rural and urban nurses may not amount to as much if you factor in cost of living.

Career Outlook

Sharp is very clear about the demand for rural nurses: “We need more because there are not enough nurses in rural communities,” she says. She explains that nursing students are more likely to want to work in bustling medical centers.

That said, people in high-need areas are more likely to have access to nurse practitioners than those in more affluent, healthier areas, according to a study by researchers at the University of Michigan. The findings paint a picture of opportunity for rural nurses who want to go on to become NPs—and have a big impact.

Sharp is quick to emphasize the rewards of rural nursing, which she says many students don’t know about. “Rural nurses tend to have even more of a commitment to patients, their community, and their colleagues,” she says. “You get to be part of the community—and part of the solution.”

Professional Resources

If you are interested in rural nursing, consider exploring these groups for insight and information.

The Rural Nurse Organization advocates on behalf of nurses and patients for quality healthcare in rural communities.

The National Rural Health Association provides advocacy, research, and education on issues particular to the rural U.S.


catherine ryan gregory

Written and reported by:

Catherine Ryan Gregory

Contributing Writer

dayle sharp

With professional insight from:

Dayle Sharp, PhD, DNP, MPH, FNP-BC, APRN

Rural Nurse