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What Is a Rural Nurse?

nurse visits elder patient in casual setting

Rural Nurse Fast Facts

What you’ll do: Provide nursing care in small towns or remote locations where access to primary care may be limited

Where you’ll work: Hospitals, clinics, public health departments, home health

Degree you’ll need: Associate Degree of Nursing (ADN) or Bachelor of Science in Nursing (BSN)

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 this Article

“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. Rural nurses shouldn’t expect an exceptionally high salary, however.

Median Annual Salary for Registered Nurses

$77,600

“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.

Written and reported by:

Catherine Ryan Gregory

Contributing Writer

With professional insight from:

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

Rural Nurse