Nurse practitioners who practice in rural areas face a different set of opportunities and challenges than those working in suburban or urban environments. Overall, serving rural populations can prove to be a rewarding and lifelong career path for some clinicians.

Nurses who work in a rural practice get to know their patients and the local community better than nurses employed in suburban or urban practices, according to Kristin Juliar, director of the Montana Office of Rural Health.

“They often know their patients in the context of the community and the families in the community. Patients express a great deal of satisfaction in having nurses and hospitals that treat them as if they were family,” Juliar said.

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Autonomy is another benefit of working in a rural setting, according to Bette A. Ide, PhD, RN, FAAN, a professor at University of North Dakota School of Nursing. She said that rural nurses have a greater independence and freedom in their practice. “The rural nurse is a community leader and can be a change agent.”

But challenges can include isolation and lack of support. Rural nurses have higher demands placed on them by small communities that typically depend on a single nurse to meet all of their health needs. “The rural nurse lives in a fish bowl and is expected to be available at all times to be all things to all people,” Ide said.

Because of this many rural nurses are faced with the “burnout factor,” said Casey Blumenthal, MHSA, RN, CAE, also of the Montana Office of Rural Health. Rural nurses typically do not get as much time off because they work on smaller staffs and there is less coverage. “Nurses are asked to work extra all the time or asked to wear even more hats than they normally do.”

Other factors contributing to nurse burnout include the limited resources and training available in small rural communities. Nurses employed in urban and suburban clinics often have at their disposal Human Resources departments; higher salaries and better benefits; and a larger variety of patients, which can present challenging learning opportunities.

Another distinction is that nurses working in rural areas do not have the opportunities to specialize as easily as their urban and suburban counterparts, according to Juliar. “A rural nurse has to be a generalist or a specialist in many areas, and may have to practice in several areas in one day,” Ide added

For nurses or nursing school students contemplating a livelihood in rural nursing, there are benefits as well as challenges to weigh before committing to a position in a rural clinic. Ultimately a career in rural nursing involves a commitment, not only to being a medical professional but to being an integral member of the community.

Jennifer Leeper is a freelance medical writer living in Kansas City, Mo.