Addressing the Nursing Shortage in Rural Tennessee

By Bobbie J. Murphy

Chief Nursing Officer & Vice President of Patient Care Services, Bristol Regional Medical Center, Ballad Health

Healthcare news from rural regions shows the many challenges we face as providers. The national nursing shortage is often at the top of the list. At Ballad Health – a community health improvement organization that exists to serve the 1.1 million residents of the 29-county Appalachian Highlands region – we currently have more than 600 open bedside nursing positions. This shortage has led to higher workloads for our current staff, fewer beds to treat patients, and crowded emergency departments. approach.

Like many rural systems, Ballad Health is partially offsetting the shortage by relying on temporary staffing agencies. These agencies have provided traveling nurses and respiratory therapists critical to our patients during the ongoing COVID-19 pandemic. But there are significant costs associated with these agencies, which means there are still gaps in resources needed to meet the demands of patient acuity and volume.

In October 2021, Alan Levine, president and chief executive officer at Ballad Health, testified before a Congressional subcommittee on an “emerging national crisis.” Nursing shortages have been growing for years, but the rapid rise in costs associated with temporary staffing agency solutions – many now owned by private equity firms – significantly impact rural healthcare systems and their ability to invest in the communities they serve. We need to reassess our approach.

One solution is to invest in building a professional workforce from within the local community. To be successful with a “grow-your-own” workforce, hospitals will need to make it easier for rural residents to obtain the necessary qualifications.

In January 2021, senior writer at Best Colleges, Anne Dennon, published an article about college attendance in rural areas. She reports that rural students tend to go to college at lower rates, even though they graduate high school at higher rates than the national average. This is because “underprivileged rural students are largely ignored” in educational surveys, studies, funding initiatives, college retention and recruiting, and dedicated scholarships.

For many rural residents who have already completed a licensed practical nursing (LPN) program, it is prohibitively expensive to obtain the continued education necessary to qualify for higher-level positions. LPNs may get “stuck,” short of higher credentials, because many higher education programs are not well-suited for full-time employees. This barrier keeps many from pursing further education, forcing hospitals to remain reliant on a transient workforce.

Many healthcare systems—including Ballad Health—have instituted scholarships, tuition reimbursement, and other incentives to offset these challenges for the rural community. But they cannot do it alone.

We need to continue to work closely with our elected officials and stress the challenges faced by rural healthcare providers. This includes the need for a unified effort to help residents of rural communities earn higher degrees in clinical education. This would raise up clinicians from rural areas who are more likely to remain, in order to provide care for their friends and neighbors.

Educational institutions can also help by keeping tuition costs low, and creating new pathways to opportunity. For example, Western Governors University—parent university of WGU Tennessee—has one of the lowest tuition rates in the country for accredited nursing programs. They have hundreds of thousands of dollars in available scholarships, including designated scholarships for healthcare professionals. WGU also offers a Family Nurse Practitioner degree program, which is often a great fit for rural residents, and with WGU’s competency-based model, full-time employees can work at their own pace.

Rural Tennessee hospitals need qualified healthcare professionals. Helping our local community members seek higher clinical certifications is critical to their individual success, as well as the success of the rural communities that we serve.

Bobbie Murphy is a member of WGU Tennessee’s Board of Advisors.