Research into Rural Healthcare and Isolation


Published: 15 August 2017

In 2014, I had accumulated thirty-three years of bedside and clinical education nursing practice.

My resume included a wealth of home-care, nursing education, and several years of clinical practice in a major teaching hospital in the northeastern portion of the United States. I truly felt privileged to be a nurse and I wanted to give back to the profession that had given so much to me.

During that time, I was Director of Graduate Education at a university that offered online programs for licensed nurses. At the start of the 2014 winter semester, I was introduced to a student who would help me to change the trajectory of my passion for nursing.

The student was enrolled in an online leadership course that was designed for nurses who intended to complete a graduate program in nursing. The course required that all students complete a weekly reflection journal and analyse a 'leadership moment' that they had witnessed. Beverly was one of my most prolific students and her reflections captivated my attention.

Each week, Beverly would complete a self-reflection log that described her experiences working in a Critical Access Hospital (CAH). Critical Access Hospital is a designation given by the United States federal government to certain rural hospitals by the Centers for Medicare and Medicaid Services (CMS) (Rural Information Hu, 2017). This description was created by U.S. Congress in the 1997 Balanced Budget Act as a consequence of multiple small hospital closures in the 1980s and early 1990s.

Nurses who work in critical access hospitals are typically caring for patients for whom they have personal connections, including family members, friends, neighbours and colleagues. The weekly reflection logs that Beverly submitted were evidence of her passion for nursing and a deep commitment to her rural community.

Beverly's reflections included her recounts of a typical patient assignment that was based on a day’s census of new admissions that often included newborns, trauma patients and elderly patients in need of end-of-life care. Beverly’s ability to care for patients who spanned the life-cycle amazed me. I was anxious to better understand the lived experiences of nurses working in CAH and rural hospital settings.

Nurses working in CAH and other rural settings frequently provide the primary healthcare services for people living in these areas (Long & Weinert in Winters, 2013). However, little has been written to guide rural nursing practice or understand the lived experiences of these healthcare providers.

During the past three years I have completed two qualitative research studies examining the lived experiences of nurses working in rural settings in the Northeast and the Midwest portion of the United States. The participant responses from these studies elicited vastly different themes. However, the common theme was a feeling of isolation that rural nurses are confronted with on a daily basis.

The participants expressed concerns about being isolated from nursing colleagues in urban settings; being isolated due to limitations related to technology and Internet capabilities; and being isolated from access to educational programs that would allow them to advance their clinical practice.

I am committed to expanding this research to other rural settings in order to examine the impact of culture on the lived experiences of rural nurses. The consequence of expanding nursing knowledge regarding your practice will allow educators to implement strategies that will support the recruitment and retention of rural nurses.

  • Long, K & Weinert, C 2013, Rural nursing: Developing the Theory Base, in Rural Nursing: Concepts, Theory and Practice, 4th edition, Springer Publishing, NY: NY.
  • Rural Health Information Hub 2017, Critical Access Hospitals (CAHs), RHI Hub, Grand Forks, ND, viewed 11 August 2017,