By James X. Stobinski
Sarah Falcone, in a recent article, described a spate of recent mergers, partnerships and re-structuring of services at rural health care facilities. She explained that 14% of Americans live in rural communities and that 147 rural hospitals have eliminated services or closed in the period 2010-2019. News releases from sources such as Becker’s Healthcare Review inform us that these trends continue unabated into 2023 in the financial reality of post-pandemic American health care where labor and supply expenses are rising sharply.
There are many potential benefits to mergers and some rural facilities do successfully re-invent and re-position themselves (Gooch, 2023). But, with these mergers and realignments there is one undeniable fact. It remains difficult to recruit and retain staff in geographically isolated areas with low patient volumes. There is a paucity of research on which incentives are effective in recruiting health care workers to rural settings (Russell et al, 2021). Many rural facilities are now faced with hard choices from years of decreased revenues and higher current costs which have strained limited financial reserves.
Let’s take a closer look at the connection between rural health care facilities and the makeup of the perioperative nursing workforce which is the subject of this column. Employers who provide the requisite perioperative orientation are the de facto gatekeepers to the profession. Data on the demographics of perioperative nursing are incomplete and no one group has assumed responsibility for gathering those statistics. Recent survey findings illustrate that the makeup of our specialty differs from the overall nursing workforce and the greater American population (Stobinski, Maio & Homme, 2022). Barriers to entry to the perioperative nursing specialty and difficulty in recruiting from all geographic regions contribute to the current demographics of perioperative nursing.
Rural facilities that are struggling financially may not have the resources for perioperative orientation programs. Secondly, early career nurses working in other specialties such as med-surg nursing are often recruited for perioperative specialty training. Rural facilities, by nature of their size, have fewer candidates in this pool. Thus, there are fewer potential recruits for the perioperative specialty. Finally, we must consider that in rural areas there may be limited options in pre-licensure registered nurse education programs. Likely, there will only be one associate degree (AD) program in the region. Few AD programs offer an introduction to perioperative nursing.
The result for perioperative nursing is then clear. The loss of rural facilities ultimately leads to a less diverse pool of possible accessions to the specialty. A lack of exposure to rural health care and fewer nurses from rural areas will exacerbate the recruiting and retention burden. Cultural competency in caring for rural residents will also be lessened. The loss of employer sites which can facilitate entry to the perioperative nursing specialty will further decrease the opportunity for rural nurses to become perioperative nurses.
The closure and realignment of rural hospitals is one salient aspect of the ongoing consolidation and regionalization of American health care as smaller facilities are forced by a financial imperative to be acquired by a larger health care system. These systems may then be merged into larger systems which may span regions and multiple states. Few rural facilities can approach the range of services and the resources found in a regional collection of diverse health care facilities which include hospitals, ambulatory surgery sites and urgent care centers. The consolidation of American health care and the concomitant loss of control in smaller facilities will continue. It will take a commitment of resources, a level of innovation and perhaps some entrepreneurial spirit to address this issue relative to the perioperative nursing workforce.
References
Falcone, S. (June 21, 2023). How rural hospital acquisitions are impacting surgical care access. OR Manager. https://www.ormanager.com/how-rural-hospital-acquisitions-are-impacting-surgical-care-access/?oly_enc_id=0139F0779901C0U
Gooch, K. (June 30, 2023). Texas hospital finds “new identity” as rural emergency hospital. https://www.beckershospitalreview.com/finance/texas-hospital-finds-new-identity-as-rural-emergency-hospital.html?utm_medium=email&utm_content=newsletter
Russell, D., Mathew, S., Fitts, M. et al. Interventions for health workforce retention in rural and remote areas: a systematic review. Hum Resour Health 19, 103 (2021). https://doi.org/10.1186/s12960-021-00643-7
Stobinski, JX, Maio, S and Homme, C (2022). Select demographics of nationwide sample of OR nurses. OR Manager. Accessed: April 15th, 2022, at: https://www.nxtbook.com/accessintelligence/ORManager/or-manager-april-2022/index.php
