Working at a rural hospital, I have found myself at a junction between healthcare and the broad social issues affecting the health of our patients. In nursing school, we learn about the social determinants of health as an abstract concept, a faraway theory that can be summed up as “grandma can’t get to the doctor’s office because she has no one to drive her.” In rural areas, the mixture of poverty, decreased health literacy, unmanaged mental health issues, and lack of access to quality housing, transportation, food, and clean water creates a population that is more chronically ill than the average. These patients have higher incidences of obesity, diabetes, heart disease, and higher infant and child mortality. Over time, rural nurses and healthcare teams develop moral injury due to hopelessness and the inability to truly help.
Coming from the ICU and trauma bays in large, level I hospitals, I had seen my fair share of patients who could not afford their medications or alcoholic patients who were given the option between jail and sobering up at the hospital. However, in a rural community, the social determinants of health appear to me to be a bigger, much more systemic problem. The population in any given sprawling metropolis in south Florida has multiple options for healthcare. In this area, there is one safety net hospital with extremely limited services and a smattering of primary healthcare clinics. There are few grocery stores and pharmacies, and every year, the nearby factory pumps burning smoke into the atmosphere that chokes the lungs of countless adults and children. In the westernmost counties of Florida, numbers of people with a bachelor’s degree are in the single digits. This contributes to the complications of low health literacy, which include the inability to manage chronic conditions like asthma and vaccine hesitancy. Compound this with a shortage of healthcare professionals in the country without considering that doctors and nurses may not want to work in a rural area due to a perception of limited education opportunities and professional isolation. All these factors create fertile ground for the consequences of nurse burnout that include negative physical and emotional health outcomes as well as high organizational turnover.
Unfortunately, individual measures for combating nurse burnout, such as self-care and getting adequate sleep, are temporary and cannot work against systemic issues. Institutional changes such as having nurse leaders in administration, prioritizing healthcare worker mental health, prioritizing nursing professional development with robust nurse residency and preceptor programs, and giving point of care nurses and their direct supervisors more power to make changes in their workflow will help nurses feel more valued and supported. Communities such as this are doing what they can to create programs to increase health literacy and dispel the stigma of mental health, but it is not enough; the problem is multi-faceted. One thing that I have noticed in my time here is how resilient this community is. I am surrounded by friendly people and doctors who know their patients from outside this ER. As a healthcare system, we cannot let our rural nurses and healthcare workers fall through the cracks.
Christine Rincon, MSN, RN, CCRN, has nearly 10 years of experience in ICU, Trauma Resuscitation, Flight, and Ground Transport. She currently serves as a Critical Care Transport Educator with the Healthcare District of Palm Beach County’s Ground Transport Program.
References
CareTalk: Healthcare. Unfiltered. (2023, April 23). The Challenges of Rural Health. YouTube.
Schlak, A. E., Rosa, W. E., Rushton, C. H., Poghosyan, L., Root, M. C., & McHugh, M. D. (2022). An expanded institutional- and national-level blueprint to address nurse burnout and moral suffering amid the evolving pandemic. Journal of Nursing Management, 53(1), 16-27.
