I, Who Have Nothing: Nurse Leadership Development in Rural Healthcare

When Tom Jones or Shirley Bassey sing I Who Have Nothing, they are talking about unrequited love and their lack of resources to be considered as a suitable partner to the one they adore. I'm just a no one with nothing to give you but, oh, I love you. This song could be sung by most rural health nurse leaders as well.

In the (knock-on-wood) post-COVID era, healthcare systems have undergone a severe trauma for the last two years, followed by the great workforce resignation and the onset of travelers, hospitals everywhere are trying to figure out not only how to woo talent to their organization, but also how to keep talent from leaving. And as difficult as this period has been for the larger healthcare systems, it is exponentially more problematic in smaller rural healthcare facilities. With most rural healthcare providers operating in the red or at best, just treading water with razor-thin profit margins, -the oxygen for a conversation on nurse leadership development is thin.

Nurses in rural healthcare stand apart from their urban counterparts in a variety of ways. They often have a much greater role in the healthcare of their patients. Rural healthcare nurses tend to see more elderly patients, more Medicaid and Medicare patients, and they are limited in addressing preventive care (it’s just not a priority for most). They are often working with limited resources and a lack of specialty care and specialists.

Professional growth opportunities stand out as a unique opportunity for rural health to level the playing field, as long as they can creatively re-think their options. In recent article published in the Online Journal of Rural Health Nursing and Health Care (22,1) the authors asked two questions:

1. What are the competency needs of nurse leaders in rural hospitals?
2. What is the preferred method of getting continuing education for nurse leaders?

To the first question, the research on nurse leadership competencies is fairly generic, regardless of the industry or discipline. You can anticipate seeing conflict resolution, leading teams, communication, and the fundamentals. Healthcare has a few nuanced aspects in addition to the core competencies.

In a survey conducted by the authors of Nursing Leadership in Rural Hospitals, two other competencies rose to the top: quality training and generational leadership. Nurse leaders wanted support in understanding how to improve quality outcomes using a systematic methodology such as continuous process improvement, business process excellence, or lean. They also saw a large gap in understanding how to lead nursing units across the generational divides that are still in the workplace (which conceivably could be 4-5 generations).

For the second question, just-in-time vignettes and mini-courses (webinars) were the preferred learning modalities. Not surprisingly, in-person, classroom training was least preferred. Providing synchronous or asynchronous web-based learning options give the learner so much more flexibility that in-person training events. Where learning options were feasible only for healthcare systems that had a critical mass of learners who needed the same learning topic at the same time, the virtual options have leveled the playing field for rural health nurse leaders. Virtual learning means that learning content can be more customized to the learner at the most advantageous time for practical application.

Consider that the average nurse leader in healthcare has <5 years of experience in leadership. In the last few years, we’ve gone through COVID and the subsequent reverberations of financial struggles and attrition. Most healthcare organizations did not have the luxury of putting IT projects on hold during this time, so it is likely that they experienced major rollouts of one sort or another. Nurse leaders have been through a very rough period without question.

When an organization puts someone into a leadership position, the new nurse leader, their team, the organization, and the patient have a vested interest in that leader’s success. The organization at the very least owes the nurse leader the developmental support needed to be successful. In healthcare, where change is constant and quality outcomes are the goal, the skills of the nurse leaders are the differentiator that will make the difference.