Rural Health Care and Reform


Today’s healthcare challenges are many in the current environment of prolonged healthcare reform. Rural health nursing leaders are challenged with transforming practices and creating new cultures that meet the demands of a diverse range of patient needs, including the management of chronic disease. Gone are the days when the medical provider directed all of the care, today’s nurses and doctors have now become partners in wellness for patients in the rural healthcare setting. By the unique nature of rural health, there has been highlighted a greater awareness and understanding of contemporary issues facing rural health nurse leaders. This new paradigm in rural health requires nurses to manage dual roles as members of the community and health service delivery system, while managing the complexities associated with this new relationship. Nurse leaders must quickly develop new education delivery models that serve to increase the capacity and capabilities for nurses to practice at the top of their licensure, and provide care based on the best possible evidence. Through situational leadership, nurse leaders can be both directive and supportive in the success of these new models.

In the typical rural healthcare setting teams are comprised of many levels of expertise. From the entry level receptionist and medical assistant, to the seasoned registered nurse and medical provider, newer models of patient-centered care are placing demands for better decision making and astute clinical judgments. How do nurse leaders train and educate to this in a time of many competing priorities, including a lack of time and adequate resources? According to Northouse (2013), situational models demand that nurse leaders match their style to the competence and commitment of the subordinates. Effective nurse leaders are those who can recognize what educational needs the medical team has, and then adapt their own style to coach and meet those needs. Nurse leaders can use a situational style approach in an attempt to influence others in learning, in that it will improve the knowledge of the care staff and the level of excellence in patient outcomes. To accomplish this aim, nurse leaders will need to adopt a coaching approach that is both highly directive, as well as highly supportive.

The contemporary issue at hand is in developing an ongoing education and competency program, within the financial and time constraints so common to today’s rural healthcare clinics. The healthcare organization today, and its leaders must develop a strategy for incorporating this into the newer models and expectations of medical and nursing teams, and the Patient Centered Model of care. There is a need for a highly an educated workforce with nurses as equal partners, specific to the needs of rural health. To meet this aim nurse leaders must develop constructive processes that meet the newer regulatory demands and newer models of care.

Today’s patient centered models of care are dependent on effective, value based relationships. Moving an organization from a task oriented culture to one with a focus on developing relationships as an effective new approach to better outcomes for the increasingly complex patient will take effort. Applying effective leadership to this situation means that contemporary leaders must learn the art of relationship centered communication and exhibit the behaviors to the team that will result in a growing trust of the newer system. As much as the healthcare climate has changed, and placed new expectations on the healthcare teams in the rural setting, so has it on the demands for new learning on the nurse leader.In this new model of care the medical team is being asked to demonstrate communication and socio-emotional competencies as never before.

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