Rural nurses' continuing education needs: A U.S. multi-site survey reveals challenges and opportunities

Background: Provision of relevant, evidence-based continuing education (CE) is an integral part of maintaining a highly competent rural nursing workforce. Numerous tangible and intangible barriers exist to nurses’ participation in CE in rural settings. Major barriers to accessibility and participation in CE for rural nurses include: 1) Geographic isolation, 2) lack of perceived administrative, financial, and/or technological resources and support, 3) lack of time due to workload, inadequate staffing, and/or travel distance, 4) lack of relevance of continuing education topics, and 5) lack of a dedicated on-site nurse educator. Proactive development of academic-practice partnerships is important to support rural care providers regarding CE delivery. The purpose of this study was to assess perceptions of CE needs of nursing unit staff working in a group of health care facilities in a rural region of midwestern U.S. Methods: A cross-sectional CE needs assessment survey was conducted in winter of 2010 with rural health care providers (N=302/1107; response rate 27%) working in rural healthcare facilities (N=40), including rural hospitals (n=10) and long-term care (LTC) facilities (n=30). A well-validated 72-item Likert-type survey was distributed via a secure online university survey platform, and included assessment of 59 CE need areas. Internal consistency reliability was 0.87. Data were analyzed using SPSS software, version 16.0. Results: Descriptive statistics revealed a greater number of licensed practical nurses and nursing assistants working in rural LTC’s (27.2% and 62.5%, respectively) compared to rural hospital setting (14% and 15%, respectively). There are a large number of associate degree-prepared nurses (63%) working in the participating rural hospitals compared to LTC setting (8.4%). Respondents’ priority learning needs included: 1) Review aspects of medication administration/drug interactions; 2) improve skills in patient assessment (physical/mental); 3) increase knowledge of management of patients with comorbidities; 4) promotion of patient safety; 5) enhance communication skills/teamwork; 6) increase lifelong learning. Student’s t tests revealed LTC nursing unit staff reported significantly higher priority learning needs in “manage aggressive behavior (verbal/physical)” ( t = 2.044, d f = 300,  α = .003), “family participation in care” ( t = 2.470, d f = 300, α = .036), and “maintain standards of care” ( t = 2.880, d f = 300, α = .042), whilst acute care nursing staff reported a significantly higher priority learning need in “manage a crisis”  ( t = 2.122, d f = 300, α = .050). Conclusions: Study results revealed key learning needs related to several aspects of patient care delivery for rural nursing unit staff who are primarily nursing assistants or nurses meeting minimum state educational requirements. Basic health- care workforce training does not typically emphasize continuous quality improvements, or how to recognize and develop an evidence-based practice at the entry level. The potential for nursing knowledge stagnation among entry level nursing unit staff in rural settings needs to be addressed to help break down isolation barriers impacting knowledge, attitudes and behaviors of health care providers practicing in rural health care facilities.