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RNO Blog

This Blog from RNO that expresses the opinions of our members and not necessarily the opinions of RNO, if you wish to share something please contact

michelle-cheshire-150x200-DSC_7883-2[1]March 27, 2016

Advancing Nursing Education in a Rural State

Alabama is a rural state with all 67 counties containing federally designated medically underserved areas or medically underserved populations (MUA/MUP). In Alabama, as in many rural states, entry into nursing practice for the majority of nurses is at the LPN and/or Associate Degree (ADN) level. In 2011, in response to the 2010 Institute of Medicine: Future of Nursing Report recommendation to increase the proportion of BSN prepared RNs to 80% by 2020 the state of Alabama, expanding on previous partnerships, formed a taskforce to address seamless academic progression. The Advancing Education Taskforce includes nurse educators from 2 and 4 year institutions, and representatives from all types of healthcare agencies, including the Alabama Department of Public Health. In 2012 the Advancing Education Taskforce joined forces with the Alabama Health Action Coalition (AL-HAC).  In 2013 AL-HAC was awarded a State Implementation Program (SIP) Grant from the Robert Wood Johnson Foundation (RWJF). The focus of the project was to improve Alabama’s RN workforce by increasing RN to BSN progression.

Paramount to accomplishing the goals set by the task force was fostering strong respectful relationships across educational programs. The Advancing Education Taskforce includes nurse educators from 2 and 4 year institutions, and representatives from all types of healthcare agencies, including the Alabama Department of Public Health. Some states have chosen to meet the 2020 goal by promoting BSN degrees as the entry to practice. Instead, the Alabama Advancing Education Taskforce is focusing on improving the nursing education system by creating seamless academic articulation from LPN through graduate education. Data indicates that the efforts in the state are working. Alabama saw a 13.8 % increase in enrollment in nursing mobility programs from 2012 to 2014.  Board of Nursing data also indicates an increase in the proportion of RNs with a BSN degree or higher from 35% to 50%, from 2010 to 2014.  The state was recently awarded a second round of SIP funding from the RWJF which will be used to continue to increase the educational level of the nursing workforce in the state.

Michelle Cheshire EdD, MSN, RN; Alabama Health Action Coalition


ann-graves-DSC_0485February 1, 2016

Future Directions for Rural Health Research

“Nearly one in five Americans live in rural communities totaling about 57 million people” (HRSA, 2015). It has also been noted that the lives of over 400 thousand rural residents are impacted by federally funded rural health programs (HRSA, 2015). The United States Department of Health and Human Services, Health Resources and Services Administration provides funding for community-based health programs, state hospitals, telehealth, & policy research aimed to increase access and improve quality of healthcare for those living in rural areas.

The Federal Office of Rural Health Policy (FORHP), operating within HRSA, provides funding each year through eight rural health research centers and three rural health policy analysis initiatives. These rural health centers focus on rural health research and policy. The following is a list of links to rural health centers funded September 2015 by the FORHP:

(USDHHS, HRSA, 2015)

Identifying the future directions for rural health research might best begin with a reflection of current rural health research. Exploration and careful review of the funded research centers and their current areas of expertise can easily paint a picture of the most current state of rural health research. Below is a word cloud constructed from text from the FORHP website regarding current research funded to rural health centers by FORHP. This image provides a quick overview of what is currently being done in rural health research.

for rno page

For those interested in the future of rural health research a closer review of the currently funded projects at the FORHP website can draw an even clearer picture of what is being done in rural health research today. From this review, researchers can determine what may be needed next for rural research for the future.



US Department of Health and Human Services (USDHHS) (2015). Health Resources & Services

Administration (HRSA). Federal Office of Rural Health Policy (FORHP). Retrieved from: health

Ann Graves, PhD, RN; Associate Professor, University of Alabama



Judith December 4, 2015

As I See It: Infusing the Human Factor at the Bedside for Rural Health Care Consumers

The role of the Clinical Nurse Leader (CNL) is ideally suited to lead and support nurse generalists who are working in rural settings. Rural healthcare consumers are looking for nurses to be educationally prepared, compassionate professionals who have an understanding of the challenges and opportunities of rural life (Sivamalai, 2008). These attributes require advanced education for nurse generalists and a desire to emerge as a change agent for individuals in need of care in acute, chronic, and community-based settings.

The CNL is a masters-prepared clinician certified by the Commission on Nurse Certification. Graduate education is mandated because the CNL must bring an advanced level of clinical skills and synthesis of didactic knowledge to the point of care and serve as a leader for the nursing team. In practice, the CNL oversees the plan of care from admission to discharge and integration of care for a distinct group of patients. This master's degree-prepared clinician puts evidence-based practice into action to ensure that patients benefit from the latest innovations in care delivery. The CNL evaluates patient outcomes, assesses cohort risk, and has the decision-making authority to adapt care plans when necessary. The flexibility of this role makes it ideally suited to rural healthcare environments. The next step should be for nurse leaders to seek funding for pilot research studies to investigate the patient care outcomes and nursing satisfaction in rural settings that support the role of the CNL.


AACN (2015). What is CNL certification? Retrieved from:

Simamalai, S. (2008). Desired attributes of new graduate nurses as identified by the rural community. Rural and Remote Health 8(938), Retrieved from:

Judith M. Paré, Ph.D., RN, By-Laws Committee Chairperson

Online Journal of Rural Nursing and Health Care

Ranking of Online Journal of Rural Nursing and Health Care

The Online Journal of Rural Nursing and Health Care is the official organ of the Rural Nurse Organization (RNO)

An analysis of free scholarly electronic journals (EJ) conducted by Isfandyari-Moghaddam, Danesh and Hadji-Azizi (2015) identified the Online Journal of Rural Nursing and Health Care as one of the top-ranked free EJs in medical sciences.

The top-ranked free EJs in the medical sciences according to Isfandyari-Moghaddam et al. (2015) are:
  • Health: New South Wales Public Health BulletinPLoS Biology and Environmental
Health Perspectives – National Institute of Environmental Health Sciences.
  • Nursing: Online Journal of Rural Nursing and Health Care and Online Journal of
Nursing Informatics.
  • Dentistry: BMC Oral Health and Brazilian Oral Research.
  • Medicine: Brazilian Journal of Medical and Biological ResearchClinics and Sao
Paulo Medical Journal.
Isfandyari-Moghaddam, A., Danesh, F., &  Hadji-Azizi , N. (2015). Webometrics as a method for identifying the most accredited free electronic journals. The Electronic Library, 33(1) 75 – 87.
Pamela Stewart Fahs, Editor-in-Chief

Outstanding Performance of Rural Nurses:

July, 2014 

The Anna Mae Ericksen RNO Award20140730_122333-1Congratulations! Dr. Angeline Bushy, PhD, RN, FAAN

The Rural Nurse Organization (RNO) is an international organization formed for the purposes of recognizing, promoting and maintaining the specialty of Rural Nursing practice. As such, the RNO wishes to recognize leadership in the specialty of Rural Nursing and the provision of health care in rural populations. This leadership may have been exhibited in one or more of multiple roles, not limited to practitioner, educator, or researcher. The recipient of this award will have provided a voice for rural nursing in nursing or health care agencies, professional organizations, academia, community and/or government. Typically, the winner of this award will have influenced rural nursing beyond the local level with work that is recognized as supportive of the specialty of rural nursing and / or health care for rural populations. The award winner’s work will be recognized as having long lasting influence in rural nursing and health care. This award may be based on recognition of a single achievement or a trajectory of work in the area of rural nursing.


CBeldenBB June 1, 2013
Throughout my career in rural healthcare, I have been fortunate to discover (sometimes through trial and error) some of the most useful practice resources to improve my clinical and administrative practices.  A prime example is the National Guideline Clearinghouse (NGC) sponsored by the Agency for Healthcare Research and Quality (AHRQ).  Originally created in partnership with the American Medical Association, NGC offers healthcare providers and support organizations with objective, detailed guidelines for science-based research and best practices.  NGC considers guidelines from all quarters of healthcare, but specific parameters must be met to be included into the guideline repository.   AHRQ, in and of itself, provides a plethora of resources, some of which are specifically aimed at the challenges encountered in rural healthcare.  As the ACA has specific requirements for reduction in hospital readmissions, organizations such as Boston University Medical Center has put forth a comprehensive discharge toolkit designed to assist organizations in improving rehospitalizations and educating patients to perform effective self-care out of the institutional setting.
Another comprehensive resource for rural organizations and clinicians is the Rural Assistance Center.   The Center’s website offers a wide variety of resources aimed at the challenges experienced by rural healthcare organizations and clinicians.  In conjunction with the American Hospital Association, the Center’s links and tools section present resources for quality and patient safety in the rural setting and Health Information Technology (HIT) Meaningful Use the latest guidance, practices, and quality indicators pertinent to the rural healthcare setting.
Of course, there are a myriad of resources available from the internet, but it is important that rural healthcare leaders and clinicians be discerning connoisseurs of what is considered “best practice” or “evidence-based”.  As research opportunities may be sparse in rural healthcare, leaders in such settings must be willing to reach out within the industry to network with others to bring opportunities to their organizations and, subsequently, the bedside.
For more information on the resources discussed, please follow the attached links:

Catherine V. Belden, RN, DHSc, MSN, RNO Education Committee Chair



rsz_pam_photo_2008April 26, 2013
Last night was a special evening for me, nurses, and future nurses interested in research in a rural area of upstate NY. The event was the “Nursing Research Evening” at the Mary Imogene Bassett Hospital in Cooperstown, NY. I was asked to be a speaker for this Nursing Research Evening with the talk entitled “A Nursing Research Trajectory to Improve Heart Health in Rural Women”, looking back at my own research trajectory in conducting research to help reduce CVD burden of rural populations and often focusing on the cardiovascular health or rural women. I had the pleasure of attending the poster session for nursing research prior to the dinner and met some dedicated and enthusiastic nurses and future nurses. The event was well attended, booked to capacity according to the planners. What impressed me was the enthusiasm and excitement for nursing research as nursing students, prelicensure as well as RN to BS, from Hartwick College of Nursing, presented their beginning endeavors in the area of nursing research; and the research being generated by practicing nurses, clinicians, educators and academicians from the Bassett Health Care System and surrounding areas. I would love to be able to bottle that enthusiasm and spread it to nurses at all levels of educational preparation and practice. We need to harness that enthusiasm and use it to move nursing practice forward. I believe it is especially critical in rural practice settings, where we need to make everything we do “count” to get the best outcomes for those served in the rural health care system. We as nurses need to be able to identify what works and does not work in our practice. We need to be able to implement evidence-based guidelines, but in the absence of evidence we need to create evidence and in my opinion, the best way to create evidence is through nursing research. As rural nurses, what I have coined “the consummate generalist” we need to be able to look at a clinical issue, identify what is the evidence for best care, where are the gaps, and if there are gaps how do we fill them. In my opinion the answer how do you fill gaps in evidence-based care is “Do research”
I believe it is critical to generate an appreciation for nursing research in practice, particularly in rural areas where resources may be scarce but the sense of community is strong. Understanding, using and being able to generate research in rural nursing is the best way for us as rural nurses to have a positive influence in the practice of rural nursing.

Pam Stewart Fahs, RNO President

Springer Publishing Company is pleased to announce the March 2013 publication of:



Rural Nursing, Fourth


Concepts, Theory, and Practice

Winters, Charlene A.

Pub. Date: 03/28/2013 – ISBN-13: 9780826170859 – 520 pp., Softcover – The fourth edition of the only text to focus on nursing concepts, theory, and practice in rural settings continues to provide comprehensive and evidence-based information to nursing educators, researchers, and policy-makers. The book presents a wealth of new information that expands upon the rural nursing theory base and greatly adds to our understanding of current rural health care issues.  Authored by contributors from the United States, Canada, and Australia, the text examines rural health issues from a national and international perspective.