Nursing Education in Rural Environments

Abstract

Nursing education in rural areas brings about both challenges and rewards. Immense distances between students, clinical sites, and resources often require faculty to teach over videoconference and internet mediums. Additionally, clinical site assignments extend beyond the traditional hospital units. Rural teaching in distance programs takes motivated faculty who are willing to approach challenges using innovative techniques and exceptional communication skills. Approaches to bridge the education gaps while teaching over videoconference are possible; however, they do require abstract thinking, preparation, learning, and motivation to adapt from the traditional synchronous classroom structure. Similarly, faculty must look beyond the common hospital placements for clinical sites when in the rural environment. Patients can be found in their natural and sometimes unconventional settings. Baccalaureate nursing students can receive an exceptional learning experience in a rural environment; however, this does require significant skills and innovation for instructors who wish to take on the challenge.

Introduction

Distance poses its own set of issues that call for creative and innovative approaches to teaching and learning. Montana is a state where there are fewer than a million people and vast rural areas. Montana is the fourth largest state per square miles only coming in behind Texas, California, and Alaska (Fifty State Rankings for Size, 2015). Distance between scholarly institutions, clinical opportunities, and students are enormous challenges to delivering high-quality education. This article will address innovative teaching methods developed to meet the challenge of a rural environment. Distance learning through synchronous videoconference methods will be discussed and helpful tips provided which are aimed to improve teaching effectiveness. Creative and highly effective clinical experiences adapted to meet rural community limitations will also be addressed. This is an opinion article, with topics and tips learned from 16 years of experience and mistakes in the rural teaching environment. Much of the content in this article pertains to experience teaching nursing courses; however, the content could easily be expanded to just about any health-related field in a rural setting.

Current Challenges of Teaching Rural Nursing

Nursing, much like any other health science field, requires significant time learning about and interacting with patients. During students’ 4-year education, they must be exposed to a variety of cultures, ethnicities, diseases, and psychosocial population subsets. Finding these types of learning experience is an enormous challenge for nursing faculty. Exposing students to cardiac, neurological, pediatric, and obstetric patients are just a few of the subpopulations curriculum requires to produce well-educated, prepared nurses. Additionally, health fields require significant one-on-one teaching and oversight. Each state sets their faculty/student guidelines for this ratio. Much of the time it is as low as 8:1 or 10:1 (McCulloch, 2015). Providing this type of intense oversight requires well-trained instructors. Consequently, clinical placements for students can be difficult to find when populations are separated by many miles. Often instructors have students assigned in two or even three communities at the same time in order to tap into specific patient populations and to find enough patients to create a clinical opportunity for the student. To address this issue, if a university has considerable applications for a nursing program but limited clinical placements, satellite campuses can be set up in other parts of the state. Once core requisites of a student’s education are completed on the main campus, students are sent to the satellite campuses to live and complete their last 2 years of clinical work. This way the university can meet the low student/faculty ratios and have more opportunity to provide a diverse clinical experience for each student.

Similarly, transportation and distance are a significant challenge for many instructors in rural education. Students can expect to travel up to 60 miles or more from their hometown to clinical sites. If a clinical site requires further distance, it is common for students to stay anywhere from one to seven nights away from home in order to remain close to their assigned clinical placement. As a result, a common challenge faculty face is students who cannot afford a car or gas for multiple distant clinical trips. Troubleshooting by instructors includes working with communities to host students while they are placed in clinical facilities. Additionally, clinical sites can sponsor students by providing living space or even gas money while the students utilize their facility for clinical purposes.

Finally, finding highly trained and qualified faculty to meet the demands of rural teaching is difficult. The nursing discipline is experiencing a shortage of faculty (American Association of Colleges of Nursing, 2015). Teaching in a university with rural populations comes with additional demands that many faculty have not been prepared to undertake. Teaching vacancies mean fewer students can be properly educated. Recruitment of faculty must rely on individuals who enjoy wide open space and a slower pace of life. These must be individuals who appreciate challenge and innovation. Providing support and opportunity for faculty in rural areas is a challenge that will be discussed in the latter part of this article.

Rural Education Delivery Systems

Education today can be delivered using a variety of methods. The rural issues of distance lend themselves to online and hybrid models for teaching. Long past are the days when teaching was done solely real time face-to-face in the classroom. The need for diversity in clinical placement and the hundreds of miles that separate students in the same class dictate an online or hybrid model classroom environment to deliver content. Carefully monitoring student outcomes is one way to ensure quality of education. In the past, there has been some concern regarding quality over distance mediums. As technology and teaching techniques have improved, this gap for concern has decreased (Li, Amin, & Uvah, 2011; Tran et al., 2014).

For the purpose of this article, discussion will be focused on the hybrid classroom where lectures are delivered real time synchronously by videoconference. The challenges and benefits of video conference in the rural setting will be discussed. This is a common model used in the rural setting, as programs aim to maintain the traditional classroom experience to avoid the label of being an all online program.

Challenges

When an instructor is designing a class in rural areas, several key concepts must be kept in mind. The first is resources: what resources are available and what support is there to maintain those resources? A related and often-overlooked issue is fiber optic infrastructure. Online videoconferencing, teleconferencing, and even Internet access uses fiber optic cable. If a state does not have a sufficient or large enough fiber optic infrastructure, an online or hybrid class may not be possible.

The second consideration for an instructor is teaching style. Not everyone can or should teach online or through videoconference. This mode of delivery requires considerable abstract thinking and spatial skills that extend beyond the traditional classroom skills. The traditional classroom allows students full access through synchronous audio and visual learning. Students are able to see the instructor, hear him or her clearly, and formulate a relationship based on spoken and unspoken communication. When teaching online, creating this relationship requires a very different set of skills. Instructors must understand the challenges and benefits of distance teaching. Things like voice inflection, time delay when speaking, command of the audio visual teaching tools, pausing for questions, and anticipation of technical disconnection are all to be considered in addition to those expected of the traditional real-time teaching skills. Instructors who understand how to include all participants and communicate clearly even with the issues of poor sound, visual quality, time delay, and so on will be most effective in teaching content well over videoconference.

Similarly, online instructors must have an understanding of how to create class unity without real-time communication. This can be done in a variety of ways, for example, group assignments (online), discussion boards, calling on students by name during lecture on distance campuses, and ensuring time is allotted throughout lectures to pause and ask for questions. All these tactics give the recipients on the distant site the message that they are important and part of a bigger classroom (Lei & Gupta, 2010).

A common challenge of rural teaching is financial. Videoconference systems can cost $20,000 to $70,000, not even taking into consideration the fiber optics that may need to be installed to support such a large system (Burton & Kitchen, 2011). Additional costs to be considered are the technicalities of hiring distance proctors for exams, teaching clinicals, and performing student evaluations. Distance sites must be staffed with qualified faculty who assist in facilitating the nondidactic portions of class. These adjunct faculty serve as a link between the main campus and the students at the distance site.

Similarly, an obvious challenge to a distance program in a rural setting is oversight from a distance. This mode of education delay presents possibilities for immense miscommunication. There is an increased need for communication with instructors in the distance environment. This translates to increased e-mails, phone calls, texts, and videoconference meetings. Similarly, the chance of miscommunication exponentially increases when there is more than one professor teaching a course (Lei & Gupta, 2010).

Additionally, a rural health program requires the same high-quality clinical placements as other synchronous programs. In any given semester, a class size of 24 students can require 255 clinical placement days with approximately 15 different agencies. This requires clinical professors to be familiar with a variety of agency policies, security, confidentiality, and so on. Collaborative relationships with each agency are required to ensure students and facility staff have a beneficial experience. The public relationships are essential to continued and improved student experiences. The critical feature of any rural program is communication and coordination from the faculty. When distance teaching modes are added to the skill set required of the instructor, the difficulties can be extreme.

Finally, the instructor must have a firm grasp of the seven different learning styles: visual, auditory, verbal, physical, logical, social, and solitary (Edwards, 2002). To face the challenge of online teaching, classroom activities, assignments, and lectures need to be tailored in a variety of ways to meet these styles including the rural challenges. Lectures should include variety such as pictures as well as audio clips, case studies, practice exam questions, student presentations, discussion, and demonstrations. These can all be done online with videoconference and in prerecorded lectures. Adaptation for each method may be necessary depending on the number of students, whether class is synchronous or asynchronous, and the quality of video capabilities. This may feel and sound like an enormous variation. The types of learning taking place in the classroom have just as much if not more variation, making these tactics essential.

Benefits

Distance delivery in the rural setting definitely has its benefits. The common thinking today is online delivery has more benefits than challenges (Shultz, 2011). Students can remain in their homes and communities while working toward their 4-year degree. Upon graduation, graduates are in place in rural settings where there are shortages, thus fulfilling a need within the community. Additionally, more clinical opportunity is available when students are spread out into rural communities. By having small satellite campuses, students can take full advantage of clinical placements within their community without competing with students in other health-related programs.

Similarly, distance students become exceptional users and executors of information technology through their experience with distance learning equipment. Initially, students over distance formats may experience anxiety and stress due to their reliance on technology (Lei & Gupta, 2010). This reliance is what encourages students to become proficient in technology. Many distance students master videoconference equipment, as well as develop proficiency in participation in class discussions, performing presentations, operating computer programs within the system, and excelling in written communication methods. Distance students have a definite advantage over students in face-to-face classrooms in that their situation requires these skills to be developed. These skills will be very helpful in their own professional careers.

Finally, creativity, innovation, and empathy are honed when students participate in distance learning (Lei & Gupta, 2010). Students must become creative and organized in how they communicate. For example, if a student is doing a demonstration for classmates on a distance campus, the student must plan in advance to send the same materials needed for the demonstration to the main campus and arrange for the instructor to also demonstrate the concept just as the student is doing for his or her classmates at the distance site. Additionally, students learn empathy. This is especially true when different instructors from various sites sporadically deliver content. This means some lectures are delivered from the distance site while others are delivered from the main campus. Students are put in one another’s shoes while experiencing the challenges and benefits of getting educational materials over videoconference.

Some may question why more instructors do not embrace the distance learning model as an effective mode of teaching. The skill set required to teach effectively over distance is not part of every instructor’s talents. Additionally, not all professors are interested in taking on the challenge of building or employing these skills. This mode of teaching will surely put a professor beyond his or her comfort zone. Similarly, troubleshooting will require thinking outside the box and using a considerable amount of creativity. Abstract thought will be necessary to problem solve and come up with effective solutions. All these requirements are above and beyond those required to successfully teach in the real-time classroom.

Challenges for teaching and learning styles exist in every classroom. However, benefits of distance teaching using videoconference technology make it clear this is an educational option that will continue to increase in demand in the future. When the option of distance teaching is added to education, a unique subset of techniques can be employed to help bridge the learning gaps. Several suggestions for addressing these issues have been mentioned. Each will be discussed in detail in the next section.

Methods for Managing Distance Education

As mentioned, keeping multiple delivery sites as part of one classroom can be an enormous challenge. Giving every student equal time to discuss, ask questions, and feel part of the group takes time and some key skills from the instructor. Health profession courses are relatively small: Getting to know students individually may enhance the connectivity students feel with their classmates. To accomplish this, the instructor must know what the students look like on all the distance campuses. This requires photos to be taken and printed of every student in class. These photos serve as a visual reminder for the instructor. Second, the faculty must come to know about the students on the distance campus just as well as those in the main campus classroom. Therefore, getting reports from previous instructors or asking students to answer some basic questions about themselves is recommended. These notes serve as an introduction to the individual students. Notes can additionally be added under the students’ photos throughout the semester as the instructor learns more about each individual.

A second consideration to improve connection with each student is to have a solid understanding of when communication can be done via phone, text, e-mail, videoconference, or in person. As a faculty member becomes more experienced, decisions about when to use these different communication methods will become clearer. For example, all serious student issues or questions should first be addressed in writing with the individual student and then followed up with a videoconference where all parties are visible. This is how issues would be handled in a face-to-face classroom, thus they are handled similarly using distance equipment. If a student just has a question about class or an assignment and the written response is less than one paragraph, e-mail is acceptable. Additionally, this gives all parties a written document to utilize for reference. If a reply may be more complex, an initial e-mail describing the complexity followed by a phone call is most effective.

An enormous issue with distance learning is literal disconnection, when videoconference equipment fails to operate effectively. Unfortunately, this occurs more often than not. It is the faculty’s responsibility to anticipate this and to be prepared with several backup plans to deliver the content (Renes & Strange, 2011). The most critical issue with disconnection is the loss of time in the classroom. Faculty cannot make up lost time, by policy; therefore, when a system fails and a quick reconnection is not possible, a backup plan must be ready. There are several options for backup plans. First, the professor can initiate a teleconference call. This way, students on the distance campus can hear the class. This is a simple telephone connection, however, there will be no visual contact, so slides, Internet clips, and photos will not be visible. A second option would be to record each lecture. This backup must be set up at the beginning of the semester. Lectures can be recorded, depending on how this is accomplished students will see the instructor or the slides during the recording, they do not see both. A key component to feeling connected is having a visual of the instructor; thus, the recording that includes visual of the instructor is preferred. Finally, a key and critical component when disconnection does occur is to keep calm. Students will emulate what they see. If the professor is calm, collected, and prepared, the students will be able to deal much better with technical difficulties during lectures (Lei & Gupta, 2010).

Additionally, when trying to bridge the disconnect felt with distance learning, faculty must expect and accommodate for sound delay. No matter how expensive the fiber optics or how technically advanced the equipment, there will always be a sound delay when delivering content. Professors need to accommodate about 5 minutes per hour for this delay. When a question is asked on a distance campus, allow for pauses before answering. When asking a question to the distance campus, again, pause before asking the question. Additionally, it is always a good idea to repeat all questions. This way when, recorded, questions are heard clearly and all participants get to hear the question, even if the microphone was not functioning optimally. An instructor may be tempted to not take pauses or ask for questions if running behind. This is highly discouraged, as pauses during presentations communicate to the students that the instructor cares and is seeking feedback or questions. Students need this respect to maintain connectedness with the professor. Some faculty are tempted to make up for the time delay by omitting class breaks, but this too is discouraged and disrespectful of students’ needs.

Similarly, professors may not be motivated to learn the video system they are using. It is strongly recommended that professors practice with their system and take responsibility for it (Yang & Cornelius, 2005). The professor will need to move cameras, select settings, adjust sound, and so forth, to improve their presentations. It is the professor’s responsibility to know how to zoom in on a student who is presenting or to increase the volume when a movie is played. These technical details are essential every time the system is utilized. To simply apologize during lecture for not knowing how to operate the system is a serious problem for student learning. Additionally, it may communicate an indifference or uncaring attitude on the instructor’s part.

Finally, a common complaint is not being able to see body language. It is common for cameras to be out of focus and for distance participants to look like colored blobs on the television screen. This leads to a serious disconnect, as body language cannot be used in communication (Lei & Gupta, 2010). For example, if a professor says something confusing, he or she may not see the students’ faces on the distance campus communicating that they do not understand. Or, maybe a distance learning student is using humor, but the main campus cannot interpret the joke as they cannot see the gestures and smile from their classmate. These are all common challenges to be anticipated, so adjustment needs to be made for misunderstanding, and faculty must constantly be aware of this limitation. This will save frustration as the semester progresses.

Faculty Skills for Managing Distance Learning

Managing Disconnects

Faculty themselves are the primary barometer of effective teaching in the distance learning environment. It is essential that faculty have a few basic skills to ensure students receive the best experience possible. Flexibility is key: as mentioned, the online environment is unpredictable at best. When an unpredictable event occurs, for example, the sound does not work or the incorrect classroom appears on the screen during connection, the lecturer must be flexible and calm.

Similarly, faculty need to plan ahead for their teaching experience. As in traditional synchronous classroom teaching, faculty must arrive early, turn on equipment, troubleshoot connection problems, and upload all necessary materials for the course, prior to the students’ arrival. This takes significant time management and planning skills. One issue that commonly arises during the start-up process is student interruptions. If a student arrives early and sees the instructor, it is tempting for them to approach with their question or concern. This typically would not be an issue in synchronous classrooms. When there are so many variables starting up a videoconferenced class, it is important the faculty make their needs and expectations known. Faculty should ask students at the beginning of the semester, “Please do not approach until the lecture is uploaded and the system is on. I will make eye contact with the class if I can talk before class begins.” Students may need a reminder of this sporadically throughout the semester. It is the faculty’s responsibility to ensure class starts on time and runs smoothly; voicing expectations of students’ behavior will help ensure this occurs. Similarly, faculty can also expect to stay after the class has finished to disconnect and turn off all equipment. This is in addition to answering students’ questions.

Similarly, empathy and patience for the students and the challenges they experience with distance learning are essential to communication (Lei & Gupta, 2010). Students greatly appreciate faculty who try to understand their perspectives. Verbally acknowledging difficulties is helpful; also, being prepared with tools for learning if the system fails tells the students that the lecturer empathizes and understands the challenges they face. For example, if a group of students is presenting content over videoconference and the system cuts off, it is considerate to acknowledge the frustration and arrange for the presenters to communicate the content in other ways, such as an outline or asking them to record and post their content at a later date.

Creating Connection

Faculty engagement is a set of skills that needs to be developed with experience. The camera views are key to engaging all students in the class. Toggling between camera views, depending on the class activity, can greatly improve engagement and interest of the students. Other techniques include use of software that decreases the limitations of distance. There are free online programs to allow instructors to ask examination questions and monitor students’ feedback in real time during class. Similarly, there are websites where students can interact with one another asynchronously in a competitive manner concerning class content. These websites are set up like games, in which students compete to receive the highest scores. A third technique faculty can employ is student presentations. This can be done with planning, using a videoconference system. Students appreciate being able to see one another and hear what others have to say. Allowing a group to present and be center stage is a great engagement technique and encourages deeper learning of the material.

Finally, it is well documented that students’ attention span in the learning environment is approximately 10 minutes or less (Bunce, Flens, & Neiles, 2010). Even though a course is taught over distance videoconference, the faculty must integrate this concept into the classroom teaching. This can be done using many of the same techniques used in a synchronous classroom. Every 10 minutes, the faculty can switch learning activities: for example, using test questions, discussion, pictures, video clips, case studies, and demonstrations. The trick is to plan ahead and think through how to approach those challenges before the start of class.

Faculty are the keys to a strong learning environment in the videoconference teaching medium. Faculty must exhibit flexibility, planning, empathy, and engagement to ensure student success. Finally, it is important for faculty to keep it real. This means understanding the system with which they teach. Sometimes there are situations and circumstances completely outside of anyone’s control. When this happens, professors must keep expectations of themselves and the students realistic. This will alleviate much of the pressure videoconference can create.

Innovative Clinical Opportunities

When a nursing student is ready to graduate, he or she is expected to be educated and trained in deductive reasoning, critical thinking, collaboration, independent practice, and leadership. Additionally, students must fully understand how to communicate, chart, decipher, and navigate complex health care record systems. This list of required skills places demands on the faculty beyond traditional lecture and hospital training. Keeping in mind the limited clinical placements and populations, creativity becomes an essential skill of nursing faculty.

Creativity in the Laboratory

Nurses must be creative. For centuries, nurses have had to work with whatever circumstances they encounter and make the best of every situation. The rural setting, with scarce resources and miles between campuses, is one of the challenges nursing faculty have used to creatively enhance their students learning.

One approach is to bring experts on selected topics into the classroom. This can be done multiple times in a student’s 4-year education to supplement the readings and didactics. One avenue an instructor can take when finding guest speakers is to go to the horse’s mouth. Experts with a PhD credential may not always be available in a rural community. Some of the best and most excellent speakers come from the trenches. For example, if the topic to be discussed is autism, a faculty member could choose the public school system’s child development experts who have worked with these children many years. Or, the faculty could choose parents of children with autism and ask the parents to share their experiences, what they have learned, and what they need nurses to know when treating children with autism. The latter has proven a much better learning tool. The speaker instills a sense of empathy that will serve the nurse well as he or she embarks on his or her own career. It is important for faculty to remember that a higher credential does not always mean better learning opportunity.

A second way rural and distance nursing education has tackled clinical challenges is through simulation. Nursing schools across the nation have set up designated laboratory space where real-life simulator patients are placed in mock hospital beds and rooms. These laboratories are realistic down to the hospital grade bed, gloves, patient robes, and supplies one would typically see in any hospital room. Additionally, the simulation patients have realistic features that can imitate physiological changes such as bleeding ulcers, tears, sweat, vomit, cardiac arrest, urination, giving birth, all with lifelike presentation. These simulation laboratories have filled the void in nursing education where either the opportunity was impossible to find or it was too unsafe to allow a student to participate, for example, a birth. Simulation scenarios allow the faculty the ability to create any situation and any variables to test students’ skills as well as leadership, delegation, critical thinking, and deductive reasoning, all while keeping the environment safe for participants. Depending on the state regulations, students may receive 25 to 50% of their clinical time in simulation laboratories rather than with live patients. The important questions of is this as effective and is this really building skills have been well researched and documented. Current research shows that simulation activity affects acquisition of knowledge and clinical skill. Students who care for simulation patients learn and retain knowledge just as adequately as they do with real patients (Oh, Jeon, & Koh, 2015; Shin, Park, & Kim, 2015).

Creativity in Clinical Placements

Exceptional clinical placements are top priority for faculty when dealing with rural or distance issues. Faculty often struggle not just to find clinical placements but to find exceptional placements. This means a placement must provide ample opportunity for the student to learn, as well as be advantageous for the clinical agency. Creativity takes on a whole new meaning when instructors are faced with working in a limited population, for example, pediatrics, for which it is difficult to find clinical sites no matter the location or demographics. When rural challenges are added to this mix, the situation is that much more problematic.

One of the ways to combat the issue of limited clinical sites in a rural state is to think outside the traditional boundaries. Most people think of nurses in hospitals. However, 40% of nursing is now in the community setting. Therefore, it can be expected that 40% of a student nurse’s clinical training will take place outside a hospital (Bureau of Labor Statistics, 2015). Additionally, the population of interest, for example, obstetric, pediatric, cardiac, or geriatric, and so on, must be taken into consideration. For example, children typically are healthy. Much of the time their health care needs are common and acute illnesses such as asthma, broken bones, and rashes and well-child developmental monitoring. Most of these diagnoses and needs are cared for in the outpatient setting. Therefore, it makes sense for student nurses’ clinicals to be in settings children frequent, for example, schools. Understanding this concept is essential in identifying exceptional clinical placements.

Addressing the need for community-based clinical placements, faculty must next look at where the population of interest is most available. Instructors know hands-on care of patients brings lasting and effective learning (Bachelor, Vaughan, & Wall, 2012). Understanding this can lead to some of the most unexpected but highly effective community-based placements. For example, a primary learning objective in pediatrics is understanding development. A child’s developmental needs change quickly and frequently, especially the first 5 years. Nursing students can be placed in a preschool setting where they are expected to interact with and assist the school in caring for the children. However, to elevate the nursing student’s learning, choosing a preschool that serves high-risk populations can yield an even richer experience. Placements in schools with children who have attachment disorders, poverty, severe disabilities, or mental health problems are environments in which students can learn a broad range of skills. Asking students to identify children with typical and atypical development in this environment is effective in honing developmental monitoring skills. Additionally, rich multicultural discussions can occur based on the populations observed. Keeping in mind the need for a symbiotic relationship, many of these clinical sites welcome the extra hands and developmental knowledge of students.

Similarly, students can find some of the most complex cases in the children’s own homes. This approach takes significant networking and patience as the instructor gets to know families with critically ill children. However, the experience students have is unobtainable anywhere else. Students visit these chronically ill and medically fragile children in their homes with their families present. For legal purposes, this is a mostly observational experience for the nursing student. However, they are encouraged to ask questions of the family as they relate to living with a medically fragile child. The student is to watch family dynamics, roles within the family, and step back to see the whole picture of how it is to live in these families. The empathy and understanding the nursing student obtains are exceptional. This type of vicarious learning allows the student nurse to have a much deeper perspective of issues that may affect compliance and capabilities of families once they leave the clinic or hospital.

Finally, having student nurses open and staff a school nurse health clinic to gain clinical experience can be welcomed by a school system and provides different leadership skills of nurses. Many of the schools in rural areas today are in fiscal crisis, and when this occurs, all dispensable programs are removed, often including the school nurse. It is common for schools to function without any school nurse or health education during the school year. Research has demonstrated significant improvement in child and staff health when student nurses run a health clinic and serve in the role of school nurse (Rossman, Dood, & Squires, 2012). Student nurses learn a variety of skills in this clinical setting: they must do needs assessments to find out what the health status of the children are, dispense medications, triage illnesses and injuries, make follow-up phone calls to parents, and document the care electronically. This is all in addition to providing health-related teaching to the children at the school. It is common for students to identify educational needs, then design and implement an age-appropriate teaching project to address the issue, for example, dental care, body awareness, or hand washing. School-based health clinics staffed by student nurses do have legal constraints. A licensed instructor must be present when all care is given. However, the benefit of being able to have many students working in the clinic at once serving in various roles and providing much-needed healthcare to children and staff is a fantastic example of a symbiotic relationship where all benefit.

Conclusion

Healthcare education in a rural setting has its challenges and benefits. Nursing programs are faced with issues of quality education while dealing with distance, faculty shortage, and limited clinical placements. Faculty are key to creating student success. They must utilize communication, flexibility, empathy, planning, and engagement when teaching over videoconference and designing clinical sites. Finding patients in their primary environments often leads to rich learning opportunities. Programs that make effort to identify and educate motivated faculty often have exceptional results. The challenges of rural programs can be overcome with effort and creative approaches to the traditional profession.