How Transformational Leadership is Addressing the Rural Nursing Workforce

Greater supplies of nurses who are prepared at the BSN level minimally are needed to address increasingly complex healthcare and community needs in rural counties.  Workforce planning to achieve the goals set forth in the IOM’s Future of Nursing Report (2010) has several known barriers: the nursing shortage itself, the nursing faculty shortage, clinical site shortage, and financial and regulatory barriers. These barriers are especially true in rural areas where the supply of RNs has historically been low (Cramer, et. al., 2009). The majority of nurseS in rural areas do not have access to baccalaureate nursing education (Fulcher & Mullin, 2011). Rural residents have several unique challenges to attaining higher education including: geographic access to programs, competing work-life demands, money for tuition, insufficient preparation for college level work, lack of successful role models, and lack of incentives to pursue more education (Hunsberger, et al., 2009).  Evidence supports that a better educated nursing workforce improves patient outcomes, increases the available human capital which encourages innovation, enhances recruiting, and retains quality nurses thus multiplying nursing talent in the area (Aiken, et al., 2003; Henry, et al., 2004; Murray, et al., 2011). Bringing education to rural areas “will tap into a larger group of possible nurses that cannot easily leave the area and bring them into nursing profession, and likely keep them there” (Dotson, et al., 2011, p. 407; Williams, 2012). 

Through innovation and partnerships, a major university was able to extend baccalaureate nursing education beyond the university walls into rural areas. Increasing the capacity of this rural distance program to address the demands of the IOM required effective leadership. Transformational leadership was essential throughout the process of enlarging the program size.  Transformational leaders are able to describe the change in a way that allows those involved to understand its value and how it will affect their own efforts (Porter-O’Grady & Malloch, 2007; Williams, 2012). Transformational leaders are able to identify needed change, create vision to guide change through inspiration, and execute change with commitment of others.  These leaders develop the leadership potential of the entire team by empowering colleagues, inspiring others to achieve what could be, engaging stakeholders, and sharing commitment to values (Marshall, 2011). Effective leadership could establish direction, align, and energize people to overcome major political, bureaucratic, and resource barriers to produce change (Kotter, 1996). Kotter’s eight-stage process of creating major change was used as the framework (1996). Each of these qualities was reflected in the steps of Kotter’s change process (1996) proving a goodness of fit between effective leadership qualities and successful change. 

Effective leveraging of resources allowed the distance based program to enlarge enrollment. By 2020, over 200 graduates from this program will enter the local rural workforce. This is timely and necessary as BSNs in rural areas are needed to decrease current shortages, replace retiring nurses, and confront the demands from aging baby boomers, the expected ACA influx, and the Instutute of Medicine's recommendations (Williams, 2012).  As long as significant portions of the population reside in rural areas, the need for leadership to meet the unique needs of the environments, communities, and healthcare conditions is enormous (Marshall, 2011).