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Online Journal of Rural Nursing and Health Care, vol. 9, no. 1, Spring 2009 
 

Editorial 

QUALITY CHALLENGES IN RURAL COMMUNITIES 

Marietta Stanton, PhD, RN, CNAA, BC, CCM, CMAC 
Editorial Board Member 

 
 
In a few short weeks the Rural Nursing Organization will sponsor their annual conference 

on quality health care in the rural environment. What do we really by the term quality? The U.S. 
Institute of Medicine (IOM) defines "quality" as: the degree to which health services for 
individuals and populations increase the likelihood of desired health outcomes and are consistent 
with current professional knowledge. IOM released the report, "Crossing the Quality Chasm: A 
New Health System for the 21st Century" (IOM, 2001) calling for fundamental reform of the 
U.S. health care system. This report identified six aims for health care quality improvement: safe, 
effective, patient-centered, timely, efficient, and equitable.  These six aims are just as appropriate 
in a rural environment as they are in an urban setting.  They are also appropriate across all levels 
of prevention and across a variety of health care settings.  To accomplish these aims in the rural 
environment The IOM in their report, "Quality Through Collaboration: The Future of Rural 
Health Care" (IOM, 2004) identified a five point strategy for rural communities: 

• Adopt an integrated, prioritized approach to addressing both personal and 
population health needs at the community level;  

• Establish a stronger quality improvement support structure to assist rural health 
systems and professionals in acquiring knowledge and tools to improve quality;  

• Enhance the human resource capacity of rural communities, including the 
education, training, and deployment of health care professionals, and the 
preparedness of rural residents to engage actively in improving their health and 
health care;  

• Monitor rural health care systems to ensure that they are financially stable and 
provide assistance in securing the necessary capital for system redesign; and  

• Invest in building an information and communications technology (ICT) 
infrastructure, which has enormous potential to enhance health and health care 
over the coming decades 

Nursing in the rural community is in a integral position to promote interventions that will 
advance these strategies through research, education, practice and nursing administration. No 
professional provider is in a better position to effect change in the rural environment than the 
rural based professional nurses. They may be employed in a variety of roles in a variety of 
settings but in general they can implement ways to improve the quality of rural care. As nursing 
administrators, rural nurses do not just coordinate services within a health care institution. They 
can serve as community health advocates, leaders, policy makers and political leaders in their 
communities. As educators, they can mentor and teach all levels of health care providers to 
provide safe effective care. They can support student experiences and encourage ongoing 
continuing education as well as encouraging career development through academic program 
completion for other local health care providers. They can provide health care teaching in health 



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Online Journal of Rural Nursing and Health Care, vol. 9, no. 1, Spring 2009 
 

promotion, disease prevention and chronic disease management. They can seek training on 
technologies to increase the efficiency and effectiveness of health care provision. 

In clinical practice rural nurses can implement evidence based care, address high volume 
conditions, and monitor outcomes. As researchers, they can test and monitor innovative practice 
and disseminate findings to encourage excellence. They can focus on performance improvement 
to enhance quality, increase efficiency and decrease costs. Perhaps the most important point is 
that nurses in the rural setting can provide leadership.  

As rural nurses, our organization and it constituents can produce change and ensure that 
rural residents have the best care while providing a responsible stewardship of clinical resources. 
The challenge is apparent and nurses are the primary element for success. 
 

REFERENCES 
 

Institute of Medicine (IOM) (2004). Quality through collaboration: The future of rural health. 
Washington, DC:  National Academy Press. Retrieved on May 12, 2009, from 
http://www.iom.edu/?id=29734 

Institute of Medicine (IOM) (2001). Crossing the quality chasm: A new health system for the 
21st century. Washington, DC:  National Academy Press. Retrieved on May 13, 2009, 
from http://www.iom.edu/?id=12736