Summary
The application of standards in health care can differ significantly depending on the specific practice setting. For instance, conditions of coverage and participation in a typical hospital setting are quite distinctive from those in a rural health clinic. While staffing requirements and administrative structure of the standard urban hospital and rural health clinic may have a certain affinity, they also have significant differences. Therefore, it is necessary to understand how the practical application of particular standards can vary in specific circumstances.
Staffing Requirements: Similarities and Differences
The first common point between staffing requirements in hospital and rural health clinic settings is an evident need for qualified medical personnel. According to Saville et al. (2019), employing a sufficient number of staff members is a prerequisite for patient safety and positive outcomes. As such, both urban hospitals and rural health clinics should be adequately staffed with sufficiently qualified personnel. Overall, the nurse-patient ratio and nursing staff competence have equal importance in urban and rural healthcare settings.
The second similarity between the two healthcare settings is a significant probability of facing the problem of understaffing. Due to the increasing need for nursing personnel, managers within U.S hospitals have to deal with chronic understaffing and negative consequences for the quality of care (Metcalf et al., 2018). Rural health clinics also face shortages of qualified physicians, which presents a significant challenge. For instance, out of 415 students who graduated from North Carolina medical schools in 2010, only 11 were practicing in rural health clinics by 2015 (Iglehart, 2018). As such, understaffing remains an unpleasant similarity for both healthcare settings.
The third similarity is in methods, which can be used to calculate staffing requirements necessary for achieving optimal nursing workload. Healthcare managers must decide how many staff members must be employed and deployed per shift in both settings. These decisions can be supported with such tools as patient classification, time-tasked approach, or regression-based approach (Saville et al., 2019). Overall, both settings demand optimal allocation of available workforce, especially in understaffed conditions.
In regard to differences, the most evident one is the specific healthcare needs of rural populations, which must be acknowledged and considered by the nursing staff. For instance, by 2016, there was a gap of 20% or 134.7 excess deaths per 100 000 population between rural and urban areas (Harrington et al., 2020). As such, nursing staff in rural health clinics would likely have to master new care delivery models aimed at helping diverse rural populations.
The second difference lies in the size of the professional scope of responsibility. While staff in a hospital setting is more likely to be mainly charged with direct responsibilities, their colleagues in rural health clinics often have to combine several roles. In this regard, Harrington et al. (2020) argued that generalist and specialist physicians should support practitioners in rural areas. As a result, their patients would benefit from the broader expertise healthcare providers possess.
Lastly, the third difference in staffing requirements between urban hospitals and rural health clinics is an increasing need for training non-traditional medical students. This necessity arises from the depopulation of rural areas and the closures of existing rural health clinics. According to Reimers-Hild (2018), rural healthcare must focus on training people who already live in rural communities in order to fill the existing positions in healthcare organizations. Traditional recruiting of young adults with a college education is unreliable and unrealistic in a rural setting.
Administrative Structure: Similarities and Differences
The first similarity between the administrative structures of hospitals and rural health clinics is their top-down character. Boards of urban hospitals usually employ a chief of staff who supervises such positions as chief medical information officer, business intelligence manager, and nurse officer (Tanniru et al., 2018). Consequently, nursing personnel reports directly to a nurse officer, creating a top-down chain. In a rural health clinic setting, this chain may be shorter but is typically present as well.
The second common point is a possible need for administrative structure reform in the foreseeable future. According to Tanniru et al. (2018), traditional top-down leadership is not sufficiently flexible for supporting innovation in healthcare. This notion is essential for rural health clinics since severe understaffing can be alleviated via digital innovations, such as the telehealth care delivery model (Germack et al., 2019). Therefore, the top-down administrative structure may be altered by digital technologies in both healthcare settings.
The main difference in the administrative structures of urban hospitals and rural health clinics is their level of complexity. An urban hospital usually has several clinical departments which heads supervise nursing staff (Tanniru et al., 2018). Department heads report to the chief of staff, who reports directly to the board, and is responsible for healthcare quality provided by the hospital (Tanniru et al., 2018). On the contrary, rural health clinics usually have a simpler administrative structure with fewer physicians.
Finally, the second difference between hospitals and rural health clinics in regard to administrative structures is the extensive hiring of advanced practice registered nurses (APRNs) and physician assistants. According to Germack et al. (2019), this practice stems from the shortage of physicians in rural areas. As a result, physician positions in the administrative structure of rural health clinics may often be occupied by nurses, who may lack specialization in particular areas of care. In the end, this situation may cause negative implications for care provision in a rural setting.
References
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Harrington, R. A., Califf, R. M., Balamurugan, A., Brown, N., Benjamin, R. M., Braund, W. E., Hipp, J., Konig, M., Sanchez, E., & Joynt Maddox, K. E. (2020). Call to action: Rural health: A presidential advisory from the American Heart Association and American Stroke Association. Circulation, 141(10), e615-e644. Web.
Iglehart, J. K. (2018). The challenging quest to improve rural health care. The New England Journal of Medicine, 378(5), 473-479. Web.
Metcalf, A. Y., Wang, Y., & Habermann, M. (2018). Hospital unit understaffing and missed treatments: Primary evidence. Management Decision, 56(10), 2273-2286. Web.
Reimers-Hild, C. (2018). Strategic foresight, leadership, and the future of rural healthcare staffing in the United States. JAAPA, 31(5), 44-49. Web.
Saville, C. E., Griffiths, P., Ball, J. E., & Monks, T. (2019). How many nurses do we need? A review and discussion of operational research techniques applied to nurse staffing. International Journal of Nursing Studies, 97, 7-13. Web.
Tanniru, M., Khuntia, J., & Weiner, J. (2018). Hospital leadership in support of digital transformation. Pacific Asia Journal of the Association for Information Systems, 10(3), 1-24. Web.