Rural Missouri hospitals need more nurses like me, but the current system is broken

I’ve had a passion for nursing since the first time my daughter, who struggled with spinal muscular atrophy Type 2, was hospitalized.

The hospital’s understaffed pediatric intensive care unit was not having a good day: I remember nurses running room to room, commotion in the halls, and my daughter desperately needing a diaper change. I began doing it myself when a frantic nurse rushed into the room, scolding me that I could have killed my daughter. The thought of harming her by doing something so natural terrified me.

The next day, another nurse clocked in, pulled a rocking chair next to my daughter’s hospital bed, picked her up and placed her on my lap. She told me to sit and hold my daughter until I was ready to put her back down. That made a world of difference for me, and showed me the value of leading patient care with empathy. That’s when I made the decision to become a nurse. I wanted to make that difference for other people, and I’ve been doing exactly that for two decades. But it’s getting harder and harder.

At the beginning of my career, I was a staff nurse at a local hospital. Just before the Great Recession, I became a travel nurse, picking up 13-week assignments in emergency rooms and ICUs throughout Missouri. The pay was better, and the work was rewarding for a time, but finding assignments in locations that allowed me to be home on my days off became increasingly difficult. When I began taking assignments farther from home, I would miss my family, my farm and my community. There was simply too much I was responsible for at home to make travel nursing work for me. Eventually, the downsides of traveling began to outweigh the upsides. COVID-19 was my turning point.

The first two years of COVID-19 was a heartbreaking time to be an ICU nurse. I saw more people die in one year than I’ve seen in 20 years of nursing. Five patients would come into my unit, and I wouldn’t know if any of them would be alive on my next shift. It was overwhelming, but like many of my peers, I needed to work to support my family. The way I worked just needed to look different.

Dissuaded from traveling and unwilling to take on more shifts for less pay as a staff nurse, I began picking up per diem shifts at local hospitals. Per diem, I’ve found, provides the flexibility I’ve been looking for my entire career. I create my own schedule, allowing me to avoid exhausting myself to the point where I become the kind of nurse I never wanted to be. I never pick up a shift on a Sunday, so I can remain active in my church community. I take time to manage my responsibilities on the farm. That’s the kind of flexibility I can’t have with a full-time role or a travel assignment. I choose when to work, and for which hospitals.

But there are only so many hospitals to choose from for rural nurses like me. The options seem clear: Become a full-time nurse at a local hospital, or pick up a travel assignment and leave town. Many of us don’t want to do either, but with the nearest hospital sometimes many miles away, our options for per diem shifts are limited.

All hospitals do things a little differently, but one thing they all have in common is a need for more nurses. Most haven’t opened their eyes yet to the thousands of nurses like me who want (or need) to work outside of the traditional staffing model — nurses who aren’t able to up and leave town to travel, nurses who no longer wish to adapt their lives to the commitment of full-time nursing.

There are lots of us. We’re an untapped resource. We can be a boon to hospitals and their full-time staff when patient volumes fluctuate. But most importantly, our work is critical to the health of our communities. Even when the ICU is having the worst of days, patients still deserve caregivers who have the flexibility, space and support they need to be able to provide empathetic and compassionate care.