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Most of Idaho is rural. Most of Idaho’s nurses are not. A bill aims to fix that.

Randall Hudspeth, executive director for the Idaho Center for Nursing, presented a bill to create a state-funded nursing loan repayment program. Hudspent is a member of the Healthcare Transformation Council of Idaho and a former nursing administrator, as well as a nurse practitioner. (Image via Idaho in Session)

Rural Idaho lost more than 1 in 4 nurses between 2018 and 2020

The Idaho Senate Health and Welfare Committee on Tuesday advanced legislation to the Senate that would create an incentive for nurses to take jobs in Idaho’s rural areas.

Health care facilities have long struggled to fill jobs in Idaho’s remote mountain towns and frontier areas. In some of those communities, a nurse practitioner may be the only available primary care provider for miles.

The legislation, Senate Bill 1287, would create a state-funded student loan repayment program for nurses who work in Idaho’s rural towns.

The bill creates a bucket, and the Legislature would then have to appropriate the money to fund the program, which is proposed at $250,000 per year.

“We set a target of 10 nursing graduates annually to be recruited into rural Idaho,” Randall Hudspeth, executive director for the Idaho Center for Nursing, told the committee when he presented the bill Tuesday. “Now, it would be nice if we could recruit more, but based on (recent history) in the state, 10 is a realistic target.”

‘This is a crisis for rural hospitals’

In a recent two-year period, Idaho lost 26% of its rural nursing workforce, Hudspeth told the committee.

That workforce brain drain happened just as a pandemic was flooding Idaho’s small hospitals, as the Idaho Capital Sun and other news outlets have reported.

“In 2020, I identified some concerning trends about the nursing workforce in rural Idaho and the migration of nurses,” Hudspeth said.

There were 6,459 registered nurses in rural Idaho in 2018, according to Hudspeth. That number fell to 4,755 by 2020, he said.

Many nurses in rural Idaho were leaving their communities for Boise, the greater Treasure Valley and other metropolitan areas such as Twin Falls, Pocatello and Coeur d’Alene. Others quit their jobs for travel nursing, retired, went back to school for advanced degrees or found new careers.

About 46% of all registered nurses in Idaho now live in Boise or the surrounding area, he said.

“This is a crisis for rural hospitals. It’s also a crisis for long term care agencies and other agencies that employ RNs in the community, and that rely on a resident nursing workforce,” Hudspeth told the committee.

“What we are more concerned about is that … there are (rural) hospitals without nurses that might close, and what the literature teaches us is that when a hospital closes in a rural community, within 18 months, the providers — mainly the physicians — will leave the community because they don’t have a hospital,” he said.

Hudspeth: Student loan incentives ‘one mitigation strategy’ of several

Similar state and federal programs attract more graduates to rural areas, by offering to help pay off or forgive their student loans. The National Health Service Corps is for health care workers who go to shortage areas — all of Idaho’s rural areas qualify.

There are specific programs that help with student loans for specialists who work in rural Idaho, such as veterinarians or behavioral health clinicians in areas hard-hit by opioids.

The average student loan debt for Idaho nursing school graduates is almost $26,000, Hudspeth told the committee.

The new program would be open to licensed practical nurses and registered nurses.

RNs are the backbone of Idaho’s hospitals, and LPNs are the backbone of long-term care facilities, but they both work in every health care setting imaginable.

The nurses in the program would have to work in rural areas or in designated “critical access hospitals.”

CAHs make up more than half of Idaho’s hospitals; without them, people in those communities would have to fly or drive long distances to get hospital care.

Hudspeth said the plan has support from the Idaho Hospital Association, the Idaho Health Care Association, the Rural Health Association, all of Idaho’s nursing schools and nursing associations.

The Idaho Capital Sun is a nonprofit news organization delivering accountability reporting on state government, politics and policy in the Gem state. As longtime Idahoans ourselves, we understand the challenges and opportunities facing Idaho. We provide in-depth reporting on legislative and state policy, health care, tax policy, the environment, Idaho’s explosive population growth and more. Our mission is relentless investigative journalism that sheds light on how decisions in Boise and beyond are made and how they affect everyday Idahoans. We aim to tell untold stories and provide data, context and analysis on the issues that matter most throughout the state. The Capital Sun is part of States Newsroom, a national 501(c)(3) nonprofit supported by grants and a coalition of donors and readers. We retain full editorial independence.