With rural health care worker shortages projected to only worsen in the coming decades, many rural communities are attempting to institute local training and education in hopes of retaining a stable local direct care workforce. This study uses qualitative methods to explore how local health care training, education, and employment are perceived by rural residents in one isolated community where most of the local jobs have transitioned from manufacturing and natural resource extraction to health care and education. Based on 60 in-depth, semi-structured interviews and 40 hours of participant observation primarily as a volunteer in a long-term care facility, I find that perceptions about the opportunities in health care that remain in “Independence Creek, Washington” are complex and divergent. The majority of participants speak positively of the local trainings for nursing assistants and the innovative on-site two-year nursing program and argue that these opportunities, seen as either a stepping stone for college-bound young adults or a pathway to decent employment for place-bound individuals, are much needed. Perceptions of pay for nurses are also favorable. Perceptions of pay for nursing assistants are more mixed. Respondents consider it better than other service work, but also not a livable wage. Job security is perceived as a big plus, as respondents describe the ability to “get a job anywhere” as a nurse or nursing assistant. However, job stability (having regular hours and work place stability) are not described as strong qualities of working in rural health care. Despite issues with some negative perceptions of rural health care work, this study demonstrates a continuing need for more local training as we work towards higher quality working conditions and compensation.
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