Rural-urban differences in educational attainment among registered nurses: Implications for achieving an 80% BSN workforce

Disparities in COVID-19 Mortality Rates: Implications for Rural Health Policy and Preparedness

CONTEXT

It is well established that rural communities face geographic and socioeconomic challenges linked to higher rates of health disparities across the United States, though the coronavirus disease 2019 (COVID-19) impact on rural communities is less certain.

OBJECTIVE

To understand the COVID-19 pandemic's impact on rural communities in Tennessee, investigate differences in rural-urban mortality rates after controlling for confounding variables, and inform state pandemic response policy.

DESIGN

A cross-sectional analysis of cumulative COVID-19 morality rates.

SETTING/PARTICIPANTS

Tennessee county-level COVID-19 mortality data from March 1, 2020, to January 31, 2021, were matched with county-level sociodemographic and health data from public datasets: Agency for Healthcare Research and Quality Social Determinants of Health, PLACES: Local Data for Better Health County Data, and the US Census Bureau. County status was defined using the 2013 National Center for Health Statistics Urban-Rural Classification.

MAIN OUTCOME MEASURES

A negative binomial regression model estimated adjusted incidence rate ratio and 95% confidence intervals (CI) for rural compared with urban mortality. Unadjusted rate ratios and rate differences for COVID-19 mortality in rural versus urban counties were compared with those for influenza and pneumonia and all-cause mortality over the past 5 years.

RESULTS

During the study period, 9650 COVID-19 deaths occurred across 42 urban and 53 rural counties. Controlling for county-level sociodemographic characteristics, health care access, and comorbidities, incidence rate ratio was 1.13 (95% CI, 1.00-1.28, P < .05) for rural as compared with urban deaths. Unadjusted COVID-19 mortality risk difference between rural and urban counties was greater (61.85, 95% CI, 54.31-69.31) than 5-year influenza and pneumonia rural-urban risk difference (12.57, 95% CI, 11.16-13.00) during 2015-2019.

CONCLUSIONS

COVID-19 mortality rates were greater for populations living in Tennessee's rural as compared with urban counties during the study period. This differential impact must be considered in public health decision making to mitigate COVID-19.

Student’s Reasons of Choosing the Bachelor Study Program in Nursing

AIM: The aim of this study was to identify the reasons why students that attending nursing study program decide to choose this study program for their future. METHODS: We conducted a cross-sectional study on students at University of Shkodra “Luigj Gurakuqi” in Albania and University of Pristina “Hasan Prishtina,” in Kosovo, during October–November 2021. The students that participated attended the bachelor study program in nursing and program of professional master. Data collection was done using a questionnaire with closed and opened questions. Student’s opinions were collected through a self-administered online questionnaire. The survey was administered using the Google Forms® platform, performed in classroom and was anonymous. To analyze the sample, it was used the exact Fisher’s Test, Pearson’s correlation R and ꭓ² test. RESULTS: The study included 376 students which 259 from Albania and 117 from Kosovo. 335 were female and 41 males. 195 of students were from urban area and 181 from rural area. 130 students were at the 1st year of studies, 98 at the 2nd year, 100 of 3rd year, and 48 students attend professional master’s degree. About 66% of students have chosen nursing program because it is easy to find a job and 81.6% of students think that by choosing the nursing study program, they can make a career. About 82.2% of students have chosen the nursing study program because they can ensure a satisfactory economic level. More than 77% of students think that finding a job as a nurse is easy and for 75% of students nursing program has been the first choice. About 88.3% of students say they have chosen to continue their studies in nursing because they believe they can be employed after completing their studies in European Union countries. About 97.1% of students chose this program because they feel valuable in helping people with health needs. In our study, we have evidenced that 58.8% of all students would like to work in Germany. CONCLUSIONS: Students choose the bachelor study program in nursing mainly to be able to easily secure a job, for a career, to help people with health problems and to secure an employment in the countries of the European Union. The same reasons evidenced in two student’s group from two universities.

Changes in proportion of bachelor's nurses associated with improvements in patient outcomes

This study uses data from two cross-sections in time (2006, 2016) to determine whether changes over time in hospital employment of bachelor's of science in nursing (BSN) nurses is associated with changes in patient outcomes. Data sources include nurse survey data, American Hospital Association Annual Survey data, and patient administrative claims data from state agencies in California, Florida, New Jersey, and Pennsylvania. The study sample included general surgical patients aged 18-99 years admitted to one of the 519 study hospitals. Multilevel logistic regression and truncated negative binomial models were used to estimate the cross-sectional and longitudinal effects of the proportion of hospital BSN nurses on patient outcomes (i.e., in-hospital mortality, 7- and 30-day readmissions, length of stay). Between 2006 and 2016, the average proportion of BSN nurses in hospitals increased from 41% to 56%. Patients in hospitals that increased their proportion of BSN nurses over time had significantly reduced odds of risk-adjusted mortality (odds ratio [OR]: 0.95, 95% confidence interval [CI]: 0.92-0.98), 7-day readmission (OR: 0.96, 95% CI: 0.94-0.99) and 30-day readmission (OR: 0.98, 95% CI: 0.95-1.00), and shorter lengths of stay (incident rate ratio [IRR]: 0.98, 95% CI: 0.97-0.99). Longitudinal findings of an association between increased proportions of BSN nurses and improvements in patient outcomes corroborate previous cross-sectional research, suggesting that a better educated nurse workforce may add value to hospitals and patients.