Nursing supply and characteristics in the nonmetropolitan areas of the United States: findings from the 1988 National Sample Survey of Registered Nurses

Employment retention of health care providers in frontier areas of Alaska

OBJECTIVES

The objectives of this study were to: describe the length of employment of health care providers in rural Alaska; assess whether there are differences in length of employment among community health aides, medical doctors, and nurses; and determine whether provider length of employment is significantly increased following implementation of telemedicine.

STUDY DESIGN

We conducted a prospective cohort study of length of employment among health professionals in rural Alaska, and identified the cohort based on current employment status of community health aides, medical doctors, and nurses.

METHODS

Employment data were collected from four Alaska Native regional health corporations. Kaplan-Meier product-limit survival analysis was used to assess employment length. The Mantel-Haenszel log-rank test was used to test the difference between retention (survival) curves among doctors, nurses, and community health aides for all four regional health corporations combined. Data included provider hire date, termination date, and position title. Fifty seven percent of the data points were right-hand censored.

RESULTS

The community health aides (median (Mdn) = 1186 days) were retained significantly longer than either the doctors (Mdn = 596 days), or the nurses (Mdn = 408 days), who were not significantly different from each other (log-rank chi2 (2, N = 996) = 68.30, p = 0.0001).

CONCLUSIONS

Our findings document that community health aides in the region retain their jobs significantly longer than doctors and nurses. Findings highlight the problem of providing an adequate health work force in rural areas.

Commuting to work: RN travel time to employment in rural and urban areas

PURPOSE

To investigate the variation in average daily travel time to work among registered nurses (RNs) living in urban, suburban, and rural areas. We examine how travel time varies across RN characteristics, job setting, and availability of local employment opportunities.

METHOD

Descriptive statistics and linear regression using a 5% sample from the 2000 Census and a longitudinal survey of newly licensed RNs (NLRN). Travel time for NLRN respondents was estimated using geographic information systems (GIS) software.

FINDINGS

In the NLRN, rural nurses and those living in small towns had significantly longer average commute times. Young married RNs and RNs with children also tended to have longer commute times, as did RNs employed by hospitals.

CONCLUSIONS

The findings indicate that travel time to work varies significantly across locale types. Further research is needed to understand whether and to what extent lengthy commute times impact RN workforce needs in rural and urban areas.

Existing population-based health databases: useful resources for nursing research

Important research questions, such as the prevalence of health conditions in specific groups and health disparities, can be addressed through population-based health databases. Government-funded, federal databases can provide nurse researchers with a representative sample for various levels of analyses. Population-based health databases easily accessed from federal government Web sites for analysis are identified and discussed. These databases, such as the National Health Interview Survey and the National Sample Survey of Registered Nurses, were collected through rigorous probability sampling and data collection methods and can be generalized to the population of the study. The benefits and limitations of analyzing the databases as a research approach are summarized, using examples from the recently released National Survey of Children's Health. Findings from population-based studies provide significant information on health-related indicators and contribute to the development of sound recommendations for health care practice and policy, thereby supporting evidence-based practice. Analyses of population-based databases provide additional opportunities for nurse researchers to contribute to health policy and evidence-based practice within a framework of nursing-health services research.

Comparative analysis of urban and rural nursing workforce shortages in Nebraska hospitals

Current workforce models that rely on economic indicators have seriously underestimated the rural RN shortage and its impact on rural hospitals. This cross-sectional study developed an algorithm using the concept of need and applied it to health service demand data in 66 counties of a midwestern state (1993-2002) to determine trends in RN shortages between urban and rural areas. Results showed that rural areas consistently had the largest gap between predicted need for RNs and numbers employed and that the rural RN shortages were significantly greater than in urban areas. This study suggests that adequate and geographically specific targets of RN need are essential, especially for rural areas, because of policy implications for rural hospital staffing and workforce planning. Inadequate workforce targets perpetuate the shortage, especially in rural areas, and exacerbate the very reasons that RNs leave over concerns for patient safety, inadequate staffing, and job dissatisfaction.

Characteristics of registered nurses in rural versus urban areas: implications for strategies to alleviate nursing shortages in the United States

METHODS

This study compares characteristics of rural and urban registered nurses (RNs) in the United States using data from the 2000 National Sample Survey of Registered Nurses. RNs in 3 types of rural areas are examined using the rural-urban commuting area taxonomy.

FINDINGS

Rural and urban RNs are similar in age and sex; nonwhites and Hispanics are underrepresented in both groups. Rural RNs have less nursing education, are less likely to work in hospitals, and are more likely to work full time and in public/community health than urban RNs. The more rural an RN's residence, the more likely he/she commutes to another area for work and the lower salary he/she receives.

CONCLUSIONS

Strategies to reduce nurse shortages should consider differences in education, work patterns, and commuting behavior among rural and urban RNs. Solutions for rural areas require understanding of the impact of the workplace on these behaviors.

Rural health care providers in the United States

One of the most recalcitrant problems of the rural health landscape is the uneven distribution and relative shortage of medical care providers. Despite considerable efforts by federal and state governments over the past three decades to address these problems, rural provider distribution and shortage issues have persisted. The purpose of this article is to identify the challenges for rural health research and policy regarding health provider supply in the first decade of the 21st century. While the emphasis in this article is on physicians, workforce concerns pertaining to nurses, nurse practitioners, and physician assistants are briefly described. Physician supply, geographic and specialty distribution, age, gender, quality of care, recruitment and retention, training, productivity and income, reimbursement and managed care, federal and state ameliorative programs, safety net, and telehealth are discussed. Also highlighted are issues concerning rural health care workforce research, methods, and data as well as a series of policy-relevant questions. Solutions to rural health personnel problems can only be successfully addressed through multifaceted approaches. No vision of the future of rural health can come to fruition if it does not promote stable, rewarding, and fulfilling professional and personal lives for rural health care providers.

Returns to nursing education: rural and nonrural practice

This study uses data from a national sample of registered nurses to compare earnings of nurses in rural and nonrural practice. The comparisons, conditioned by the nurses' education level, are analogous to the concept of "returns to human capital investment" used in labor economics. A general linear model is applied within a framework of labor economics analysis. Results show that nurses with more education receive less for their investment if they practice in rural areas. Work experience and employment setting are also related to lower annualized earnings for rural practice. One exception to the otherwise consistent findings is that returns to advanced practice nursing are higher in rural areas. Results and policy implications are discussed.

Recruitment barriers in rural community hospitals: a comparison of nursing and nonnursing factors

Despite encouraging signs suggesting that many rural hospitals are experiencing less severe staff shortages, the challenge of successfully recruiting nurses to rural practice settings continues to be a major obstacle. Based on a 1993 survey of 164 directors of nursing (DONs) practicing in rural community hospitals, exploratory factor analysis (EFA) was used to cluster 21 DON-rated recruitment barriers into factors associated with nursing delivery, local community, and professional interaction. DONs, most notably those practicing in the smallest rural facilities (< or = 25 beds), reported community-related barriers such as spouse's employment as the most severe obstacles to successful registered nurse (RN) recruitment. However, upon examination conducted by using multiple regression analyses, only those factors related to nursing delivery and professional interaction were found to be statistically significant predictors of existing staff RN full-time equivalency vacancy rates. Given that barriers related to individual nursing staffs are likely to be far more amenable to change than those associated with rural environments, these findings offer encouragement to nursing administrators who are faced with the difficulties of attracting RNs to rural practice settings.

Effects of educational focus on a graduate nurse's initial choice of practice area

Nursing students have been educated to acquire the skills necessary to practice in different settings. This study examined whether the focus of education (rural or urban) had an effect on the area that the graduate nurse chose to practice in after graduation. To prepare the nursing student for her or his role in rural nursing, one program focused its curriculum on rural health needs. Another nursing program located in an urban area had a traditional educational nursing program with only once community nursing course. A curriculum review was completed to examine whether the curriculum focus of the study programs were consistent with the stated foci. A retrospective study design was used to answer the research questions. Survey instruments were mailed to 379 urban and rural nursing school graduates. The analysis of study results showed that students who attended a nursing program focusing on rural nursing were twice as likely to practice in rural areas than nurses who completed an urban-focused nursing program. Another factor that had an impact on the graduate nurses' choice of practice area was the students' original places of residence.

Job satisfaction of nurses employed in rural and urban long-term care facilities

Previous investigators have identified residential differences in the job satisfaction of hospital nurses. However, the degree to which the greater job satisfaction of rural nurses can be generalized beyond hospitals to other work settings, including nursing homes, is unknown. The purpose of this research was to examine the job satisfaction of nurses (registered and licensed practical) employed in both rural and urban nursing homes. A total of 281 nurses from 26 participating nursing homes completed a mailed questionnaire that measured the personal and job-specific characteristics of the nurses and the contextual properties of the facilities in which they worked. The data indicated no statistically significant differences in the overall job satisfaction, or on any of the five subscales of the instrument, between rural and urban nurses. However, a pooled multivariate model identified five factors that predicted the job satisfaction of nurses employed in long-term care facilities: the employees' race and personal income; the employees' perception that their supervisor was interested in their career aspirations; the length of time that the nurses had intended to stay at the time of their hiring; and their current intent to leave.

Retainment incentives in three rural practice settings: variations in job satisfaction among staff registered nurses

Researchers have demonstrated repeatedly the importance of the relationship linking job satisfaction to employee retention. In rural areas of the country, where a persistent maldistribution of nurses continues to hamper health care delivery, the potential benefits of bolstering retention via enhancements in job satisfaction are of utmost utility to administrators and providers alike. Data were gathered from a multistate survey of registered nurses (RNs) practicing in rural hospitals, skilled nursing facilities, and community/public health settings (N = 1,647; response rate = 40.3%). The investigators found that the use of tuition reimbursement corresponded significantly with increased levels of job satisfaction among nurses in all three practice environments, as did day care services for nurses in acute care settings. Also, among hospital-based RNs, level of nursing education was found to be a significant factor in the relationship between tuition reimbursement and job satisfaction, with the highest level occurring among diploma-prepared nurses.

Redefining the nursing shortage: a rural perspective

A number of researchers have suggested that nursing shortages are closely related to geographic maldistribution, specialty areas, and even individual shifts. As these findings have documented, the nursing shortage, as defined by the federal government, exists predominantly in rural areas of the country that are not adjacent to metropolitan areas. As a result, many of the economic, demographic, and health-related disparities that exist between rural and urban populations are mirrored in shortage and nonshortage counties. Higher unemployment rates and lower per capita incomes suggest an underlying relationship between economic vitality and the recruitment and retention of health care personnel. This suggests that a fundamental obstacle to staffing adequate numbers of qualified nurses in rural areas may not be a shortage of nurses, but economic barriers (domestic and health care related) deeply rooted in the rural settings themselves. In those states burdened with significant shortage areas, emphasis must be placed on easing the maldistribution of available nurses away from rural, often medically underserved settings. However, while the notion of producing appropriate "types" of nurses is well founded, the temptation to "solve" the problem simply by producing more providers should be resisted, since it will not markedly benefit those areas that are currently in greatest need. The time frame necessary for such "trickle down" approaches to affect rural areas could, when combined with other factors, render many health care delivery systems virtually unsalvageable. To address the persistent distribution problem, we could change how health professionals are educated.(ABSTRACT TRUNCATED AT 250 WORDS)