Isolated, small, and large hospitals have fewer nursing resources than urban hospitals: Implications for rural health policy

Smith, Joan; Plover, Colin; McChesney, Moira C; Lake, Eileen

doi:10.1111/phn.12612

Cited by 32 publications

(23 citation statements)

References 30 publications

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“…The PES-NWI has been validated for use to measure aspects of the rural acute care nurse practice environments (Havens et al, 2012). Data missing for the nurse work environment were minimal at less than 2%, and PES-NWI items that were missing responses were replaced with the row mean when scores were aggregated for hospital level analyses, as described in a prior report using this sample (Smith, Plover, McChesney, & Lake, 2019). The nurse work environment composite scores, which are comprised of all five subscales, were standardized for interpretation of logistic regression results.…”

Section: Predictor Variablesmentioning

confidence: 99%

Rural Hospital Nursing Skill Mix and Work Environment Associated With Frequency of Adverse Events

et al. 2019

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Introduction: Although rural hospitals serve about one fifth of the United States, few studies have investigated relationships among nursing resources and rural hospital adverse events. Objectives: The purpose was to determine relationships among nursing skill mix (proportion of registered nurses [RNs] to all nursing staff), the work environment, and adverse events (medication errors, patient falls with injury, pressure ulcers, and urinary tract infections) in rural hospitals. Methods: Using a cross-sectional design, nurse survey data from a large study examining nurse organizational factors, patient safety, and quality from four U.S. states were linked to the 2006 American Hospital Association data. The work environment was measured using the Practice Environment Scale of the Nursing Work Index (PES-NWI). Nurses reported adverse event frequency. Data analyses were descriptive and inferential. Results: On average, 72% of nursing staff were RNs (range ¼ 45%-100%). Adverse event frequency ranged from 0% to 67%, across 76 hospitals. In regression models, a 10-point increase in the proportion of RNs among all nursing staff and a one standard deviation increase in the PES-NWI score were significantly associated with decreased odds of frequent adverse events. Conclusion: Rural hospitals that increase the nursing skill mix and improve the work environment may achieve reduced adverse event frequency.

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Section: Predictor Variablesmentioning

confidence: 99%

Rural Hospital Nursing Skill Mix and Work Environment Associated With Frequency of Adverse Events

et al. 2019

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“…CAHs can host fewer students at once and require nurses to be competent in providing both general care and being able to call on a specialized skill set on-demand to meet the needs of a community with different resources. 4 Thus, it is important to determine how to retain quality resources in terms of nursing staffing and skill mix in rural areas. CAHs typically do not have the same level of support for new hires as larger institutions due to lower staffing needs.…”

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confidence: 99%

“…CAHs typically do not have the same level of support for new hires as larger institutions due to lower staffing needs. [4][5][6] Because of this scenario, CAHs may be at risk for recruitment and retention issues when less support is perceived as available.Few published studies were available to describe the experiences of new nurse graduates in a rural setting. [6][7][8] Previous research tends to focus on new graduates' needs and support in urban acute care settings and the outcomes of nurse residency or transition to practice programs.…”

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confidence: 99%

Lived experiences of new nurse graduates in critical access hospitals

Hoppe

Clukey

2020

Nursing Forum

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The purpose of this descriptive, phenomenological study was to explore and uncover the phenomenon of the lived experiences of new nurse graduates in the first year of employment in critical access hospitals. One-on-one interviews were completed with 13 participants working in critical access hospitals in three Midwestern states. The Dr. Snyder, and Dr. Rings, for their guidance, direction, and encouragement along the way and in the production of my final drafts. In my home academia environment, a special thanks to Dr. Delahoyde and Dr. Pilker for their consistent encouragement, understanding, and support of my goals, and to all my BCOHS colleagues for cheering me on. My colleagues amongst the graduate faculty were more than supportive in providing a listening ear for the highs and lows of my doctoral experience, with careful advice and confidence in my direction. Lastly, the ladies of our 2014 cohort and a couple wonderful classmates picked up along the waywho would have thought the bonds and the support would become so strong via mostly distance-I honestly couldn't have done it without you as we all added a dynamic, new v dimension to conversations, projects, and group work, creating a fascinating opportunity and honor to experience a doctoral journey with nurses from all over the United States. Special thank you to the Nu Rho chapter of Sigma for the grant award for my research project. I also would like to thank Connie Beard for her assistance in editing my final draft of my dissertation. vi DEDICATION This is for my husband and my children. To my husband, this was truly a jointventure, a sacrifice of four rigid years of a different lifestyle that felt exhausting and challenging for all at times. You never backed down in supporting me and listening, and were always there, steadfast, to help or round up additional family support when needed for the periods of writing, testing, and thinking while I still maintained a full-time job as well. You helped me keep watch over the holistic health of our family, playing, planning, budgeting, dreaming and taking on so many more roles than we may have realized at the time. To my children, dream big and shine bright, as we always say! I hope that seeing mama complete this endeavor inspires you to value education and new knowledge throughout your lifetimes. I must dedicate this work to my parents as well, as they've modeled hard work and sacrifice for years for our family, in loving support, teaching and sharing the tools and resources to launch onward, inspiring me to push forward and know that my goals were within reach all along. They've helped make this journey possible, as well. For the friends that have stood by my side in faith-thank you-you know who you are. vii TABLE OF CONTENTS CHAPTER I.

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“…Too often, it is assumed that rural and urban nurses experience the same organizational and workplace challenges. The resources available to rural nurses depending on the rurality of the community are not taken into account (Smith, Plover, McChesney, & Lake, 2019).…”

Section: Introductionmentioning

confidence: 99%

The importance of organizational commitment in rural nurses' intent to leave

Stewart

MacLeod

Kosteniuk

et al. 2020

Journal of Advanced Nursing

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Aims To examine determinants of intention to leave a nursing position in rural and remote areas within the next year, for Registered Nurses or Nurse Practitioners (RNs/NPs) and Licensed Practical Nurses (LPNs). Design A pan‐Canadian cross‐sectional survey. Methods The Nursing Practice in Rural and Remote Canada II survey (2014–2015) used stratified, systematic sampling and obtained two samples of questionnaire responses on intent to leave from 1,932 RNs/NPs and 1,133 LPNs. Separate logistic regression analyses were conducted for RNs/NPs and LPNs. Results For RNs/NPs, 19.8% of the variance on intent to leave was explained by 11 variables; and for LPNs, 16.9% of the variance was explained by seven variables. Organizational commitment was the only variable associated with intent to leave for both RNs/NPs and LPNs. Conclusions Enhancement of organizational commitment is important in reducing intent to leave and turnover. Since most variables associated with intent to leave differ between RNs/NPs and LPNs, the distinction of nurse type is critical for the development of rural‐specific turnover reduction strategies. Comparison of determinants of intent to leave in the current RNs/NPs analysis with the first pan‐Canadian study of rural and remote nurses (2001–2002) showed similarity of issues for RNs/NPs over time, suggesting that some issues addressing turnover remain unresolved. Impact The geographic maldistribution of nurses requires focused attention on nurses' intent to leave. This research shows that healthcare organizations would do well to develop policies targeting specific variables associated with intent to leave for each type of nurse in the rural and remote context. Practical strategies could include specific continuing education initiatives, tailored mentoring programs, and the creation of career pathways for nurses in rural and remote settings. They would also include place‐based actions designed to enhance nurses' integration with their communities and which would be planned together with communities and nurses themselves.

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Isolated, small, and large hospitals have fewer nursing resources than urban hospitals: Implications for rural health policy

Cited by 32 publications

References 30 publications

Rural Hospital Nursing Skill Mix and Work Environment Associated With Frequency of Adverse Events

Rural Hospital Nursing Skill Mix and Work Environment Associated With Frequency of Adverse Events

Lived experiences of new nurse graduates in critical access hospitals

The importance of organizational commitment in rural nurses' intent to leave

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