“It's not right”: Nurse perspectives on rural hospital closures: A qualitative study

Abstract

Objective(s) Despite providing lifesaving care, 106 rural hospitals have closed in the United States since 2010. Although the role of rural hospital nursing is central, limited information is available about closures from a nursing lens. The purpose was to describe rural hospital closure contributors, processes, and outcomes from the perspective of licensed rural nurses in a hospital during its closure. Design This cross‐sectional study used a retrospective, qualitative design grounded in subjective epistemology. Sample Purposive, snowball sampling was used to recruit ten participants from two rural hospitals that closed in Texas between 2014–2015. Sample size was sufficient and comparable to prior rural nursing research. Measurements Between July 2020 and February 2021, participants completed online demographic questionnaires and semi‐structured interviews. Results Thematic analysis yielded six themes and 16 subthemes. The themes are presented in three main components: pre‐closure, closure process and dynamics, and closure impacts. According to nurses, pre‐closure contextual factors can influence closure dynamics. Nurses also reported perceived long‐term impacts after closure. Conclusion Beyond financial explanations, community politics and organizational characteristics can contribute to rural closure processes and outcomes from the nursing lens. Policies are needed to address modifiable factors contributing to closures and to create sustainable rural care models.

Understanding the impacts of rural hospital closures: A scoping review

“…30 In addition to quantitative evidence in the availability of providers, qualitative assessments of nurses have described their perceptions on rural hospital closure. 31 Nurses have highlighted personal job loss, loss of well-being, and loss of ability to apply their expertise as key issues related to rural hospital closure. In addition to nursing insight on the impact of closures on their workforce, the same study identified their perception of rural hospital closure's impact on the local community.…”

“…services, overall inaccessibility of services, and concerns around adverse impacts on quality of care. 31 Another focus group study of community members in a small community that experienced hospital closure found that among the 37 people interviewed, sentiments centered around fear and anger-with feelings of abandonment by the health system, fear regarding new travel distance for care, and confusion regarding where to obtain care going forward. 32…”

“…Moreover, they identified a year‐over‐year decline in the supply of primary care physicians over a 10‐year period following closure, nearing 10% annually 30 . In addition to quantitative evidence in the availability of providers, qualitative assessments of nurses have described their perceptions on rural hospital closure 31 . Nurses have highlighted personal job loss, loss of well‐being, and loss of ability to apply their expertise as key issues related to rural hospital closure.…”

“…Key themes that emerged from nurses included identification of the loss of a large employer for the area and eventual loss of health care workers and services. For patient care, nurses identified a potential for diminished access to care, delays in obtaining health care services, overall inaccessibility of services, and concerns around adverse impacts on quality of care 31 . Another focus group study of community members in a small community that experienced hospital closure found that among the 37 people interviewed, sentiments centered around fear and anger—with feelings of abandonment by the health system, fear regarding new travel distance for care, and confusion regarding where to obtain care going forward 32 …”