To fully conceptualize familiarity, delineating it from other rural concepts and understanding its role in rural life.Background: Rural nurse researchers identify familiarity as a concept found in rural life. Familiarity is a term used in rural literature, nursing research, and theory but lacks comprehensive conceptual understanding. To advance rural nursing science, concepts need updating to support rural research and advance theory development. Method: A scoping review of the literature was completed using the Joanna Briggs Institute methodology and supported by the seminal work of Arksey and O'Malley (2005). Using Walker and Avant's (2019) eight-step method, the scoping review findings informed this familiarity concept analysis. Findings: The familiarity analysis revealed three defining attributes, 'repeated exposure', 'knowledge', and 'deep understanding'. Antecedents which proceed familiarity include: (i) varied contexts; (ii) lack of anonymity; (iii) novelty. Consequences which result from familiarity are: (i)