The Determinants of Nurses' Attraction to Working in Rural Areas: An Empirical Study in the United States

Article excerpt

This paper explores the current and predicted nursing shortage factors that attract nurses to work in rural areas, which tend to be the ones hardest hit by the shortage. A comprehensive literature review suggested a number of factors worthy of investigation. These factors were subsequently assessed through six focus groups and a survey that was successfully distributed to 3,120 registered nurses. From this distribution, 1,046 usable surveys were received. Results indicate that nurses break out into four distinct clusters, those with a rural preference (29%), urban preference (19%), those who do not want to change location (15%), and those who are looking for a change (37%). Findings from this study suggest that the decision to work in the rural area is dependent upon the type of area (rural versus urban) where the respondent was raised, the presence of family connections, and their perception of a rural life style.


The shortage of nurses in the United States is having a significant impact on the American healthcare system (Andrews and Dzlegielewski, 2005; Bednash, 2000; Buerhaus et al, 2000). According to Upenieks (2005), "nurses have felt physically exhausted and emotionally drained because of the increased patient load and the conditions under which they must work. . .the present shortage is more acute as a result of nurses opting out of the nursing profession due to dissatisfaction with their roles in a clinical setting."

It has been estimated that, by 20 10, there will be a shortage of 729,000 registered nurses with a BSN. The estimate increases to 1,119,000 by 2020 (Sigma Thêta Tau, 1999). In a 2004 study, the Health Resources and Administration forecasts for a registered nurse shortage in 2020 will be between 400,000 to 1,000,000 nurses. This situation will increasingly worsen as more "baby boomer" nurses retire and, in turn, more aging "baby boomers" require care. Thus, by 2020, there will be 340,000 fewer nurses practicing than today (Auerbach et al., 2007). In the March 2008 issue of RN, it is estimated that the United States is currently facing a shortage of approximately 150,000 nurses; in the next decade, more than 650,000 new nursing jobs will be created, and about 450,000 nurses will have retired.

A number of reasons have been proffered for this shortage. As previously mentioned, the nursing population is aging and nearing retirement. According to HRSA (2007), "the average age of RNs climbed to 46.8 years in 2004, the highest average age since the first comparable report was published in 1980. Just over 41 percent of RNs were 50 years of age or older in 2004, a dramatic increase from 33 percent in 2000 and 25 percent in 1980. Only 8 percent of RNs were under the age of 30 in 2004, compared to 25 percent in 1980."

Nursing has a poor image in the marketplace (Stein and Deese, 2004; Goodin, 2003). When choosing a career, nursing does not present an attractive option for men or women. In the past, women (the primary component of today's nursing supply) had fewer employment opportunities, their choices being limited to teaching, secretarial work and nursing. Since women today have more opportunities, competition from the outside environment has siphoned away nurses whose patient care skills are greatly needed (Upienieks, 2005 and Goodin, 2003).

Despite the efficiencies produced by managed care, the need for nurses, ironically, is increasing. As the length of hospital stay is reduced, for example, the acuity level of patients increases; with increased acuity comes the need for more nursing care hours (Seifert, 2000). Further, as a result of the downsizing that often accompanies managed care together with the lack of new entrants into the profession; fewer nurses are called upon to do more work.

Rural Nursing

The nursing shortage is even more severe and perhaps more demanding in rural areas. While rural residents comprise 20% of the population, only about 9% of physicians practice in the rural environment. …