A new analysis of national nursing data offers a much better picture of what keeps advanced practice registered nurses (APRNs) working in rural America. And what’s driving them away.
This new research, appearing in The Journal of Rural Health, hints that while burnout and pay remain powerful factors, others are gaining ground. Other influences include family proximity, lower living costs, and a sense of purpose in serving underserved communities.
Nearly one in five Americans lives in a rural area, yet those communities still struggle with an escalating dearth of healthcare professionals. As the number of rural physicians continues to plummet, APRNs have become an increasingly essential lifeline. But keeping them employed there has become an increasingly daunting challenge.
The researchers analyzed data from the “2022 National Sample Survey of Registered Nurses,” a federal survey of 49,000 nurses from across the country. The researchers focused on 18,804 APRNs. Roughly 20% of them worked in rural settings. Each respondent reported whether they’d stayed in or left their job as of late 2021. They also listed their reasons for the career choices.
Their analysis revealed that rural APRNs were, on average, an older, less racially diverse, and more experienced group than their urban counterparts. They also earned less and less likely to have access to employer-provided professional education benefits. Even so, they still reported greater use of telehealth and were more likely to declare patient care as their primary job function.
Why They Stay
Among APRNs who remained in their jobs, the top reasons for staying were strikingly similar – regardless of the region:
- They liked their job
- They valued the benefits and pay.
- And they also enjoyed a balanced work schedule.
That being said, rural nurses also mentioned a few specific motivators. They were more likely than their nonrural peers to mention:
- Shorter commutes.
- A lower cost of living.
- Proximity to their family.
- A commitment to their underserved communities.
- And access to loan repayment programs.
Together, these factors worked together as “protective elements,” benefits that counteract the disadvantages tied to working in a rural setting.
“A strengths-based approach,” the authors argue, “may better address workforce shortages than the traditional deficit framing that paints rural jobs as undesirable.”
Why They Leave
Turnover among rural APRNs ranked slightly higher than in urban areas (23% vs. 20%), but the explanation varied. Rural nurses who left explained their exodus by citing better pay or benefits elsewhere, while complaining of weak leadership, burnout, and inadequate staffing.
However, they were also less likely than their urban colleagues to blame burnout or stress for packing up and heading elsewhere.
Urban APRNs, on the other hand, more often reported stressful work environments and limited career advancement as reasons for leaving.
A Workforce in Transition
The new research also highlights the retirement crisis that looms on the horizon for rural communities, since so many rural APRNs are inching toward retirement. Many of them are already over 50. Combine that with lower racial and ethnic diversity in rural healthcare settings, a trend emerges that suggests long-term challenges for building a sustainable and representative workforce.
The authors suggest that targeted recruitment will be crucial moving forward. They suggest training programs that include rural clinical rotations or emphasize community service. But the researchers add that more tailored messaging could help, too.
Drawing on recruitment theory, the researchers recommend “person-environment fit” strategies, such as crafting job advertisements and training materials that emphasize values and lifestyles. Instead of portraying rural healthcare as a hardship, recruitment materials that highlight its community impact, patient relationships, and work-life balance might work better.
“Recruitment messages with greater specificity and affective (value-based) content are more effective than generic, information-only messages,” the authors wrote.
In other words, the authors conclude that the best way to recruit rural nurses might be to find those who already share rural values.
The Power of Liking the Job
The most common reason that APRNs offered for staying put turned out to be pretty straightforward. They liked their jobs. That finding, the authors point out, reflects the importance of workplace culture, autonomy, and organizational fit. They’re intangibles that a bigger paycheck can’t necessarily fix.
“Understanding what fosters job satisfaction and organizational fit,” they wrote, “is essential for developing workforce strategies that not only meet operational needs but also capitalize on the strengths of rural practice.”
Further Reading
Investing in Nurses Saves Lives. And Money.
How a Simple Satisfaction Score Might Save Healthcare Workers
