Jessica G Smith1,2, Colin M Plover2,3,4, Moira C McChesney5, Eileen T Lake2,5. 1. College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas. 2. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania. 3. Thomas Jefferson School of Population Health, Philadelphia, Pennsylvania. 4. Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania. 5. Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
Abstract
OBJECTIVE: The purpose was to compare nurse education, patient-to-nurse staffing, nursing skill mix, and nurse work environments across hospitals depending on extent of rurality. DESIGN: Cross-sectional, comparative, and descriptive. SAMPLE: The final sample included 566 urban, 49 large, 18 small, and 9 isolated hospitals from California, Florida, and Pennsylvania. MEASUREMENT: Data collected from large random samples from the 2005-2008 Multi-State Nursing Care and Patient Safety Study funded by the National Institute of Nursing Research and National Institutes of Health were linked to 2005-2006 American Hospital Association data. Rural-Urban Commuting Area codes developed by the University of Washington and the United States Department of Agriculture Economic Research Service were used to determine the extent of hospital rurality across the sample. RESULTS: Hospital percentages of baccalaureate prepared nurses differed significantly among urban (38%), large (28%), small (31%), and isolated rural hospitals (21%). Patient-to-registered nurse ratios in urban (4.8), large (5.6), small (5.6), and isolated rural hospitals (7.3) differed. Rural hospital nursing skill mix differed, and was lowest in isolated rural hospitals (65%). Nursing foundations for quality care were poorer in large, small, and isolated rural hospitals. CONCLUSION: Results support bolstering rural nursing resources in more remote locations, potentially through rural health policies.
OBJECTIVE: The purpose was to compare nurse education, patient-to-nurse staffing, nursing skill mix, and nurse work environments across hospitals depending on extent of rurality. DESIGN: Cross-sectional, comparative, and descriptive. SAMPLE: The final sample included 566 urban, 49 large, 18 small, and 9 isolated hospitals from California, Florida, and Pennsylvania. MEASUREMENT: Data collected from large random samples from the 2005-2008 Multi-State Nursing Care and Patient Safety Study funded by the National Institute of Nursing Research and National Institutes of Health were linked to 2005-2006 American Hospital Association data. Rural-Urban Commuting Area codes developed by the University of Washington and the United States Department of Agriculture Economic Research Service were used to determine the extent of hospital rurality across the sample. RESULTS: Hospital percentages of baccalaureate prepared nurses differed significantly among urban (38%), large (28%), small (31%), and isolated rural hospitals (21%). Patient-to-registered nurse ratios in urban (4.8), large (5.6), small (5.6), and isolated rural hospitals (7.3) differed. Rural hospital nursing skill mix differed, and was lowest in isolated rural hospitals (65%). Nursing foundations for quality care were poorer in large, small, and isolated rural hospitals. CONCLUSION: Results support bolstering rural nursing resources in more remote locations, potentially through rural health policies.
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