CoChat
Sign Up
Cited by 49Nursing education and managementGlobal Health Workforce IssuesNursing Roles and Practices

Isolated, Small, and Large Hospitals Have Fewer Nursing Resources than Urban Hospitals: Implications for Rural Health Policy

Open access
Smith, Jessica G., Plover, Colin M., McChesney, Moira C., Lake, Eileen T.·2019·Public Health Nursing
DOI 10.1111/phn.12612PMC PMC6635079
Open this paper in CoChat — free account

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.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1111/phn.12612

Cites

1 of 1 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Patients living in rural areas commonly have limited medical resources and staffing since advanced medical services and equipment are primarily found in urban areas or private facilities.

    “Patients living in rural areas commonly have limited medical resources and staffing since advanced medical services and equipment are primarily found in urban areas or private facilities [40,41].”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [41]

    The Discussion reports fewer nurses and higher patient-to-RN ratios as hospitals become more rural, supporting the claim about limited staffing. The paper also describes limited healthcare access for rural populations, but it does not establish that advanced medical services or equipment are primarily found in urban areas or private facilities, or that this explains the staffing shortfall. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 31

  1. Aiken LH (2014). Baccalaureate nurses and hospital outcomes: more evidence. Medical Care, 52(10), 861– 863. doi: 10.1097/mlr.0000000000000222 25215645 · DOI
  2. Aiken LH, Cimiotti JP, Sloane DM, Smith HL, Flynn L, & Neff DF (2011). Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Medical Care, 49(12), 1047– 1053. doi: 10.1097/MLR.0b013e3182330b6e 21945978 PMC3217062 · DOI
  3. Aiken LH, & Fagin CM (2018). Evidence-based nurse staffing: ICN’s new position statement. International Nursing Review, 65(4), 469– 471. doi: 10.1111/inr.12499 30561798 · DOI
  4. Aiken LH, Sloane D, Griffiths P, Rafferty AM, Bruyneel L, McHugh M, … Sermeus W (2017). Nursing skill mix in European hospitals: Cross-sectional study of the association with mortality, patient ratings, and quality of care. British Medical Journal of Quality and Safety, 26(7), 559– 568. doi: 10.1136/bmjqs-2016-005567 PMC5477662 28626086 · DOI
  5. Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Griffiths P, Busse R, … Sermeus W (2014). Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study. Lancet, 383(9931), 1824– 1830. doi: 10.1016/s0140-6736(13)62631-8 24581683 PMC4035380 · DOI
  6. Anderson TJ, Saman DM, Lipsky MS, & Lutfiyya MN (2015). A cross-sectional study on health differences between rural and non-rural U.S. counties using the County Health Rankings. BMC Health Services Research, 15, 441. doi: 10.1186/s12913-015-1053-3 26423746 PMC4590732 · DOI
  7. Baernholdt M (2018). Fall rates in urban and rural nursing units: Does location matter? Journal of Nursing Care Quality, 33(4), 326– 333. doi: 10.1097/NCQ.0000000000000319 29346186 PMC6047925 · DOI
  8. Baernholdt M, & Mark BA (2009). The nurse work environment, job satisfaction and turnover rates in rural and urban nursing units. Journal of Nursing Management, 17(8), 994– 1001. doi: 10.1111/j.1365-2834.2009.01027.x 19941573 PMC3607628 · DOI
  9. Bolin JN, Bellamy GR, Ferdinand AO, Vuong AM, Kash BA, Schulze A, & Helduser JW (2015). Rural healthy people 2020: New decade, same challenges. The Journal of Rural Health, 31(3), 326– 333. doi: 10.1111/jrh.12116 25953431 · DOI
  10. Bratt MM, Baernholdt M, & Pruszynski J (2014). Are rural and urban newly licensed nurses different? A longitudinal study of a nurse residency programme. Journal of Nursing Management, 22(6), 779– 791. doi: 10.1111/j.1365-2834.2012.01483.x 25208945 · DOI
  11. Duffield C, Diers D, O’Brien-Pallas L, Aisbett C, Roche M, King M, & Aisbett K (2011). Nursing staffing, nursing workload, the work environment and patient outcomes. Applied Nursing Research, 24(4), 244– 255. doi: 10.1016/j.apnr.2009.12.004 20974086 · DOI
  12. Enders CK (2010). Applied missing data analysis New York: Guilford Press.
  13. Estabrooks CA, Midodzi WK, Cummings GG, Ricker KL, & Giovannetti P (2005). The impact of hospital nursing characteristics on 30-day mortality. Journal of Nursing Research, 54(2), 74– 84. 15778649
  14. Gillespie AB, & Langston N (2014). Inspiration for aspirations: Virginia nurse insights about BSN progression. Journal of Professional Nursing, 30(5), 418– 425. doi: 10.1016/j.profnurs.2014.01.001 25223290 · DOI
  15. Hart LG, Larson EH, & Lishner DM (2005). Rural definitions for health policy and research. American Journal of Public Health, 95(7), 1149– 1155. doi: 10.2105/AJPH.2004.042432 15983270 PMC1449333 · DOI
  16. Hege A, Ball L, Christiana RW, Wallace C, Hubbard C, Truesdale D, … Fleming H (2018). Social determinants of health and the effects on quality of life and well-being in 2 rural Appalachia communities: The community members’ perspective and implications for health disparities. Family and Community Health, 41(4), 244– 254. 30134339
  17. Kaufman BG, Thomas SR, Randolph RK, Perry JR, Thompson KW, Holmes GM, & Pink GH (2016). The rising rate of rural hospital closures. The Journal of Rural Health, 32(1), 35– 43. doi: 10.1111/jrh.12128 26171848 · DOI
  18. Kim HY (2015). Statistical notes for clinical researchers: Post-hoc multiple comparisons. Restorative Dentistry & Endodonics, 40(2), 172– 176. doi: 10.5395/rde.2015.40.2.172 PMC4432262 25984481 · DOI
  19. Lake ET (2002). Development of the practice environment scale of the nursing work index. Research in Nursing and Health, 25(3), 176– 188. doi: 10.1002/nur.10032 12015780 · DOI · Paper page
  20. Landry LG, Orsolini-Hain L, Renwanz-Boyle A, Alameida M, & Holpit L (2012). The nursing educational highway in action: Results of a needs assessment and the formation of a collaborative workgroup. Nursing Education Perspectives, 33(4), 274– 277. 22916635
  21. McCafferty KL, Ball SJ, & Cuddigan J (2017). Understanding the continuing education needs of rural midwestern nurses. The Journal of Continuing Education in Nursing, 48(6), 265– 269. doi: 10.3928/00220124-20170517-07 · DOI
  22. McHugh MD, & Lake ET (2010). Understanding clinical expertise: Nurse education, experience, and the hospital context. Research in Nursing and Health, 33(4), 276– 287. doi: 10.1002/nur.20388 20645420 PMC2998339 · DOI
  23. Newhouse RP (2005). Exploring nursing issues in rural hospitals. Journal of Nursing Administration, 35(7–8), 350– 358. 16077277
  24. Newhouse RP, Morlock L, Pronovost P, & Sproat SB (2011). Rural hospital nursing: results of a national survey of nurse executives. Journal of Nursing Administration, 41(3), 129– 137. doi: 10.1097/NNA.0b013e31820c7212 21336041 · DOI
  25. Skillman SM, Palazzo L, Keepnews D, & Hart LG (2006). Characteristics of registered nurses in rural versus urban areas: Implications for strategies to alleviate nursing shortages in the United States. The Journal of Rural Health, 22(2), 151– 157. doi: 10.1111/j.1748-0361.2006.00024.x 16606427 · DOI
  26. Terrell SR (2012). Statistics translated: A step-by-step guide to analyzing and interpreting data New York, NY: The Guilford Press.
  27. The National Academies of Sciences Engineering Medicine. (2018). Achieving rural health equity and well-being: Proceedings of a workshop (2018) Washington, D.C.: The National Academies Press Retrieved from http://nap.edu/24967 30307731
  28. Warden DH, Probst JC (2017). The Role of the Nurse Executive in Rural Hospital Closure. The Journal of Nursing Administration, 47(1), 5– 7. doi: 10.1097/NNA.0000000000000429 27893499 · DOI
  29. Warshawsky NE, & Havens DS (2011). Global use of the practice environment scale of the nursing work index. Journal of Nursing Research, 60(1), 17– 31. doi: 10.1097/NNR.0b013e3181ffa79c PMC3021172 21127450 · DOI
  30. Winters CA (2013). Rural nursing: Concepts, theory, and practice (4th ed. ed.). New York, NY: Springer.
  31. Wolf L, & Delao AM (2013). Identifying the educational needs of emergency nurses in rural and critical access hospitals. Journal of Continuing Education in Nursing, 44(9), 424– 428. doi: 10.3928/00220124-20130816-38 23964675 · DOI

Cited by

Sorted by citations

Authors
Smith, J. G., Plover, C. M., McChesney, M. C., & Lake, E. T.
Affiliations
  • The University of Texas at Arlington (US)
  • Thomas Jefferson University (US)
  • University of Pennsylvania (US)
  • Leonard Davis Institute of Health Economics (US)
Corresponding author
Smith, Jessica G.
ORCID
Venue
Public Health Nursing
Publisher
Wiley
Published
2019-04-08
Volume
36
Issue
4
Pages
469-477
ISSN
  • 0737-1209 (ISSN-L)
  • 1525-1446
DOI
10.1111/phn.12612
PMC
PMC6635079
OpenAlex
W2936786079
Cited by
49
References
1
Citations by year
2026: 8 · 2025: 8 · 2024: 9 · 2023: 3 · 2022: 9 · 2021: 5 · 2020: 6 · 2019: 1
FWCI
9.72
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Public Health Nursing (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Nursing Research
  • National Institutes of Health (T32‐NR‐007104, R01NR014855)
  • American Nurses Foundation
Topics
  • Health Sciences › Nursing › Research and Theory › Nursing education and management
  • Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
  • Health Sciences › Health Professions › General Health Professions › Nursing Roles and Practices
Keywords
rural hospitals, nursing workforce, nursing education, nursing skill mix, nursing work environment, rural health policy, urban hospitals, nursing care quality
MeSH terms
California, Cross-Sectional Studies, Education, Nursing, Florida, Health Policy, Health Resources, Hospitals, Rural, Hospitals, Urban, Humans, Male, Nursing Staff, Hospital, Pennsylvania, Quality of Health Care, Rural Health, United States, Health Care Rationing, Workload, Workplace

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review