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Exploring Nursing Issues in Rural Hospitals

Newhouse, Robin P. PhD, RN, CNA

Journal of Nursing Administration: July-August 2005 - Volume 35 - Issue 7 - p 350–358

Objective To explore the impact of legislative, strategic, and organizational changes on nursing in rural hospitals since 1995.

Background Rural hospitals have faced decreasing financial margins. This economic pressure is due to multiple reasons, and is a major issue for nurse executives. Nurse executives are responsible for assuring quality of nursing care. Nursing care affects patient outcomes. The impact of legislative, economic, and strategy decisions on nursing in rural hospitals is unknown.

Methods A focus group was conducted with 11 nurse executives from rural hospitals who attended the American Organization of Nurse Executives Annual Meeting held on April 20, 2004.

Results Themes from the content analysis were grouped into 3 major categories: external environmental (physical isolation, patient population, services needed, legislation), internal organizational (patient acuity, volume, services, technology, financial margin and strategy, staffing, leadership, culture, and resources), and nursing infrastructure (staffing, salary, registered nurse–physician conflict, continuity of care, competency, culture, politics and leadership).

Conclusions Nurse executives in rural hospitals face distinctive issues and challenges. Further study of the impact of policy and strategy decisions on rural nursing is needed.

Nurse Researcher, The Johns Hopkins Hospital, and Assistant Professor, The Johns Hopkins Hospital University School of Nursing, Baltimore, Md.

Correspondence: The Johns Hopkins Hospital, 600 N Wolfe St, Billings 220, Baltimore, MD 21287 (

© 2005 Lippincott Williams & Wilkins, Inc.