Small towns without hospitals have trouble keeping nurses, new A&M-Penn-Stanford study suggests

Rural communities that lack hospitals tend to experience higher levels of nurse turnover than those with hospitals, according to a new study co-authored by Elena Andreyeva, assistant professor at the Texas A&M University School of Public Health. The paper, “Nursing turnover in a large, rural health system,” was recently published in The Journal of Rural Health.

This study conducted by Andreyeva and researchers from the University of Pennsylvania and Stanford Health focused on a large health care system with 27 affiliated hospitals in South Dakota, North Dakota and Minnesota. The health care system provided researchers with data from 7,634 registered nurses who were employed by the system between January 2016 and December 2017. Approximately 1,765 of these nurses worked in rural communities that were served by the system’s health care facilities.

The research team’s most important finding was that the presence of a hospital in a community serves as the linchpin supporting nurse retention in these rural areas. Communities without an affiliate hospital had a 27% nursing turnover rate during the study’s two-year period. In comparison, the turnover rate was approximately 18% in rural communities that had an affiliated acute hospital or a critical access hospital.

“What we found is that if a nurse worked in a rural area that did not have a hospital, they were much more likely to leave the health care system,” Andreyeva said.

This study is important because of the increasing number of closures of rural hospitals in the United States. According to the Center for Healthcare Quality and Payment Reform, more than 130 rural hospitals have been shuttered over the past decade, while an additional 600 rural hospitals are currently at risk of closure.

“If you think of a hospital serving as an anchor for all of the health care resources and facilities in the particular area, if that anchor is gone, there is a ripple effect across other health care facilities,” Andreyeva said. “The hospital’s loss makes things worse for the geographic area that is affected. Other health care providers who might have been impacted by the closure are much more likely to leave the area once the hospital is gone.”