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Policy, Politics, & Nursing Practice
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Comparative Analysis of Urban and Rural Nursing Workforce Shortages in Nebraska Hospitals

Mary Cramer, PhD, RN, CS

Gerontological, Psychosocial, and Community/Public Health Nursing Department at the University of Nebraska Medical Center, College of Nursing

Jill Nienaber, MSN

University of Nebraska Medical Center

Peg Helget, MSN

Fremont Area Medical Center, Fremont, Nebraska

Sangeeta Agrawal, MSc

University of Nebraska College of Nursing in Omaha

Current workforce models that rely on economic indicators have seriously underestimated the rural RN shortage and its impact on rural hospitals. This cross-sectional study developed an algorithm using the concept of need and applied it to health service demand data in 66 counties of a midwestern state (1993-2002) to determine trends in RN shortages between urban and rural areas. Results showed that rural areas consistently had the largest gap between predicted need for RNs and numbers employed and that the rural RN shortages were significantly greater than in urban areas. This study suggests that adequate and geographically specific targets of RN need are essential, especially for rural areas, because of policy implications for rural hospital staffing and workforce planning. Inadequate workforce targets perpetuate the shortage, especially in rural areas, and exacerbate the very reasons that RNs leave over concerns for patient safety, inadequate staffing, and job dissatisfaction.

Key Words: nursing • workforce • hospital • shortage • staffing

Policy, Politics, & Nursing Practice, Vol. 7, No. 4, 248-260 (2006)
DOI: 10.1177/1527154406296481
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