Factors related to the recruitment and retention of nurse practitioners in rural areas

For the past several decades, rural America has experienced significant health disparities. Changes in the demographics of rural locations in the U.S. have led to (a) an increase in an aging population, (b) an increase in minority populations, and (c) a large number of unemployed individuals due to the shifting of jobs. In some locations, a large number of these unemployed or underemployed are uninsured or underinsured. Parallel to the changes in demographics, there has been a decrease in primary care providers in rural areas. Consequently, rural America is facing reduced and unequal access to healthcare. One solution to limited healthcare access is increasing the number of primary care nurse practitioners (NP) in rural areas. A significant number of NPs currently offer effective primary care; however, only 40% accept positions in rural settings. Thus, the purpose of this qualitative study is to explore factors related to recruiting and retaining NPs to rural areas. The conveniently selected sample was composed of 29 rural NPs throughout the U.S. The data collection method was semi-structured interviews. A qualitative study, using constant comparison analysis of categories and themes, determined that three of the concepts of the rural nursing theory, (a) lack of anonymity, (b) outsider versus insider status, and (c) self-reliance, were pertinent. Deconstruction of categories and themes identified NP transition to rural practice through personal, social, and professional adaptation. The ability of NPs to adapt in these three areas produces role success and gratification thus in turn leads to job retention. This study concluded that rural NPs, through adaptation, achieved role success and gratification thus in turn leads to job retention. Based on these findings, recommendations are offered for changes to NP educational programs and federal agencies involved in the recruiting and retention of NPs in rural areas