New registered nurses' lack of geographic mobility has negative implications for rural health

A study on the geographic mobility of registered nurses (RNs) recently published in the December Health Affairs magazine suggests that the profession's relative lack of mobility has serious implications for access to health care for people in rural areas.

According to the study—part of the RN Work Project funded by the Robert Wood Johnson Foundation—more than half (52.5 percent) of newly licensed RNs work within 40 miles of where they attended high school. Even more reported working in the same state in which they attended high school. Nearly four in five (78.7 percent) of the nurses surveyed who held associate's degrees and more than three in four (76.8 percent) of those with bachelor's degrees practiced in the state they had attended high school.

According to the study's authors, this lack of geographic mobility means that hospitals and other health care settings must rely heavily on locally-trained RNs and find it difficult to recruit nurses when there are not enough in the local area. This may be a particular problem in where there are fewer schools of nursing.

Lead investigators for the study were Christine Kovner, PhD, RN, FAAN, professor at the College of Nursing, New York University; Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing, University at Buffalo; and Sean Corcoran, PhD, associate professor of educational economics at New York University. Kovner and Brewer direct the RN Work Project.

The lack of geographic mobility is higher for nurses than for most other professions. According to the study, six in ten (60.8 percent) professional workers with an associate's degree and 53.3 percent of workers with a bachelor's degree resided in their state of birth as of the 2000 census. Among RNs with bachelor's degrees, 61.6 percent ages 20-39 were living in their state of birth compared with 56.8 percent of comparable professionals in other fields.

Most of the nurses surveyed attended their first nursing degree program in the state where they graduated from high school and 88 percent also took their first registered nurse job in the state where they received their first nursing degree. Approximately two-thirds of the RNs in the survey were working within 100 miles of where they grew up and more than a third (35.1 percent) were working within 15 miles of where they attended high school.

"Given the strong tendency for nurses to practice close to where they attended nursing school and to attend nursing school near where they graduated , it's not surprising that parts of the country with few or no schools of nursing are struggling to find nurses," said Kovner. "We did not investigate the reasons for nurses' lack of mobility, but this reality suggests that more needs to be done in areas with few nursing schools in order to meet the health care needs of those communities."

The authors of the study recommend four policy changes to expand the supply of nurses in underserved areas:

  • Workforce planners should target educational support, including scholarships and loan forgiveness programs, to provide incentives to local students to pursue nursing education;
  • Policy makers should expand the number of nursing education programs in underserved areas, including new four-year nursing programs and distance learning. This could include creating extension programs or expanding programs at local community colleges to offer bachelor's degrees in nursing;
  • State and university leaders should review their admission policies for nursing programs and the levels of financial aid offered, in some cases giving preference to in-state applicants should be considered;
  • Programs and policies that offer financial incentives to attract nurses to underserved areas should be encouraged, expanded and fully-funded, including those that already exist such as the National Health Service Corps and the Area Health Education Centers.
The findings are based on a cross-sectional survey of 1,765 RNs in Metropolitan Statistical Areas and rural areas in 15 states.

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