Publication Date
1-1-2026
Journal
Medical Care
DOI
10.1097/MLR.0000000000002213
PMID
41359984
PMCID
PMC12685318
PubMedCentral® Posted Date
12-2025
PubMedCentral® Full Text Version
Post-print
Abstract
Background: The rising demand for health care delivery and an aging workforce is of particular concern in rural areas, where health care access depends upon an adequate nursing workforce. To address this shortage and optimize care, it is essential to measure when registered nurses (RN) leave inpatient direct care positions (ie, inpatient RN turnover) and identify modifiable factors correlated with RN turnover.
Objectives: Apply a novel method for characterizing inpatient RN turnover to understand factors associated with variation in RNs leaving inpatient positions at rural and urban Veterans Health Administration (VHA) hospitals.
Project design: Retrospective cohort study.
Subjects: Direct care RNs working on VHA regular acute care units for at least 15 days across a 60-day period during fiscal year 2022. Measures: outcome: electronic health record (EHR)-derived RN turnover on inpatient medical, surgical, or mixed medical-surgical units; exposure: rurality of hospital location.
Results: Among the cohort of 10,415 inpatient RNs in FY22, 3537 RNs left inpatient direct care in FY22 (34.0%). There were 127 inpatient RN turnover events in rural VHA hospitals (42.8% of 297), compared with 3410 in urban (33.7% of 10,118) (P< 0.001). However, in the final mixed-effects logistic regression model, individual RN-specific features and care delivery structure, not rurality (P=0.843), were more strongly associated with variation in turnover events.
Conclusions: Inpatient RN turnover was greater in rural versus urban hospitals, but rurality alone was not associated with turnover after multilevel adjustment.
Keywords
Humans, Retrospective Studies, Male, Female, United States, Personnel Turnover, Middle Aged, Hospitals, Veterans, Hospitals, Urban, Hospitals, Rural, Adult, Nursing Staff, Hospital, United States Department of Veterans Affairs, Inpatients, Nurses, rural hospital, registered nurse, inpatient direct care, turnover, veterans health administration
Published Open-Access
yes
Recommended Citation
Bay, Katherine G; Eck, Chase S; Knox, Melissa K; et al., "Predictors of Inpatient RN Turnover in Rural and Urban VHA Hospitals" (2026). Faculty, Staff and Students Publications. 6746.
https://digitalcommons.library.tmc.edu/baylor_docs/6746