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  1. Newhouse, Robin P. PhD, RN, NEA-BC
  2. Morlock, Laura PhD
  3. Pronovost, Peter MD, PhD
  4. Breckenridge Sproat, Sara PhD, RN


Objective: The objective of the study was to describe nursing characteristics in small and larger rural hospitals and determine whether differences exist in market, hospital, and nursing characteristics.


Background: A better description of nursing in rural settings is needed to understand the work context.


Methods: A national sample of rural hospital nurse executives (n = 280) completed the Nurse Environment Survey and Essentials of Magnetism instrument.


Results: Larger rural hospitals are more likely than small hospitals to have a clinical ladder (32.4% vs 19.4%), more baccalaureate-prepared RNs (20.8% vs 17.1%), greater perceived economic (mean, 9.5 vs 8.5) and external influences (mean, 41.1 vs 39.8), lower shared vision among hospital staff (mean, 18.4 vs 19.4), and higher levels of quality and safety engagement (mean, 16.9 vs 16.1). Most nurses employed in rural hospitals are educated at the associate degree (77.4%) level.


Conclusions: Contextual differences exist between small and larger rural hospitals. To promote the best patient outcomes, attention to contextual differences is needed to tailor nursing interventions to fit the resources, environment, and patient needs in a given healthcare setting.