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  1. Newhouse, Robin P. PhD, RN, CNAA, BC
  2. Morlock, Laura PhD
  3. Pronovost, Peter MD, PhD
  4. Colantuoni, Elizabeth PhD
  5. Johantgen, Mary PhD


Objective: The aim of this study was to identify the independent effects among market forces, hospital factors, and the rural nursing work environment, controlling for hospital type, average daily census, and system or network membership.


Background: The hospital work environment affects both nurse and patient outcomes, yet little is known about the rural hospital setting.


Methods: A national sample of rural hospital nurse executives (n = 233) completed the Nursing Environment Survey and the Essentials of Magnetism (EOM) instrument.


Results: Market variables explain 11.4% and hospital variables explain 27.2% of the variance in the total weighted EOM scale. System membership ([beta] = -.204), shared vision ([beta] = .531), and quality and safety activities ([beta] = .132) have significant independent effects on the total weighted EOM scale.


Conclusions: Promoting shared vision and accelerating engagement in quality and safety initiatives will result in improvements in the nursing work environment in rural hospitals.