Need: Little is known about rural nurse job satisfaction although one can argue that job dissatisfaction can threaten the existence of small rural hospitals. The looming retirement of 46% of the workforce in the next 5-10 years will cause the loss of nursing’s most experienced, satisfied, and committed nurses. Rural administrators need to know how to recruit and retain nurses. The existent body of literature on the topic is based on urban samples and may not pertain to rural communities.

Sample: Using the conceptual framework of the Penn Nursing Outcome Model, 93 experienced nurses (over 1 year employment in a rural hospital) participated in anonymous online surveys. The Washington State University institutional review board approved the study.

Methods: The online surveys addressed organizational and personal factors with a demographics survey, the McCloskey/Mueller Satisfaction Scale (alpha .89), the Gerber Control Over Practice Scale (alpha .96) and two open ended questions.   Results: Key principles of rural life and rural nursing theory were demonstrated in participant answers.

• Lifestyle was important to respondents (personal time away from work, rural/small town lifestyles, reasonable cost of living, access to recreational activities, employment for spouse, climate, opportunities for social personal relationships, and close proximity to family and friends).
• Relationships impacted job satisfaction (Supervisor, peer, patient, physician, feedback and respect). Rural nursing theory can be used to explain why “interactions with staff” was listed as both most and least satisfying.
• Independence another tenant of rural nursing was valued (self-scheduling, flexible hours, and practice decisions). The generalist role was appreciated (patient variety and job variability).

The least satisfied nurses worked 1 to 5 years while those with over 10 years experience were the most satisfied. Unmarried participants felt the least support and reported they might move within the next year. The least satisfying concepts include: Salary, benefits, lack of pension plan, health insurance, and long hours).

Conclusions: The qualitative findings explained survey choices. Satisfied nurses preferred the rural lifestyle. Rural nursing theory can explain participants’ job satisfaction characteristics. Nurses wanted hospital relationships to reflect the same values they appreciate in their rural home lives. Organizational characteristics findings were similar to the literature for urban settings.  Rural nurses prefer the generalist’s job variability and autonomy characteristics.

Implications: The study reports a small sample and should be replicated nationally. The study indicates rural nursing can now be studied using online surveys. Implications include the suggestion to recruit by marketing the rural lifestyle. Chief nursing officers may want to interview applicants for rural life experience and access to family and friends. Mangers need to use rural health/nursing theories. Managers hired from urban settings may need to be taught how to use the theories when building relationships and making changes. Educators should consider teaching generalist skills and rural nurse theory in undergraduate programs.

Acknowledgement: Study funded by a nursing education practice and retention grant from HRSA.