Demographic and Educational Attributes that Affect the Likelihood of a Registered Nurse Practicing in a Rural/Underserved North Carolina County
Creators: name: Crook, Hannah
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2019

description: Introduction and Research Objectives: North Carolina (NC) suffers from a maldistribution of medical professionals, including Registered Nurses (RNs). Rural and underserved areas are the most affected by this problem and have worse health outcomes. To solve maldistribution problems, it is critical to understand what factors are associated with the likelihood of practicing in a rural/underserved area. I aim to explore this maldistribution and to determine what different demographic and educational factors affect the likelihood that an RN is working in a rural/underserved area two years after graduation. Specifically, I examine the proportion of graduates in rural practice by each NC educational program, type of program (2- vs. 4-year), Historically Black College and Universities (HBCU) status, public/private status, and program location (rural vs. non-rural program location). Methods: This study is a descriptive, quantitative, secondary data analysis. The study includes 2015 RN graduates from NC nursing education programs who were still in active practice in NC in 2017- a total of 3419 RNs. The data used are 2015 graduation data and data from the 2017 RN licensure renewal process. I calculated descriptive statistics on the demographic characteristics of the dataset and the proportion of 2015 RN graduates working in a rural/underserved area in 2017 by education program and program attributes. Pearson Chi-Square tests were then performed to determine if the differences in proportions between different education program attributes were statistically significant. Finally, a logistic regression model was run to determine the effects of demographic and educational factors on the likelihood of practicing in a rural/underserved area. Principal Findings: The dataset was largely female (89.5%) and white (78.4%). In total, 25.7% of 2015 NC RN graduates who were in active NC practice in 2017 were working in a rural/underserved county. The median proportion by educational program of 2015 graduates working in a rural/underserved area was 23.3%. Two-year-year programs had a significantly higher proportion of graduates working in a rural/underserved county than 4-year programs (31.4% vs 14.8%, p&lt;0.000), public programs had a significantly higher proportion of graduates working in a rural/underserved area than private programs (29% vs 10%, p&lt;0.000), and programs located in a rural/underserved area had a significantly higher proportion of graduates working in rural/underserved areas than programs not located in a rural/underserved area (59.5% vs 8.4%, p&lt;0.000). There were no statistically significant differences in the proportions of rural working graduates from HBCUs vs non-HBCUs (17.7% vs 14.2%, p=0.19). In the logistic regression model, factors associated with an increased likelihood of practicing in a rural/underserved area were being female, being non-white, attending a two-year educational program, attending a public educational program, and attending an educational program in a rural/underserved area. Discussion: Both demographic factors (being female, non-white) and attributes at the educational program level (public program, 2-year program, located in a rural/underserved area) were associated with an increased likelihood of 2015 RN graduates working in a NC rural/underserved county in 2017. This study is quite limited, as it only examines one cohort of NC RN graduates for two years and does not consider RNs who moved out of state or were not in active practice in 2017. Differences in the proportions of graduates working in rural areas may affect funding decisions by the state or other regulatory bodies. Policies that encourage increased movement of graduates to rural or underserved areas should consider the multitude of factors that affect an RN’s choice of practice location. Further research may consider including more of the NC RN workforce or encompassing a longer timeframe.