Comparative analysis of urban and rural nursing workforce shortages in Nebraska hospitals

Mary Cramer, Jill Nienaber, Peg Helget, Sangeeta Agrawal

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Current workforce models that rely on economic indicators have seriously underestimated the rural RN shortage and its impact on rural hospitals. This cross-sectional study developed an algorithm using the concept of need and applied it to health service demand data in 66 counties of a midwestern state (1993-2002) to determine trends in RN shortages between urban and rural areas. Results showed that rural areas consistently had the largest gap between predicted need for RNs and numbers employed and that the rural RN shortages were significantly greater than in urban areas. This study suggests that adequate and geographically specific targets of RN need are essential, especially for rural areas, because of policy implications for rural hospital staffing and workforce planning. Inadequate workforce targets perpetuate the shortage, especially in rural areas, and exacerbate the very reasons that RNs leave over concerns for patient safety, inadequate staffing, and job dissatisfaction.

Original languageEnglish (US)
Pages (from-to)248-260
Number of pages13
JournalPolicy, Politics, and Nursing Practice
Issue number4
StatePublished - Nov 2006


  • Hospital
  • Nursing
  • Shortage
  • Staffing
  • Workforce

ASJC Scopus subject areas

  • Leadership and Management
  • Issues, ethics and legal aspects


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