"It's not right": Nurse perspectives on rural hospital closures: A qualitative study

Despite providing lifesaving care, 106 rural hospitals have closed in the United States since 2010. Although the role of rural hospital nursing is central, limited information is available about closures from a nursing lens. The purpose was to describe rural hospital closure contributors, processes, and outcomes from the perspective of licensed rural nurses in a hospital during its closure.

This cross-sectional study used a retrospective, qualitative design grounded in subjective epistemology.

Purposive, snowball sampling was used to recruit ten participants from two rural hospitals that closed in Texas between 2014-2015. Sample size was sufficient and comparable to prior rural nursing research.

Between July 2020 and February 2021, participants completed online demographic questionnaires and semi-structured interviews.

Thematic analysis yielded six themes and 16 subthemes. The themes are presented in three main components: pre-closure, closure process and dynamics, and closure impacts. According to nurses, pre-closure contextual factors can influence closure dynamics. Nurses also reported perceived long-term impacts after closure.

Beyond financial explanations, community politics and organizational characteristics can contribute to rural closure processes and outcomes from the nursing lens. Policies are needed to address modifiable factors contributing to closures and to create sustainable rural care models.