Predictors of Inpatient RN Turnover in Rural and Urban VHA Hospitals

Area of Science:

• Healthcare Management
• Nursing Workforce Studies
• Rural Health Disparities

Background:

• Rising healthcare demand and an aging workforce exacerbate nursing shortages, particularly in rural areas.
• Understanding registered nurse (RN) turnover is crucial for optimizing healthcare delivery and addressing workforce gaps.
• Identifying modifiable factors correlated with RN turnover is essential for retention strategies.

Purpose of the Study:

• To apply a novel method for characterizing inpatient RN turnover.
• To investigate factors associated with RNs leaving inpatient positions in rural and urban Veterans Health Administration (VHA) hospitals.

Main Methods:

• Retrospective cohort study design.
• Analysis of electronic health record (EHR)-derived data for direct care RNs in VHA acute care units during fiscal year 2022.
• Examination of hospital rurality as a key exposure variable influencing RN turnover.

Main Results:

• A total of 10,415 inpatient RNs were analyzed, with 34.0% experiencing turnover in FY22.
• Inpatient RN turnover events were higher in rural VHA hospitals (42.8%) compared to urban VHA hospitals (33.7%).
• Multilevel regression analysis indicated that individual RN characteristics and care delivery structures, rather than rurality, were significantly associated with turnover variation.

Conclusions:

• While inpatient RN turnover rates were initially higher in rural VHA facilities, rurality itself was not a significant independent predictor after adjustment.
• Factors related to individual nurses and the care environment play a more substantial role in inpatient RN turnover than hospital location alone.
• These findings underscore the need for targeted interventions addressing nurse-specific and systemic factors to improve RN retention in VHA hospitals.