New York, NY, USA. Registered nurses (RNs) belong to one of least mobile professions, with serious implications for access to health care for people in rural areas.

Researchers say this lack of geographic mobility means that hospitals and other health care settings must rely heavily on locally-trained RNs and find it difficult to recruit nurses when there are not enough in the local area.


The Registered Nurses (RNs) Work Project is a study of newly-licensed registered nurses. Recruitment may be a particular problem in rural areas where there are fewer schools of nursing. The study took this into account by performing a cross-sectional survey of 1,765 RNs in Metropolitan Statistical Areas and rural areas in 15 states. The findings appear in the journal Health Affairs.



Christine T. Kovner, PhD, RN, FAAN, professor at the College of Nursing, New York University;



Sean P. Corcoran, PhD, associate professor of educational economics at New York University; and



Carol S. Brewer, PhD, RN, FAAN, professor at the School of Nursing, University at Buffalo.According to the study:

• More than half (52.5 percent) of newly licensed RNs work within 40 miles of where they attended high school.
  
  
• Even more nurses reported working in the same state in which they attended high school.
  
  
• Nearly four in five (78.7 percent) of the nurses surveyed who held associate's degrees and more than three in four (76.8 percent) of those with bachelor's degrees practiced in the state they had attended high school.

The lack of geographic mobility is higher for nurses than for most other professions.

• Six in ten (60.8 percent) professional workers with an associate's degree and 53.3 percent of workers with a bachelor's degree resided in their state of birth as of the 2000 census.

Among RNs with bachelor's degrees

• 61.6 percent ages 20-39 were living in their state of birth compared with 56.8 percent of comparable professionals in other fields.
  
  
• Most of the nurses surveyed attended their first nursing degree program in the state where they graduated from high school.
  
  
• 88 percent also took their first registered nurse job in the state where they received their first nursing degree.
  
  
• Approximately two-thirds of the RNs in the survey were working within 100 miles of where they grew up and more than a third (35.1 percent) were working within 15 miles of where they attended high school.

The study authors recommend four policy changes to expand the supply of nurses in underserved areas:

• Workforce planners should target educational support, including scholarships and loan forgiveness programs, to provide incentives to local students to pursue nursing education;
  
  
• Policy makers should expand the number of nursing education programs in underserved areas, including new four-year nursing programs and distance learning. This could include creating extension programs or expanding programs at local community colleges to offer bachelor's degrees in nursing;
  
  
• State and university leaders should review their admission policies for nursing programs and the levels of financial aid offered, in some cases giving preference to in-state applicants should be considered;
  
  
• Programs and policies that offer financial incentives to attract nurses to underserved areas should be encouraged, expanded and fully-funded, including those that already exist such as the National Health Service Corps and the Area Health Education Centers.

"Given the strong tendency for nurses to practice close to where they attended nursing school and to attend nursing school near where they graduated high school, it's not surprising that parts of the country with few or no schools of nursing are struggling to find nurses," said Christine Kovner, whi directed the project with Carol Brewer.

"We did not investigate the reasons for nurses' lack of mobility, but this reality suggests that more needs to be done in areas with few nursing schools in order to meet the health care needs of those communities."