A Systematized Review of Factors Impacting Rural Primary Care Nurse Practitioner Recruitment and Retention

Background: This systematized review investigates the factors influencing the recruitment and retention of nurse practitioners (NPs) in rural primary care across various settings. In light of persistent primary care provider (PCP) shortages and mounting healthcare disparities faced in rural areas, this study aims to synthesize existing research to identify the key factors shaping NP workforce decisions. Methods: Following Grant and Booth’s (2009) model for systematized reviews, a comprehensive search was conducted across CINAHL (EBSCO), PubMed, and Web of Science (Core Collection-SCI Expanded, SSCI, AHCI, ESCI). Fifteen studies met the inclusion criteria and were analyzed using Thomas and Harden’s (2008) thematic synthesis framework. Results: Five analytical themes emerged: (1) clinical autonomy and role complexity, (2) individual factors such as rural upbringing and mission-driven motivation, (3) financial incentives and economic pressures, (4) education and professional preparation, and (5) the presence or absence of supportive professional relationships. The findings reveal that while autonomy, rural-focused education, and financial incentives support recruitment, long-term retention is shaped by personal values, community integration, interprofessional collaboration, and economic stability. Conclusions: This review highlights the need for comprehensive strategies to address the workforce shortages in rural primary care. Policy recommendations include expanding full practice authority (FPA) for NPs nationwide, improving access to rural training, and bolstering support systems to sustain the rural NP workforce. These findings offer insights that can inform future decision-making in rural primary care settings.