What Drives Advanced Practice Nurses to Stay In Rural America? Insights From the 2022 National Survey of Registered Nurses

Purpose: Recruiting and retaining a robust rural health care workforce is critical to advancing health outcomes in rural communities. Although increasing the rural provider workforce has been a policy focus for decades, rural access continues to worsen. Using a strengths-based approach, we identify factors that influence the decisions of advanced practice registered nurses (APRNs) to leave or stay in their jobs. Methods: Secondary analysis of data from the 2022 National Sample Survey of Registered Nurses. We describe rates of turnover, retention, intention to leave, and reasons for leaving and staying by job rurality. We compare reasons by rurality using Pearson chi-squared tests with the Rao-Scott correction, applying survey weights to all analyses. Findings: Our sample included 18,804 APRNs, of which one-fifth (19.1%, n = 3,589)worked in rural areas. The rural APRN workforce was, on average, older, less raciallydiverse, more experienced, and had a lower household income compared to the non-rural APRN workforce. Those who remained in rural jobs were more likely to reportlength of commute (P = .02), cost of living (P = .02), commitment to underservedcommunities (P = .001), and proximity to family (P< .001), compared to those whoremained in urban jobs. Those who left nonrural jobs cited greater burnout (P = .02),stressful work environment (P = .05), career advancement (P = .01), and being laid off/downsized (P = .01) as reasons for leaving, compared to those who left rural jobs. Conclusions: We identified unique factors, including proximity to family, commitment to underserved populations, and less burnout, that contribute to APRN retention in rural areas. Leveraging these motivators can inform more effective, tailored strategies to support the rural health care workforce.