A Detailed Examination of the Rural Registered Nurse and Licensed Practical Nurse/Licensed Vocational Nurse Populations: Evidence to Support Holistic Workforce Planning

Abstract

Background

Research regarding the rural nursing workforce in the United States prior to the COVID-19 pandemic suggested steady growth but lagging diversity and educational attainment. Limited data are available regarding the effects of the global health crisis on the rural nursing workforce.

Purpose

To extend the literature on the rural nursing workforce and examine the impact of the COVID-19 pandemic on rural nurses’ self-reported emotional exhaustion and intent to leave.

Methods

The National Council of State Boards of Nursing’s 2022 National Nursing Workforce Survey was used for this analysis. Rural–Urban Commuting Area (RUCA) codes developed by the University of Washington and the U.S. Department of Agriculture Economic Research Service were used to classify providers’ primary place of employment as either urban or rural.

Results

In total, 3,480,612 registered nurses (RNs) and 669,338 licensed practical nurses/licensed vocational nurses (simply referred to as licensed practical nurses, or LPNs, throughout the study) were represented in the analysis. Rural RNs were significantly older (aged 47.6 vs. 45.9 years), were less diverse (male 10% vs. 12%; White/Caucasian 92% vs. 78%; Hispanic/Latino 3% vs. 8%), and reported lower educational attainment (baccalaureate 54% vs. 40%) than their urban peers. Rural LPNs were also less diverse than urban LPNs (male 6% vs. 12%; White/Caucasian 92% vs. 78%; Hispanic/Latino 3% vs. 8%), but they were similar in age (47.2 vs. 48.0 years) and education attainment (vocational/practical certificate 73% vs. 70%). More than half of all nurses reported some form of regular emotional exhaustion; results were consistent across RUCA classification. Practitioners younger than 35 years in both urban and rural areas reported significantly elevated workloads during the COVID-19 pandemic and heighted emotional distress, driving 12%–16% of these younger respondents to indicate they intend to leave nursing by 2027.

Conclusion

The rural nursing workforce in the United States provides a vital lifeline to patients who often present with more complex health issues and experience poorer health outcomes. Sustainable workforce development and planning requires attention to the impact of the COVID-19 pandemic on rural nurses’ emotional exhaustion and intent to leave. The work of the National Council of State Boards of Nursing on these issues provides critical insight to ensuring the timely and equitable delivery of high-quality care to all Americans.