Predictors of Inpatient RN Turnover in Rural and Urban VHA Hospitals.

Bay KG, Eck CS, Knox MK, Mehta P, Petersen LA. Predictors of Inpatient RN Turnover in Rural and Urban VHA Hospitals. Medical care. 2026 Jan 1; 64(1S Suppl 1):S9-S17, DOI: 10.1097/MLR.0000000000002213.

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Abstract:

BACKGROUND: The rising demand for health care delivery and an aging workforce is of particular concern in rural areas, where health care access depends upon an adequate nursing workforce. To address this shortage and optimize care, it is essential to measure when registered nurses (RN) leave inpatient direct care positions (ie, inpatient RN turnover) and identify modifiable factors correlated with RN turnover. OBJECTIVES: Apply a novel method for characterizing inpatient RN turnover to understand factors associated with variation in RNs leaving inpatient positions at rural and urban Veterans Health Administration (VHA) hospitals. PROJECT DESIGN: Retrospective cohort study. SUBJECTS: Direct care RNs working on VHA regular acute care units for at least 15 days across a 60-day period during fiscal year 2022. Measures: outcome: electronic health record (EHR)-derived RN turnover on inpatient medical, surgical, or mixed medical-surgical units; exposure: rurality of hospital location. RESULTS: Among the cohort of 10,415 inpatient RNs in FY22, 3537 RNs left inpatient direct care in FY22 (34.0%). There were 127 inpatient RN turnover events in rural VHA hospitals (42.8% of 297), compared with 3410 in urban (33.7% of 10,118) (P < 0.001). However, in the final mixed-effects logistic regression model, individual RN-specific features and care delivery structure, not rurality (P = 0.843), were more strongly associated with variation in turnover events. CONCLUSIONS: Inpatient RN turnover was greater in rural versus urban hospitals, but rurality alone was not associated with turnover after multilevel adjustment.