Aim—The aim of the present study was to determine whether there are differences in hospital
characteristics, nursing unit characteristics, the nurse work environment, job satisfaction and
turnover rates in rural and urban nursing units.
Background—Research in urban hospitals has found an association between the nurse work
environment and job satisfaction and turnover rates, but this association has not been examined in
rural hospitals.
Method—Rural and urban nursing units were compared in a national random sample of 97
United States hospitals (194 nursing units) with between 99 and 450 beds.
Results—Significant differences were found between hospital and nursing unit characteristics
and the nurse work environment in rural and urban nursing units. Both nursing unit characteristics
and the work environment were found to have a significant influence on nurse job satisfaction and
turnover rates.
Conclusion—Job satisfaction and turnover rates in rural and urban nursing units are associated
with both nursing unit characteristics and the work environment.
Implications for nursing management—Both rural and urban hospitals can improve nurse
job satisfaction and turnover rates by changing unit characteristics, such as creating better support
services and a work environment that supports autonomous nursing practice. Rural hospitals can
also improve the work environment by providing nurses with more educational opportunities.