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"Background: Rural hospitals provide greater than 20% access to healthcare for those living in rural America. Many of the populations served are low income, elderly, or geographically distant from other hospitals. Adequate numbers of RNs are needed to staff and supervise unlicensed providers. Without adequate RN staffing, rural hospitals could close and threaten an already \u201Cfragile health system,\u201D leaving many without access to healthcare services. Purpose: The purpose of this qualitative study was to explore the critical influences that affect rural RNs\u2019 perceptions, attitudes, and behaviors in rural healthcare. Theoretical Framework: A grounded theory tradition was utilized to guide this study. Method: Twenty-one English speaking rural registered nurses who had at least one-year experience and had worked in rural health for at least one year within the past three years were interviewed. Three categories emerged from the data: kinship, persevering, and transforming. A limited focus group of two RNs was used to identify the dominant categories as well as core basic processes. Results: Dignity was the basic social process that evolved from the dominant categories. This conceptual model can be used to guide future intervention studies that will promote recruitment and retention of rural RNs. Conclusions: The conceptual model identified in this study may serve to increase RN retention and attract nurses to rural health care."
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