Our findings indicated that rural nurses were less likely to be bachelor of science in nursing (BSN) trained than their urban counterparts. Urban-rural differences in nurse training may be most important for hospitals and for two other settings with large gaps, skilled nursing facilities (SNFs) and home healthcare. In each of these contexts, nurses may be required to take immediate action without the ability to consult with a healthcare provider, particularly in rural areas, making nurse preparation more essential.

Our findings support previous research indicating that nursing wages differ across practice settings and geography. Rural nurses earned less, on average, than their urban counterparts regardless of nursing education level, which may affect the willingness of rural associate degree in nursing (ADN) nurses to pursue further education. Nurses report that the principal barrier to enrolling in registered nurse (RN) to BSN programs is cost, followed by questions about the return on investment/value of a BSN degree. For rural RNs in a hospital or SNF setting, the roughly $8,000 salary difference between the ADN- and BSN-prepared nurse may be attractive – if the nurses believe that job openings at the higher salary level are present in their communities.