Influence of Professional and Physical Isolation on Enabling Evidence-based Nursing Practice in Rural Hospitals

Objective: Measure the level of influence of the rural hospital nurse executive's perception of rural hospital isolation (professional and physical) on problems encounter in enabling evidence-based nursing practice while controlling for hospital type (rural or critical access hospital).

Design: A mail or phone survey of a national sample of rural hospital nurse executives was completed using the Rural Hospital Nurse Executive Survey (NES). The NES consists of 104 continuous and categorical items. There are four items on the isolation scale that convey the perception of influence of professional and physical isolation on nursing and patient outcomes. The evidence-based practice (EBP) scale consists of seven items that represent the problems encountered by rural nurse executives in enabling evidence-based nursing practice. A four point response format is used in both scales which were summed for a total score.

Population: A national sample of 279 rural hospital nurse executives completed the survey with a response rate of 41 % (279/688) representing 185 (66%) rural and 94 (34%) critical access hospitals.

Results: Cronbach's alphas for the isolation (á =.86) and EBP (á =.85) scale were acceptable. For rural hospital nurse executives, isolation explains 15% of the variance in enabling evidence-based practice (b= .780, p<.000). The majority of nurse executives (69%) perceive that enabling evidence-based practice is a moderate or big problem, reporting that major barriers in the rural setting include wearing many hats (89%), no time (75%) and the availability of an expert (71%).

Conclusion: As the perception of physical and professional isolation increase, enabling evidence-based nursing practice is more difficult in rural hospitals. Evidence-based nursing practice is central to professional practice and promotion of better patient outcomes. Strategies to overcome physical and professional isolation need to include increased availability of experts to rural hospitals to promote use of evidence in practice, promoting the health of rural residents.