Bronwyn E. Fields, Janice F. Bell, Jeri L. Bigbee, Holly Thurston, Joanne Spetz

Recruitment and retention of nurses is an ongoing challenge for employers in rural areas worldwide. There is limited information available regarding influences on nurses' job choice in the U.S. and little understanding of how nurses make trade-offs between desired and less desirable job characteristics when choosing between jobs. The purpose of this research was to examine the hospital job preferences of registered nurses in the U.S. The specific objectives of the study were: 1) To identify the relative importance of key job attributes on registered nurse job choice, and 2) To predict the impact of changes in the levels of attributes on the probability of registered nurses choosing one job over another. A discrete choice experiment was developed and applied in the U.S. using California as a study site. 190 registered nurses currently working in nursing or intending to return to work in nursing from urban, large-, small- and isolated-rural communities. The survey instrument was developed through a literature review and semi-structured interviews with nurse experts, utilizing a hypothetical job in a hospital medical / surgical unit. Experimental design principles were applied to create a discrete choice experiment which was pilot tested with urban and rural nurses. The survey was mailed to a random sample of 1000 licensed registered nurses in California. A mixed logit model was used to estimate nurses' preferences for different levels of the job attributes. Willingness to pay estimates and simulations of job uptake rates were calculated. Eight factors were identified as important to job choice: earnings, nursing voice in management, tuition reimbursement, scheduling, patient care team, leadership, location and nursing sensitive patient care outcomes. Respondents valued a cohesive patient care team (coefficient 1.95, [SE 0.23]) and a strong nursing voice in management (coefficient 1.56, [SE 0.22]) highest. A job in a large urban inland location was negatively valued (coefficient -0.69, [SE 0.25]). Around 72% of respondents chose to stay in their current job when this choice was offered. While earnings were important, nurses were willing to sacrifice earnings to secure other valued job characteristics when choosing between jobs. Study findings provide information on how job characteristics are valued by nurses in California. Findings suggest job seekers may be 65-75 percent more likely to choose a job when valued job characteristics are present. Our findings are particularly relevant to rural hospitals with limited financial resources.