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Original Research

Development of the Nursing Community Apgar Questionnaire (NCAQ): a rural nurse recruitment and retention tool

Submitted: 17 April 2013
Revised: 25 July 2013
Accepted: 12 August 2013
Published: 4 March 2014

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Author(s) : Prengaman MV, Bigbee JL, Baker E, Schmitz DF.

Molly PrengamanJeri BigbeeEdward BakerDavid Schmitz

Citation: Prengaman MV, Bigbee JL, Baker E, Schmitz DF.  Development of the Nursing Community Apgar Questionnaire (NCAQ): a rural nurse recruitment and retention tool. Rural and Remote Health (Internet) 2014; 14: 2633. Available: (Accessed 18 October 2017)


Introduction:  Health professional shortages are a significant issue throughout the USA, particularly in rural communities. Filling nurse vacancies is a costly concern for many critical access hospitals (CAH), which serve as the primary source of health care for rural communities. CAHs and rural communities have strengths and weaknesses that affect their recruitment and retention of rural nurses. The purpose of this study was to develop a tool that rural communities and CAHs can utilize to assess their strengths and weaknesses related to nurse recruitment and retention.
Methods:  The Nursing Community Apgar Questionnaire (NCAQ) was developed based on an extensive literature review, visits to multiple rural sites, and consultations with rural nurses, rural nurse administrators and content experts.
Results:  A quantitative interview tool consisting of 50 factors that affect rural nurse recruitment and retention was developed. The tool allows participants to rate each factor in terms of advantage and importance level. The tool also includes three open-ended questions for qualitative analysis.
Conclusions:  The NCAQ was designed to identify rural communities’ and CAHs’ strengths and challenges related to rural nurse recruitment and retention. The NCAQ will be piloted and a database developed for CAHs to compare their results with those in the database. Furthermore, the NCAQ results may be utilized to prioritize resource allocation and tailor rural nurse recruitment and retention efforts to highlight a community’s strengths. The NCAQ will function as a useful real-time tool for CAHs looking to assess and improve their rural nurse recruitment and retention practices and compare their results with those of their peers. Longitudinal results will allow CAHs and their communities to evaluate their progress over time. As the database grows in size, state, regional, and national results can be compared, trends may be discovered and best practices identified.

Key words: instrument, nursing, recruitment, retention, workforce.

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