Doctor of Philosophy (PhD)


Human Resource Education and Workforce Development

Document Type



This study sought to identify nursing competencies most associated with good nursing practice in Critical Access Hospitals. The Delphi panel for this study consisted of seven rural health nurse experts who were currently employed as a Director of Nursing in a Critical Access Hospital. A survey instrument was developed for each of the three Delphi rounds. The Round One instrument consisted of two open-ended focus questions. The four classification headings used for the identified competencies included Clinical/Technical Skills, Critical Thinking Skills, Communication/Interpersonal Skills, and Management/Organizational Skills. The Round Two survey instrument was a compilation of the competencies received from the Round One instrument. The panelists were asked to rate the competency utilizing anchored scale. The Round Three survey instrument was dissimilar for each participant. The panel member was asked to rate the competency within one scale interval of the median or place their unique Round Two rating in this column and indicate why they believed their rating was more realistic. In the first round, a total of 149 competencies were submitted by the panel. These competencies were consolidated into 101 unique competencies. At the completion of the Round Two survey, one item was added and two competencies were combined into one competency. The third and final round resulted in a group consensus ranging from 71% to 100% on a total of 102 competencies. This research identified competencies unique to the Critical Access Hospital rural environment utilizing the Delphi approach. Nurses practicing in the rural setting are viewed more as generalists as opposed to specialists. Specific nursing areas including hospital nursing administration and nursing education can utilize the results of this study in planning for and promoting competent nursing practice in the rural environment. The researcher recommended additional studies that would further exemplify the uniqueness of rural nursing.



Document Availability at the Time of Submission

Release the entire work immediately for access worldwide.

Committee Chair

Krisanna L. Machtmes