Global Challenges in Rural Nursing: A Systematic Review and Meta‑Analysis of Recruitment, Retention, and Practice Across Europe and Asia
Description
This systematic review and meta-analysis examines the persistent challenges facing rural nursing workforces in Europe and Asia, focusing on recruitment, retention, and practice experiences. Drawing on 20 studies published between 2000 and 2025, the research integrates quantitative and qualitative evidence to identify both shared and region-specific determinants affecting rural nurses. Quantitative findings reveal that rural nurses in both regions are significantly more likely to express intent to leave their positions compared to urban counterparts. The pooled odds ratio was 1.5 in Europe and 1.7 in Asia. Job satisfaction was notably lower among rural nurses, with standardized mean differences of –0.32 in Europe and –0.28 in Asia. Burnout levels were higher in Asia (SMD = 0.35) than in Europe (SMD = 0.25), and five-year retention rates were 62% in Europe versus 48% in Asia. These disparities highlight systemic issues such as resource limitations, migration pressures, and policy gaps. Thematic synthesis of qualitative studies identified four overarching challenges: professional isolation, expanded scope of practice, community embeddedness, and the tension between personal sacrifice and professional fulfillment. European studies emphasized policy incentives and intra-EU mobility, while Asian studies highlighted family obligations, international migration, and infrastructure deficits. Subgroup and meta-regression analyses further revealed that lower-middle-income Asian countries had higher turnover intent, and community nurses experienced greater burnout than hospital-based peers. GDP per capita was inversely associated with turnover intent, underscoring the influence of economic context. Policy recommendations include enhancing professional development and harmonizing incentives in Europe, and investing in rural infrastructure and family-supportive policies in Asia. Globally, the study advocates for context-sensitive workforce strategies aligned with WHO guidelines and encourages cross-regional learning. Overall, the review underscores the urgent need for tailored interventions to address rural nursing shortages, balancing universal challenges with region-specific realities to ensure equitable healthcare access across diverse settings.