This research attempted to identify, classify and prioritize nursing competencies that are important for Critical Access Hospitals in the state of Maine. The study used the Delphi Panel methodology. Registered nurses practicing in the rural setting need to be knowledgeable in a wide range of general skills. The published research of rural nursing is limited. It is hoped that this research helps nursing understand those competencies that are needed by rural nurse. It is possible for rural hospitals and nursing education to utilize the results of this study in planning for and promoting competent nursing practice in the rural environment. The Delphi Panel used in this study were five registered nurses who are nurse managers of Critical Access Hospitals in the state of Maine and three registered nurses who are faculty members of nationally accredited Schools of Nursing in the state of Maine. This Delphi Panel study used three rounds of survey instruments for each of the three Delphi rounds. The Round 1 instrument was one open-ended focus question requesting a listing of nursing competencies with four identification/categories that are best utilized for safe and competent nursing practice by registered nurses in rural hospitals, specifically Critical Access Hospitals of Maine. The Round 2 survey instrument was an importance rating by the panelist of the competencies received from the Round 1 instrument using an anchored scale. The Round 3 was a consensus survey of the final competencies with a resulting consensus of 100% agreement for all ratings. Results of this study identified nursing competencies that are unique to rural nursing.