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The Benefits and Challenges of Rural Nursing

This article explores the benefits and challenges of nursing in rural settings, including expanded practice, partnerships, limited education, maintaining competency, and addressing social determinants of health. The study also examines the impact of these factors on recruitment and retention in rural nursing.

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The Benefits and Challenges of Rural Nursing

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  1. The Benefits and Challenges of Rural Nursing Kim English, RN, BScN, MN, MSc (c)

  2. Overview • Defining Rural • Characteristics of Rural Nursing • International Perspective of Rural nursing • The Issue • Rural Context • Research in Progress • Emerging Themes • Conclusion

  3. Acknowledgements • Queens University Faculty of Nursing; • Nursing Secretariat Fund; • Dr. Jenny Medves & Dr. Dana Edge; • Trent Fleming School of Nursing • Site Administration and participants.

  4. RNR Study • For nurses working in LHIN 10 small rural hospitals, what are applicable retention strategies that foster an interprofessional collaborative work environment?

  5. Three Phases of RNR Study • Phase One • Environmental scan of each community • Focus groups and interviews with rural nurses • Phase Two • Development of community specific education interventions to address issues outlined by nurses in phase one • Phase Three • Comprehensive evaluation of intervention(s) • Development of sustainability plan to continue successful interventions

  6. Defining Rural • Challenge to determine a definitive definition; • A lack of application of a rural lens to policy development and planning; • Chosen to use the CSD definition of rural and small town: refers to individuals in towns and municipalities outside the commuting zone of larger urban centres (with 10 000 or more population).

  7. Rural Nurses definition: • Kulig et. Al (2008) identified that rural nurses define their rural role within four themes: community characteristics, geographical location, health, human and technical resources, and nursing practice characteristics; • This is relevant because it provides a framework for how rural nurses define their practice and the effects of this definition on their practice.

  8. Characteristics of Rural Nursing • Benefits – role in community, expanded practice & partnerships; • Challenges- limited education, maintaining competency, scope of practice & confidentiality;

  9. Issues of geographical isolation: carrying the burden of responsibility; • Issues of professional isolation: maintaining practice excellence in distant settings; • Issues contributing to the health status of communities: addressing social determinants of health; and, • Issues of cultural safety: fitting with the rhythms and values of the community. • MacLeod, Browne & Leipert, 1998

  10. Lower education levels; • Older; • May be in a part time position for far longer than urban counterparts; • Lack access to many resources – human, clinical, information and technical • Expected to be generalist\specialists;

  11. The Issue • Nursing Shortage • Aging workforce • Quick fix approaches

  12. Rural Context • It is anticipated the shortage will be greater for rural organizations • This is due to inability to compete, the realities of rural practice and the expectations for RNs in rural settings

  13. RNR Study • The problem… While urban hospitals are experiencing a shortage of nurses, rural hospitals have noticed this trend earlier… To lose one nurse out of a group of 20 is much more critical than losing one out of group of 50.

  14. Research Question • What are the benefits of nursing in a rural setting? • What are the challenges of nursing in a rural setting? • How do the benefits and challenges influence recruitment and retention?

  15. Design Utilizing a critical ethnographic approach to gain an understanding of the culture of the environment where rural nurses work; Critical ethnography addresses the social, political, and economic dimensions of cultures; It is an appropriate approach for exploring issues relevant to the practice of nurses in rural settings;

  16. Culture • Culture of the community; • Culture of the organization – both urban & rural; • Culture of the nursing staff

  17. Sample Challenging to obtain adequate numbers of participants in rural settings; Convenience sample of nurses working in the chosen setting; Recruitment process

  18. Setting Small rural hospital located in LHIN 10; Consists of an ER and 10 inpatient beds; The community has a total population of 3 838; According to Statistics Canada data, there has been very little migration into or out of the area.

  19. Data Collection and Procedures Literature review reflective of recruitment, retention and practice issues for rural nurses; Observation during consolidated fieldwork; Development of field notes – which may prompt more focused observations; Individual interviews with key informants.

  20. Data Analysis Begin with a description of the cultural context (Hardcastle et. Al. 2006) This includes identifying social interactions, routines, roles and power relations; Concurrently, this involves my involvement and capturing my feelings and thoughts about occurrences; Data will be coded and categorized to identify themes and patterns

  21. Line by line analysis with transcripts of interviews; Information will then be compared to field observations; Constant “checking in” regarding my own involvement will be essential; “thick description” of field notes and interview data will provide the story of this organization; Data will be reviewed with the participants to ensure that it is reflective of their experience.

  22. Ethical Considerations Queens REB; QHC Ethics Board; CNO professional expecations.

  23. Expected Outcomes Greater understanding and appreciation of the cultural context of rural nursing; Identification of recruitment and retention strategies; Adding to what is known about the nature of rural nursing practice.

  24. Emerging Themes • Rural practice is different than urban; • Rural nursing is a specialty that is not valued within the profession; • Amalgamations with larger urban organizations enhance this effect; • Significant recruitment challenges; • How do you prepare new nurses to work in these settings

  25. The Irony… • We desperately need to prepare nurses to work in rural settings, BUT…. How do you do that!

  26. Implications for Nursing Practice • Recognition that we do need to think differently about rural nursing; • There is a need to be innovative in both recruitment and retention strategies; • As a profession, we need to be supportive of our rural colleagues and recognize their work; • At a policy level – we need to broaden our lenses…this includes our nursing regulations.

  27. Questions and Discussion

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