THE BENEFITS AND CHALLENGES OF RURAL NURSING

Kim English, RN, BScN, MN, MSc (c)

Overview

Defining Rural Characteristics of Rural Nursing International Perspective of Rural nursing The Issue

Rural Context Research in Progress Emerging Themes

Conclusion

Acknowledgements

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

RNR Study

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

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

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).

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.

Characteristics of Rural Nursing Benefits – role in community, expanded

practice & partnerships; Challenges- limited education,

maintaining competency, scope of practice & confidentiality;

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

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;

The Issue

Nursing Shortage

Aging workforce

Quick fix approaches

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

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.

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?

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;

Culture

Culture of the community; Culture of the organization – both urban

& rural; Culture of the nursing staff

Sample

Challenging to obtain adequate numbers of participants in rural settings;

Convenience sample of nurses working in the chosen setting;

Recruitment process

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.

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.

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

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.

Ethical Considerations

Queens REB; QHC Ethics Board; CNO professional expecations.

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.

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

The Irony…

We desperately need to prepare nurses to work in rural settings,

BUT…. How do you do

that!

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.

Questions and Discussion

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