Voices from the wilderness: an interpretive study describing the role and practice of outpost nurses.

Abstract

Outpost nurses function as primary care providers and in a community health nursing role, providing comprehensive primary health care in Canada's underserved northern communities. Little information exists regarding how outpost nurses meet this expectation. The purpose of this interpretive study was to address the following research questions: 1) How do experienced outpost nurses perceive and enact their role? 2) How are practical knowledge and clinical wisdom revealed in the practice narratives of experienced outpost nurses? Purposive sampling was used to recruit the nine experienced outpost nurses who participated by sharing narratives of clinical practice. Data analysis was conducted in accordance with Benner's model of interpretive phenomenology. Paradigm and exemplary cases served to ground the interpretation in the data. Four themes emerged from the data: a) primary care competencies are fundamental to outpost practice, b) nurses evolve into the outpost role by learning community health competencies and adapting to context-specific practice issues, c) experienced outpost nurses build and maintain responsive relationships with communities, and d) experienced outpost nurses become comfortable with the autonomy and responsibility of practice. The findings of this study reinforce the complex nature of outpost nursing; it is an anomalous community health nursing role grounded in primary care competency. Interpretation of the data suggests that outpost nurses share practice domains and competencies with nurse practitioners. A better understanding of the outpost nursing role clarifies how nurses might better contribute to improving the health status of northern residents, helping northern communities become healthy communities.