Rural Nurses Research Articles

Australian rural emergency nurses' care of paediatric patients: A qualitative study

BackgroundRural emergency nurses (RENs) are expected to provide care to paediatric patients presenting to their facilities however, as generalist nurses, they experience challenges and feelings that are unique to the rural context. Design and methodsAn exploratory qualitative study of 13 RENs via semi structured interviews of perceptions and experiences of caring for paediatrics and self-determination of autonomous practice, motivations and connectedness in care was the approach used. FindingsInductive thematic analysis of data identified four themes with sub-themes identified within each theme. The four themes were: Caring for Children, Professional Roles, Professional Care and Connection and Professional Development. ConclusionRENs describe feeling fear, stress and anxiety when caring for sick children, particularly when known to the patient and family in their community yet will self-determine autonomous practice and use gatekeeping in certain situations of paediatric care. RENs are motivated to increase their paediatric knowledge and skills, seeking paediatric education opportunities but face barriers in attendance such as travel and costs. RENs rely on connectedness with other rural nurses, seeking paediatric nursing guidance or telehealth support, particularly when performing multiple roles or in the absence of a doctor in the ED. Practice implicationsProvision of opportunities for RENs to lead education in paediatric nursing, that is contextually appropriate and co-designed with paediatric experts is preferred. This would yield greater REN engagement and participation in paediatric education for knowledge and skill proficiency, would increase rural nurse professional development and reduce feelings of fear and anxiety when caring for paediatrics.

A philosophical exploration of rural health and nursing based on an undergraduate United States-Australian collaboration through the lens of 'positionality'.

Growing nursing workforce maldistributions impede rural healthcare access globally. In-depth exploration of underlying philosophical ideas about rural health in nursing curricular could support recruitment and retention of nurses who are well positioned to support and advocated for health care and services relevant to their communities. Through a lens of positionality, the purpose of this paper is to explore rural health and nursing within the United States and Australia from the perspective of undergraduate students. Recognizing that both countries have 'first world' health services, issues of access to services associated with systemic and structural biases were significant features identified by participants. Their perceptions were supported by discussion with attendees of the 26th International Nursing Philosophy Conference from several countries, during a presentation titled 'What is different about rural health nursing: A philosophical exploration.'This international consistency suggests that systemic and structural biases are global phenomena. While exposure to rural health and rural nursing may be beneficial for recruitment, preparing nurses for rural practice requires more than educating students to complete clinical tasks. Uncovering collaboration, advocacy and policy development opportunities for nurses in rural communities could move the dial from recruiting rural nurses to fulfill immediate needs to retention of well-educated and highly skilled nurses. Building a stronger philosophical base for rural healthcare inclusive of all people, honouring their distinguishing characteristics such as age, gender, ethnicity, is long overdue. Positionality can inform how nurses across the globe relate to other countries' governments, cultures, norms, values, expectations, etc., which can influence the advancement of the profession and address social inequities among rural populations.

Rural Nurses’ Work-Life Balance and Home-Life Satisfaction in a Level 1 Government Hospital in Leyte: A Qualitative Study

Rural Nurses’ Work-Life Balance and Home-Life Satisfaction in a Level 1 Government Hospital in Leyte: A Qualitative Study

Providing microbiology education to rural nurses: A case study

Objective: This case study assesses a microbiology and infection control education workshop delivered to rural nurses. The study assesses workshop value through changes in respondents’ self-assessed confidence using measures of microbiology knowledge, teaching, and best practice. Respondents also identified the aspects of the education perceived as most useful to their practice and barriers to implementing microbiology education in practice. Study design and methods: Pre- and post-workshop surveys were administered to the participants. The surveys used a 7-point ordinal scale to measure respondents’ confidence in explaining key concepts and their perception of the influence of such education opportunities on positive patient outcomes. Change in ratings was analysed using Wilcoxon signed-ranks tests; whilst the open-ended survey responses were analysed using a manifest content analysis. Results: All thirteen nurses who participated in the education workshop responded to both surveys. The results demonstrated a significant increase post-workshop in confidence measures and belief that microbiology and infection control education influence positive patient outcomes. The perceived barriers to implementation of microbiology education in practice included poor organisational culture, lack of access to training, and lack of resources. Discussion: This case study describes a method of providing microbiology education to rural nurses and highlights the benefit of this access, particularly in the mode of face-to-face learning. A suggestion for future iterations of the program is to include content that would support nurses’ implementation of theory to practice. Conclusion: A face-to-face microbiology and infection prevention workshop, which enables participants to discuss content and undertake a tour of the pathology laboratory for practical insights, enhances nurses’ self-rated confidence on this topic. Implications for research, policy, and practice: This study demonstrates the significance of microbiology education for rural nurses and describes how this can be undertaken in practice, with insight provided on the most valued aspects. It also shows the importance of supporting in-person education. Future research could address the medium to long terms effects of this education for nurses and their practice. What is already known about the topic? Access to continuing professional development is difficult for rural nurses, particularly in comparison to their urban counterparts. Nurses hold a vital role in infection prevention and infection control. Increased knowledge leads to positive patient care and positive patient outcomes. What this paper adds It demonstrates that providing microbiology education to rural nurses increases their confidence in the topical area. It provides an example program for delivering microbiology education to rural nurses. It highlights the benefits of the face-to-face aspect of education and practical component of the laboratory tour.

The experiences and perceptions of rural and remote nurses who provide care to pregnant women in the absence of midwives.

Maternity unit closures in rural and remote settings of Australia have left a substantial gap in services for pregnant women. In the absence of midwives, and when women are unable to attend a maternity facility, registered nurses (RNs) are required to fill the void. While maternity education can attempt to prepare RNs for such encounters, there is little documented to suggest it meets all their physical and psychological needs. The existing challenges for health professionals, practising a vast generalist scope of practice while living and working in a rural and remote location, have been well researched and documented. How nurses feel about the expectation that they work outside their scope of practice to provide maternity care in a rural and remote setting in Australia has not been asked until now. This study explores the perceptions and experiences of RNs who find themselves in this situation. The study utilised a hermeneutic phenomenological methodology to examine the experiences and perceptions of rural and remote nurses providing care for pregnant women. RNs working in rural and remote health facilities that had no maternity services were recruited by a purposive sampling method. Semistructured conversational interviews were recorded and transcribed verbatim. Data analysis was guided by van Manen's analytical approach. Eight nurses participated, and from the data three themes, each with several subthemes, emerged: 'being-in-the-world of the rural and remote nurse' - described how participants viewed rural and remote nursing as an entity with unchangeable aspects that could not be considered in isolation; 'scope of practice - unprepared or underprepared' described how, despite their existing and extensive nursing skills, participants felt ill-equipped theoretically, practically and mentally to care for pregnant women; 'moral distress' - participants expanded their feelings of unpreparedness to include inadequacy, fear, and appropriateness of care delivery. The realism of rural and remote nursing practice demonstrates that at some point in their career, rural and remote nurses will care for a labouring and/or pregnant woman at high risk for complications. Participants in this study appeared open and honest in their interviews, displaying pride at their extensive nursing skills and job satisfaction. However, they were unanimous in their discussions of what being a nurse and providing maternity care in a rural and remote setting meant to themselves and to pregnant women. They suggested care was fragmented and inadequate from a workforce that is inadequately prepared and stressed. This study has highlighted another concerning aspect of rural and remote midwifery care - the experiences and perceptions of eight nurses delivering care that has previously been overlooked. The united voice of the RNs in this study warrants a platform to speak from and deserves acknowledgement and attention from government and midwifery policy drivers. These nurses, and the women receiving their care, deserve more.

Rural Nurse Practitioner Workforce Issues: Rural RNs as Potential Untapped Resource

Rural Nurse Practitioner Workforce Issues: Rural RNs as Potential Untapped Resource

Publishing Rural Nurse Stories in a Book Has Impact

Publishing Rural Nurse Stories in a Book Has Impact

A Process to Inform Rural Nursing Workforce Planning and Development

With many rural health workers approaching retirement age, a local district in Aotearoa New Zealand embarked on a project to identify the current status of the nursing and kaiāwhina (support worker) workforce to develop a visionary plan for the future to match community health needs. There were four-stages to the project: 1) profile the current population and health resources available in the community; 2) profile the current nursing workforce; 3) survey local nurses regarding their current work and future plans; and 4) seek perspectives of local nurses, health managers and community representatives on strategies to sustain a future nursing workforce. This paper focuses on the first two stages of this project. Using postcodes as a geographic locator, the parameters of the health service catchment were established. Local council and census data relating to the catchment were used to build the district’s profile, while websites provided information on current health service availability. Nursing annual practising data linked to postcodes provided the nursing workforce profile. The finalised framework was designed to inform a future match between the nursing workforce and the district’s community’s health needs. Replication of the process, this profiling framework, has the potential to benchmark progress with nursing workforce development over time, as well as benchmark nursing workforce capacity between rural localities. The findings from the profiling allowed us to demonstrate the uniqueness of the district’s population, the health services available, and both the precariousness and potential of a nursing workforce. Te reo Māori translation He hātepe hei kawe whakamua i te whakamaheretanga tapuhi tuawhenua me te whakawhanaketanga Ngā ariā matua Nā runga i te tatanga o te huhua o ngā kaimahi hauora tuawhenua ki te reanga tuku mutunga mahi, i whakarewaina e tētahi rohe whāiti i Aotearoa tētahi kaupapa hei tautuhi i te tūnga o te kāhui kaimahi tapuhi, kaiāwhina hoki, hei tārei i tētahi mahere matawhānui mō āpōpō, kia hāngai ki ngā hiahia hauora o te hapori. E whā ngā kauwhata o te kaupapa: 1) he kawe i tētahi inenga o te kōtaha taupori, me ngā rawa hauora e wātea ana i te hapori; 2) he ine i te kāhui kaimahi tapuhi o nāianei; 3) he uiui i ngā tapuhi o te rohe mō tō tātou mahi o nāianei, me ō rātou mahere mō āpōpō; me te 4) rapu whakaaro o ngā tapuhi o te rohe, ngā kaiwhakahaere hauora me ngā kanohi hapori mō ngā rautaki whakaū i tētahi kāhui tapuhi toitū mō ngā rā e heke mai nei. E anga ana tēnei tuhinga ki ngā kauwhata tuatahi e rua o tēnei kaupapa. Nā te whakamahinga o ngā waehere poutāpeta hei tūtohu takiwā, i tātaitia ngā taupā mō te whānui o te rohe hauora. I whakamahia ngā raraunga kaunihera ā-rohe, ngā raraunga tatauranga hoki mō te rohe, hei whakapūmau i te kōtaha o te takiwā, ā, i whakamahia hoki ngā pae tukutuku hei hora mōhiotanga mō te wāteatanga ratonga hauora o nāianei. Nā ngā raraunga mahi tapuhi ā-tau i paiheretia ki ngā waehere poutāpeta i hora te kōtaha kāhui kaimahi tapuhi. I āta hoahoatia te anga i whakaotingia kia whakamahia hei pou tūtohu mō te whakatairitenga o te kāhui kaimahi tapuhi ki ngā hiahia hauora o te hapori o te takiwā. Ki te tukuruatia tēnei hātepe, mā te whakamahi i te anga ine i te āhua o te takiwā, ka taea pea te tirotiro mehemea kei te eke te whanaketanga kāhui tapuhi ki ngā tohu i whakaritea, waihoki, te tirotiro mehemea kei te eke haere te raukaha kāhui tapuhi ki ngā rohe tuawhenua maha. Nā ngā kitenga o tēnei inenga i āhei ai mātou ki te whakaahua i te āhua motuhake o te taupori o te takiwā, i ngā ratonga hauora hoki e wātea ana, me te tītengi, te pitomata hoki o tētahi kāhui tapuhi. Ngā kupu matua: Aotearoa, te ine i te hapori, te kāhui kaimahi hauora tuawhenua, te tapuhi tuawhenua, ngā ratonga tapuhi tuawhenua, te whakmahere kāhui kaimahi

The impact of incentive scheme on rural healthcare workforce availability: a case study of Kazakhstan

BackgroundDuring the 1990–2000, Kazakhstan experienced a decline in the number of healthcare professionals working in rural areas. Since 2009, the national government has been implementing financial incentives to encourage healthcare professionals to relocate to rural areas. This study aims to investigate the temporal and spatial patterns in the distribution of the rural healthcare workforce and evaluate the impact of this incentive scheme.MethodsInterrupted Time Series Analysis using ARIMA models and Difference in Differences analyzes were conducted to examine the impact of the incentive scheme on the density of different categories of the healthcare workforce in rural Kazakhstan in the period from 2009 to 2020.ResultsThere was a significant increase in the number of rural healthcare professionals from 2009 to 2020 in comparison to the period from 1998 to 2008. However, this increase was less pronounced in per capita terms. Moreover, a decline in the density of internists and pediatricians was observed. There is substantial variation in the density of rural nurses and physicians across different regions of Kazakhstan. The incentive scheme introduced in 2009 by the government of Kazakhstan included a one-time allowance and housing incentive. This scheme was found to have contributed insignificantly to the observed increase in the number of rural healthcare professionals.ConclusionFuture research should be undertaken to examine the impact made by the incentive scheme on other medical subspecialties, particularly primary practitioners. Addressing the shortage of healthcare workers in rural areas is a complex issue that requires a multifaceted approach. Aside from financial incentives, other policies could be considered to increase relocation and improve the retention of healthcare professionals in rural areas.

Nurse Navigators - Champions of the National Rural and Remote Nursing Generalist Framework: A solution.

Nurse Navigators were introduced in Queensland, Australia, in 2016. Nurse Navigators coordinate person-centred care, create partnerships, improve care coordination and outcomes and facilitate system improvement, independently of hospital or community models. They navigate across all aspects of hospital and social services, liaising, negotiating and connecting care as needed. People stay with Nurse Navigators for as long as required, though the intent is to transition them from high-care needs to self-management. Nurse Navigators are a working model in rural and remote areas of Queensland. To describe where the rural and remote Nurse Navigator position fits within the Rural Remote Nursing Generalist Framework and to define the depth and breadth of the rural and remote Nurse Navigator's scope of practice. Using template analysis, data from focus groups and interviews were analysed against the domains of the recently released National Rural and Remote Nursing Generalist Framework. Navigators working in rural and remote areas across Queensland Health were invited to an interview (n = 4) or focus group (n = 9), conducted between October 2019 and August 2020. Rural and remote Nurse Navigators are proficient in all domains of the framework and actively champion for their patients, carers and the communities where they live and work. This research demonstrates that rural and remote Nurse Navigators are a working model of advanced nursing practice, acting as 'champions' of The Framework. The Nurse Navigator model of care introduced to Queensland exemplifies proficient registered nurse practice to the full extent of their knowledge and skill.

Rural home care nurses’ experiences with continuing nursing education

Purpose: Rural home care nurses require access to continuing nursing education to address the increasing complexity of client care needs. There is currently limited literature on continuing nursing education for rural home care nurses. The purpose of this study was to explore the continuing nursing education experiences of rural home care nurses. Sample: Purposive and snowball sampling were used to recruit registered nurses who worked in publicly funded rural home care in one western Canadian province, in communities with a population of less than 10,000 people. Twenty rural home care nurses participated in semi-structured telephone interviews. Methods: This study used interpretive description as its method of inquiry and analysis. Data was collected between December 2020 and May 2021 and the analysis was supported using NVivo 12 software. Findings: Key findings from this study contribute to the description of western Canadian rural home care nursing roles and the degree of autonomy required to provide expert care in the home environment. Rural home care nurses’ experiences with continuing education are impacted by external factors including (1) Chameleonic Practice (One-Person Show, Professional Intersection, Becoming their Person), (2) Foundational Instability (Roadblocks to Learning, Stretched Thin, Rural Repatriation) and (3) Learning Leadership (Filling the Learning Bucket, Finding a Way, Learning Reciprocity). Conclusions: The findings of this study suggest that the continuing nursing education experiences of rural home care nurses is dependent on many factors. Significant policy changes and updated standards of practice are required to support safe client care through the delivery of evidence-informed continuing nursing education.

Study supports for rural mature-aged university health students: a Stakian multicase study

Background The participation and success of university health students in rural areas is critical in addressing the maldistribution of the rural health workforces internationally. Particular attention to the experiences of mature-aged health students is needed to build a sustainable rural health workforce, given the higher proportions of mature-aged university students in rural, regional and remote areas compared with metropolitan areas and rural mature-aged students wanting to stay in their communities. However, little is known about the kinds of supports rural mature-aged students require to succeed with their studies.Methods Drawing on rural standpoint theory and using structural inequality as a retention lens, we explored the current and potential supports that rural mature-aged nursing and allied health students require to successfully participate and complete their pre-professional university course. A Stakian multicase study was undertaken with cases at three rural university campuses in Australia. The data collection was primarily qualitative, with semi-structured interviews, campus surveys and focus groups involving 36 participants (including students, academic and professional staff, and placement supervisors).ResultsThis study found supports were provided formally and informally by the university, by the community and manifested by students. Several support gaps as well as potential supports to alleviate them were identified. These include formally acknowledging the mature-aged cohort and their diverse experiences and non-university commitments; fostering connections between mature-aged students; making university affordable; preparing mature-aged students for university; adapting course content and delivery; and restructuring placements for mature-aged students.ConclusionsWe argue that rural mature-aged nursing and allied health students require supports that are age-specific, appropriate to the community context, and harness existing relational processes of rural university campus activity. Rural university campuses need to involve rural mature-aged students and other stakeholders relevant to each context in the process of identifying and implementing student supports for this cohort.

New Graduate Nurse Transition into Rural Home: A Case Study.

The global shortage of nurses and high attrition rates for newly graduated nurses along with the shifting demand for home care has created a critical need for retention strategies that address the specific challenges of rural settings. The effectiveness of structured transition or mentoring programs are primarily studied in acute care settings, making it difficult to translate to the unique context of rural home care nursing. The complexities of the independent nature of home care nursing practice and limited resources to address transition shock make it difficult to successfully transition newly graduated nurses to rural home care. A case study supports mentorship facilitation as a readily available, effective strategy that can overcome the challenges of rural home care settings. A comparative analysis will link Duchscher's (2008) transition shock theory to mentorship as an effective strategy for supporting NGNs' transition in home care nursing. Recommendations offer rural care leaders practical strategies bundled with mentorship to optimize the successful transition and retention of newly graduated nurses in their workplaces.

Exploring the Multifaceted and Multifunctional Roles and Activities of Rural Nurse Managers

Exploring the Multifaceted and Multifunctional Roles and Activities of Rural Nurse Managers

A Qualitative Study of Systems-Level Factors That Affect Rural Obstetric Nurses’ Work During Clinical Emergencies

Maternal morbidity and mortality is rising in the United States. Previous studies focus on patient attributes, and most of the national data are based on research performed at urban tertiary care centers. Although it is well understood that nurses affect patient outcomes, there is scant evidence to understand the nurse work system, and no studies have specifically studied rural nurses. The authors sought to understand the systems-level factors affecting rural obstetric nurses when their patients experience clinical deterioration. The research team used a qualitative descriptive approach, including a modified critical incident technique, in interviews with bedside nurses (n = 7) and physicians (n = 4) to understand what happens when patients experience clinical deterioration. Physicians were included to better understand the systems in which nurses work. Clinicians were interviewed at three rural hospitals in New England, with a mean births per year of 190. Six systems-level factors/themes were identified: (1) shortages of resources; (2) need for teamwork; (3) physicians' multiple conflicting and simultaneous responsibilities, such as seeing patients in the office while women labor on the hospital floor; (4) need for all team members to be at the top of their game; (5) process issues during high-acuity patient transfer, including difficulty finding available beds at tertiary care centers; and (6) insufficient policies that take low-resource contexts into account, such as requiring two registered nurses to remove emergency medications from the medication cabinet. Rural nurses need policies and protocols that are written with their hospital context in mind. Hospitals may need outside support for content expertise, but policies should be co-created with clinicians with rural practice experience.

“This Has Changed Everything”: The Impact of the COVID-19 Pandemic on School Nursing Practice in New Mexico

As state and local government implemented school closures in response to the COVID-19 pandemic, school health services delivery experienced a fundamental change. School nurses were confronted with significant challenges to care for their students, while responding to the avalanche of public health responsibilities thrust upon them without training or resources. This qualitative study, conducted by a community-based participatory research partnership explored school nurses’ experiences and perspectives in urban and rural communities across New Mexico. Thirty-four school nurses participated in semi-structured qualitative interviews identifying 3 distinct pandemic stages and the following themes: 1) change/confusion of school nurse identity; 2) mental health challenges and stressors; and 3) lessons learned. These study results provide contextual depth to challenges that both urban and rural school nurses in New Mexico experienced during the pandemic and outline the important role school nurses have during public health emergencies in school settings.

Evaluation of a pilot online education program to develop midwives’ knowledge, skill and confidence in perinatal mental health in rural South Australia

One in five women will experience perinatal anxiety and/or depression. In South Australia, a rural health service identified a high proportion of women with risk of perinatal mental health challenges and sought additional education for midwives. In response, a six-week facilitated, online perinatal mental health education program (e-PMHEP) was piloted. AimThe aim of this study was to evaluate the effectiveness of the (e-PMHEP) for rural midwives, nurses and Aboriginal maternal infant care practitioners. MethodProgram evaluation incorporated a validated online pre/post survey to assess self-reported knowledge, skill and confidence regarding perinatal mental healthcare. Additional questions sought feedback on satisfaction and feasibility. FindingsSixteen participants from rural South Australia engaged in the project from June to August 2022. Twelve participants completed the online pre/post survey. The overall pre/post knowledge scores were statistically significant (t = 2.73, 8df, p = 0.025) with improvement from the pre to post-test. Pre/post data also showed a measurable increase in confidence and skills. All respondents agreed that the content addressed their learning needs and would recommend this program to other practitioners. DiscussionThe e-PMHEP appeared beneficial in developing knowledge, skills and confidence regarding perinatal mental healthcare in rural midwives and practitioners. Only a third of practitioners routinely developed a mental health care plan with women. Key strengths of the program included the accessible content, and the combination of an experienced mental health clinician and a facilitator with lived experience. ConclusionProviding an accessible, facilitated online perinatal mental health education program could be beneficial for rural midwives.

Increasing Rural Nursing Students’ Awareness of the Social Determinants of Health

Increasing Rural Nursing Students’ Awareness of the Social Determinants of Health

Giving Life to Learning Through Rural Maternal Health Immersion Experiences.

Recruiting, retaining, and educating nursing students is essential to meet the growing need for nurses in rural communities. A nursing school enhanced its prelicensure education in rural and public health nursing, and interprofessional care by expanding experiential learning opportunities. To describe longitudinal community health-based rural immersion experiences for prelicensure nursing students. A prospective, correlational design evaluated students' knowledge and confidence in understanding rural characteristics, confidence in achieving public health nursing, and interprofessional education competencies. Fourteen prelicensure nursing students participated in rural maternal health immersion experiences and reported being more confident (21/27 items) than knowledgeable (18/27) in understanding rural characteristics. Over 85% reported competency in interprofessional interactions, and there was a significant difference in confidence in achieving public health nursing competencies between the beginning and end of the immersion. Using immersion experiences may be effective in enhancing students' knowledge, confidence, and competency in rural and public health, and interprofessional care.

RE-AIM applied to a primary care workforce training for rural providers and nurses: the Department of Veterans Affairs' Rural Women's Health Mini-Residency.

Application of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate workforce education and training programs targeting clinical health care staff has received relatively little attention. This paper aims to contribute to this area with RE-AIM findings from a women's health-focused workforce training program implemented by the U.S. Department of Veterans Affairs (VA). Over the past two decades, the rapid expansion of the women Veteran population in VA has necessitated a quick response to meet clinical demand. To address this health care need, the VA Offices of Rural Health (ORH) and Women's Health (OWH) partnered to deploy a primary care workforce development initiative for Rural Providers and Nurses-the Rural Women's Health Mini-Residency (Rural WH-MR)-to train VA clinicians in rural locations in skills for the care of women Veterans. Here we assess the applicability of RE-AIM as an evaluation framework in this context. We evaluated the Rural WH-MR, relying on a primarily quantitative approach, rooted in RE-AIM. It included longitudinal and cross-sectional measurements from multiple quantitative and qualitative data sources to develop selected metrics. Data collection instruments consisted of pre-, post-, and follow-up training surveys, course evaluations, existing VA databases, and implementation reports. We developed metrics for and assessed each RE-AIM component by combining data from multiple instruments and then triangulating findings. Results from the Rural WH-MR program for fiscal years 2018-2020 indicate that RE-AIM provides an instructive evaluation framework for a rural workforce training program, particularly in eliciting clarity between measures of Reach vs. Adoption and focusing attention on both provider- and patient-level outcomes. We describe evaluation metric development and barriers to and facilitators of utilizing RE-AIM as an evaluation framework for a provider- and nurse-facing intervention such as this workforce training program. We also reflect upon RE-AIM benefits for highlighting process and outcomes indicators of a training program's success and lessons learned for evaluating rural workforce development innovations. Several of our observations have implications for training and evaluation approaches in rural areas with more limited access to health care services.