Rural Nursing Workforce Research Articles

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

Tracks to Postgraduate Rural Practice: Longitudinal Qualitative Follow-Up of Nursing Students Who Undertook a Rural Placement in Western Australia

The nursing workforce is the backbone of healthcare provision in rural and remote Australia. Introducing student nurses to rural clinical placements is one strategy used to address the shortfall of healthcare workers outside of major cities, with the goal of improving the training, recruitment and retention of nurses in rural areas. The aim of this qualitative, longitudinal study was to better understand personal and professional decision-making around rural nursing practice intentions and subsequent rural employment and retention. The study methodology consisted of repeated semi-structured interviews with student nurses who had completed at least one rural placement and following them on their journey to becoming graduate nurses over a 6-year period. Thematic longitudinal analysis was undertaken, with three main themes developing, each with further subthemes: (1) participants' satisfaction with rural placements; (2) their challenges with gaining employment; and (3) considerations regarding 'going rural' for work. The participants engaged in both prospective and retrospective reflection around several professional, personal, and wider systemic barriers and enablers to rural practice, which are discussed in detail in this paper. The insights from this longitudinal study have the potential to assist the development of a sustainable rural nursing workforce through informing rural workforce programs, strategies and policies.

Addressing the challenges of early career rural nursing to improve job satisfaction and retention: Strategies new nurses think would help.

To (a) explore the experiences of early career registered nurses in rural hospitals in Australia and (b) identify strategies they believe would help increase job satisfaction and retention. Qualitative descriptive design. Thirteen registered nurses located in outer regional, remote or very remote (herein 'rural') Australian hospitals participated in semi-structured interviews. Participants had graduated from a Bachelor of Nursing program in 2018-2020. Data were analyzed using thematic analysis and an essentialist, bottom-up approach. Seven themes related to the experiences of rural early career nursing: (1) appreciate diverse scope of practice; (2) rewarding sense of community and opportunity to give back; (3) staff support determines the quality of experience; (4) feeling underprepared and the need for ongoing education; (5) diverse views on the optimal length of rotation and level of input into choice of clinical area; (6) difficulty maintaining work/life balance due to work hours and rostering; and (7) lack of staff and resources. Strategies to improve nurses' experiences included: (1) assistance with accommodation and transport; (2) social gatherings to enhance connection; (3) sufficient orientation and supernumerary time; (4) increased frequency of contact with clinical facilitators and multiple mentors; (5) prioritizing clinical education across diverse topics; (6) greater involvement in choice of rotations and clinical areas; and (7) desire for more flexible work hours and rostering. This study highlighted the experiences of rural nurses and explored their suggestions for how to overcome challenges in their roles. Greater consideration of early career registered nurses' needs and preferences is vital to improving and maintaining a satisfied, dedicated and sustainable rural nursing workforce. Many of the strategies for improving job retention identified by nurses in this study could be actioned at a local level, with little financial or time investment. No Patient or Public Contribution.

The Rural Nursing Workforce Hierarchy of Needs: Decision-Making concerning Future Rural Healthcare Employment.

Addressing nursing shortages in rural areas remains essential, and attracting nursing graduates is one solution. However, understanding what factors are most important or prioritized among nursing students contemplating rural employment remains essential. The study sought to understand nursing student decision-making and what aspects of a rural career need to be satisfied before other factors are then considered. A cross-sectional study over three years at an Australian university was conducted. All nursing students were invited to complete a Nursing Community Apgar Questionnaire to examine their rural practice intentions. Data were analyzed using principal component analysis, and mean scores for each component were calculated and ranked. Overall, six components encompassed a total of 35 items that students felt were important to undertake rural practice after graduating. Clinical related factors were ranked the highest, followed by managerial, practical, fiscal, familial, and geographical factors. Maslow’s Hierarchy of Needs provided a lens to examine nursing student decision-making and guided the development of the Rural Nursing Workforce Hierarchy of Needs model. Each element of the model grouped key factors that students considered to be important in order to undertake rural employment. In culmination, these factors provide a conceptual model of the hierarchy of needs that must be met in order to contemplate a rural career.

Evaluation of a rural undergraduate nursing student employment model

<h2>ABSTRACT</h2><h3>Background</h3> Developing a sustainable rural nursing workforce is key to good rural health outcomes, but nursing recruitment and retention is a significant challenge. Internationally, there is a body of literature that describes undergraduate nursing student employment models. There is, however, a lack of robust evaluation of these models as a workforce strategy. <h3>Aim</h3> The aim of this study was to evaluate an undergraduate nursing student employment model implemented in a rural context. <h3>Methods</h3> A mixed-methods design was used with a well-established process evaluation framework. Data collection methods included monthly online surveys, blogs, focus groups, individual interviews, and client experience surveys. <h3>Findings</h3> Paid employment models are a workforce strategy for rural health services and staff are mostly supportive. For students, engaging in healthcare employment was seen as more advantageous than other forms of employment, such as hospitality and retail. Patients/clients rated the model highly. There were significant challenges with balancing university commitments with service requirements, issues related to scope of the role, and concerns around ongoing funding of the model. <h3>Discussion</h3> The rural undergraduate student of nursing employment role was implemented as planned with key findings primarily supporting the benefits of the role. <h3>Conclusion</h3> While there is ongoing interest in nursing student employment, there is a paucity of rigorous evaluation of models. This study adds to knowledge on paid employment of nursing students, but longitudinal studies are needed. Robust economic modelling must occur to identify costs and benefits. In Australia, government interest in nursing student employment appears to wax and wane.

An Exploration of Rural Nurses in Decision Making of Academic Progression

Purpose: To explore the meaning that academic progression has for rural RNs and their decision to pursue or not pursue a BSN or higher levels of education. Background: &nbsp;Mounting evidence has linked a higher educated nurse with improved patient outcomes and decreased patient mortality prompting leaders in healthcare to call for a bachelor of Science (BSN) degree as baseline preparation for nursing practice Yet, the majority of the nation’s registered nurses (RNs) continues to be educated at the associate degree (AD) level. These numbers are even higher in rural areas of the country, where social determinants of health for rural populations places higher demands on rural nurses to provide quality of care. Sample: Nine (n=9) AD RNs from a rural community hospital in Pennsylvania who met inclusion criteria were selected. Methods: A qualitative phenomenological approach was the research design choice which captured the lived experiences of how rural RNs think and feel about pursuing a BSN or higher degree. Findings: &nbsp;Findings from this study revealed that rural RNs are motivated by the need for a BSN specifically in regard to job security, professional identity, professional development, personal enrichment, and career mobility and feeling prepared for the demands of 21st century nursing practice. The participants conveyed they want their voices to be heard regarding the unique challenges that rural nurses face in pursuit of a BSN. Conclusion: Higher education in nursing is now a key imperative. Understanding academic progression in relation to RNs practicing in rural healthcare institutions should serve to disseminate the identified gaps of knowledge in rural nursing education. This study has direct implications for curriculum development and educational strategies focused on producing a more educated rural nursing workforce to meet the growing needs of rural populations. DOI:&nbsp;&nbsp;http://dx.doi.org/10.14574/ojrnhc.v20i1.608&nbsp; Keywords: academic progression, associate degree, bachelor degree, nursing education, role transition, rural health, rural nursing, rural RN workforce.

Unmet needs in health training among nurses in rural Chinese township health centers: a cross-sectional hospital-based study.

PurposeMaintaining a sufficient and competent rural nursing workforce is an important goal of the Chinese health delivery system. However, few studies have investigated the health training status or conducted a needs assessment of rural Chinese nurses during this time of great transformations in health policy. This study was conducted to explore the current health training status of nurses working in rural Chinese township health centers (THCs) and to ascertain their perceived needs.MethodsA cross-sectional survey using a self-administered structured questionnaire was conducted among 240 THC nurses in Guangxi Zhuang Autonomous Region, China from March 2014 to August 2014. The survey questionnaire was adapted from the Second Chinese Survey of Demographic Data and Training Demand for Health Professionals in THCs developed by the Ministry of Education.ResultsThe nurses in THCs were young, with a low educational level. Their perceived needs for health training included further clinical studies at city-level hospitals to improve their skills and theoretical studies at medical universities in emergency medicine and general practice. Overall, 71.9% of the nurses with a secondary technical school background expected to pursue junior college studies, and 68.5% of the nurses with a junior college education expected to pursue a bachelor’s degree. A decentralized program with theoretical studies at medical universities and practical studies at county hospitals was regarded as feasible by 66.9% of the respondents.ConclusionHealth-training programs for nurses in Chinese THCs must be improved in terms of coverage, delivery mode, and content. A decentralized degree-linked training program in which medical universities and city hospitals collaborate would be an appropriate mode of delivery.

Rural nurses’ continuing education needs: A U.S. multi-site survey reveals challenges and opportunities

Background: Provision of relevant, evidence-based continuing education (CE) is an integral part of maintaining a highly competent rural nursing workforce. Numerous tangible and intangible barriers exist to nurses’ participation in CE in rural settings. Major barriers to accessibility and participation in CE for rural nurses include: 1) Geographic isolation, 2) lack of perceived administrative, financial, and/or technological resources and support, 3) lack of time due to workload, inadequate staffing, and/or travel distance, 4) lack of relevance of continuing education topics, and 5) lack of a dedicated on-site nurse educator. Proactive development of academic-practice partnerships is important to support rural care providers regarding CE delivery. The purpose of this study was to assess perceptions of CE needs of nursing unit staff working in a group of health care facilities in a rural region of midwestern U.S. Methods: A cross-sectional CE needs assessment survey was conducted in winter of 2010 with rural health care providers (N=302/1107; response rate 27%) working in rural healthcare facilities (N=40), including rural hospitals (n=10) and long-term care (LTC) facilities (n=30). A well-validated 72-item Likert-type survey was distributed via a secure online university survey platform, and included assessment of 59 CE need areas. Internal consistency reliability was 0.87. Data were analyzed using SPSS software, version 16.0. Results: Descriptive statistics revealed a greater number of licensed practical nurses and nursing assistants working in rural LTC’s (27.2% and 62.5%, respectively) compared to rural hospital setting (14% and 15%, respectively). There are a large number of associate degree-prepared nurses (63%) working in the participating rural hospitals compared to LTC setting (8.4%). Respondents’ priority learning needs included: 1) Review aspects of medication administration/drug interactions; 2) improve skills in patient assessment (physical/mental); 3) increase knowledge of management of patients with comorbidities; 4) promotion of patient safety; 5) enhance communication skills/teamwork; 6) increase lifelong learning. Student’s t tests revealed LTC nursing unit staff reported significantly higher priority learning needs in “manage aggressive behavior (verbal/physical)” ( t = 2.044, d f = 300, α = .003), “family participation in care” ( t = 2.470, d f = 300, α = .036), and “maintain standards of care” ( t = 2.880, d f = 300, α = .042), whilst acute care nursing staff reported a significantly higher priority learning need in “manage a crisis” ( t = 2.122, d f = 300, α = .050). Conclusions: Study results revealed key learning needs related to several aspects of patient care delivery for rural nursing unit staff who are primarily nursing assistants or nurses meeting minimum state educational requirements. Basic health- care workforce training does not typically emphasize continuous quality improvements, or how to recognize and develop an evidence-based practice at the entry level. The potential for nursing knowledge stagnation among entry level nursing unit staff in rural settings needs to be addressed to help break down isolation barriers impacting knowledge, attitudes and behaviors of health care providers practicing in rural health care facilities.

The experience of new graduate nurses in rural practice in New South Wales

The recruitment and retention of health professionals in rural areas is a long-standing concern in Australia. In the context of an ageing rural nursing workforce, recruitment and retention of new graduate nurses is an important issue. To explore the role transition for new graduate nurses in rural practice in New South Wales (NSW). This study utilised a qualitative hermeneutic-phenomenological framework. A purposive sample was drawn from eight rural health care facilities in NSW where participants were employed as new graduate nurses in the first year of a graduate nurse transition program. The ward culture, workload and level of responsibility within rural healthcare facilities were of concern for new graduates and influenced their retention within the rural nursing workforce. There are specific aspects of the transition experience that are unique to graduate nurses in rural practice settings. The findings have implications for undergraduate curricula in the preparation of graduates for the reality of the rural nursing workforce. Additionally, the expectations that staff have of new graduates as they enter the nursing workforce, and the workplace cultural issues recognised as having a significant impact on the retention of graduates must be addressed locally and at the area health service level if nurses are to be retained in this unique nursing specialty.

Studying nursing in a rural setting: are students adequately supported and prepared for rural practice? A pilot study

A rural nursing program has a vital role in improving the recruitment and retention of nurses in rural and remote settings. A small pilot study was conducted to explore the views and experiences of the first cohort of undergraduate nursing students who completed a rurally based bachelor of nursing program which commenced in 2002 in Renmark, South Australia. The participants were eight current undergraduate nursing students who were part of the first cohort of nursing students nearing completion of the program. The pilot study set out to explore support provided to rural nursing students studying in a rural setting; to investigate whether rural nursing students feel adequately prepared for rural clinical practice near completion of the nursing program; to identify the challenges and highlights of studying rurally; and to explore the probability of retention and recruitment of future nursing graduates in a rural setting. The method used was a descriptive, exploratory, web-based survey. Quantitative data were limited to descriptive statistics of demographic characteristics, career goals, graduate nurse program and future employment intentions, level of support, preparation for practice, challenges and highlights of rural study and clinical placements. Qualitative responses to open-ended questions were content analysed to identify common themes. This study found between two and four participants indicated they received no support from academic, administrative staff and clinical facilitators from the city campus. Five participants (63%) indicated they received no financial support during their studies. Seven of the participants (88%) surveyed, indicated an intention to undertake a graduate nurse program and the same number indicated they would be living in a rural or remote area in 5 years time. Six participants (75%) indicated they were prepared with regard to their 'attitude' towards their future practice as a registered nurse. The study identified some of the challenging issues of a rurally based program, such as 'realising that if you miss a day you are actually missing a whole week's worth of lectures', as well as the positive and unique aspects of rural study, 'not having to leave the family to travel to the city'. This study indicates the rural placement of the bachelor of nursing program has been of benefit to this particular community and is a positive outcome for the South Australian rural nursing workforce. The study shows that students actively sought nursing employment in a rural setting, and identifies highlights experienced by students and the advantages associated with remaining at home (as opposed to relocating) while enjoying the benefits of smaller class sizes. The challenges of rural study were issues such as limited lecture times, compared with the city campus, which often caused a disproportionate workload for rural students on alternate weeks during the study term. The quality of the delivery of some lectures was also an issue for some students. This study determined that a lack of support was encountered by students, and that further investigation is warranted. Greater consideration will be required to address the delivery of the program together with the future availability and accessibility of further university rurally based nursing programs.

Comparative Analysis of Urban and Rural Nursing Workforce Shortages in Nebraska Hospitals

Current workforce models that rely on economic indicators have seriously underestimated the rural RN shortage and its impact on rural hospitals. This cross-sectional study developed an algorithm using the concept of need and applied it to health service demand data in 66 counties of a midwestern state (1993-2002) to determine trends in RN shortages between urban and rural areas. Results showed that rural areas consistently had the largest gap between predicted need for RNs and numbers employed and that the rural RN shortages were significantly greater than in urban areas. This study suggests that adequate and geographically specific targets of RN need are essential, especially for rural areas, because of policy implications for rural hospital staffing and workforce planning. Inadequate workforce targets perpetuate the shortage, especially in rural areas, and exacerbate the very reasons that RNs leave over concerns for patient safety, inadequate staffing, and job dissatisfaction.

Educating for rural nursing practice.

Rural hospitals in Australia, as in many countries, face challenges in ensuring that appropriate, quality services are provided. The overall aim of this study was to explore the issues that impact on the ability of rural hospitals to provide effective health care. We used a qualitative descriptive method and purposive sampling, and conducted interviews in hospitals in rural Victoria, Australia. The data collected enabled major issues that impact on hospital service delivery to be identified. Using thematic analysis, global themes were extracted and organized around a thematic network. The workforce was an important theme. Whilst the impact of medical shortages on hospital function has been considered in other studies, little consideration has been given to the rural nursing workforce. The need to maintain an appropriately educated rural nursing workforce emerged as one of the major issues that impact on rural hospital service delivery. In Australia, there has been a great deal of discussion about the educational preparation required for rural nursing practice, with the emphasis on postgraduate study. However, the majority of rural nurses do not have postgraduate qualifications and face significant barriers in obtaining them. Although the vast majority of literature claims that postgraduate preparation is vital for rural nursing practice, this research suggests that the future rural nursing workforce will be recruited from undergraduate courses in regional universities. However, there is a need to include specific theoretical and operational preparation in undergraduate education, to enable nurses to make the transition to rural practice more readily. Rural nurses are central to the delivery of health services in rural hospitals. Future rural nursing recruitment and retention hinges on ensuring that they have the confidence, knowledge and skills to deliver safe, appropriate and effective care.