Document Title: Early Career Nurses and Rural & Remote Nursing
Document type: Post
I recently submitted this paper and chose rural and remote nursing as the research focus/topic as I have had to move away from my partner, family and friends to secure work.
I thought it might get people talking... and yes, it IS something you can do early in your career!
Copyright: This work is licensed under a Creative Commons Attribution 3.0 Unported License.
Early Career Nurses and Rural and Remote Nursing
Rural and Remote nursing is currently being discussed in terms of the
current workforce being maintained and preferably increased. Nursing
in general has projected staff shortages across all specialities, as
those retiring are not being replaced at the same rate, thus
exacerbating the rural and remote workforce shortages (Wakerman &
Davey 2008; Hegney et al. 2002; Lenthall et al. 2011; Witham 2000) and
leaving them in worse positions than those in the metropolitan areas.
Nurses who choose to specialise and/or work in rural and remote
communities not only have extended scopes of practice and associated
responsibilities, due to medical staff shortages, but have to contend
with issues such as: isolation (social and clinical), minimal support
(clinical and managerial), professional development, balancing
confidentiality while also maintaining social friendships in the
community and a major lack of resources: clinical and structural, to
name a few (Lenthall et al. 2011; Witham 2000; Wakerman & Davey,
All these factors have been researched and shown to have an impact in
nurses leaving rural and remote communities along with the perceived
stereotypes of clients (e.g. indigenous peoples are always drunk,
fighting etc) (Wakerman & Davey 2008). There is a dearth of research
in this area looking at strategies to try and minimise the above
While all of the above are important factors to consider when trying
to retain staff, what couldn't be found were reasons why nurses
choose to leave the metropolitan area and go rural and remote nursing
in the first place.
Research has shown previous exposure to the area as a student or a
professional growing up in a rural environment will be open to
returning to work in rural/remote practice as a professional (Hegney
et al. 2002; Kenny & Duckett 2003; Bennet et al. 2012).
Extensive research on transition to practice for grad nurses, and some
research on why grad nurses chose rural and remote practice as a
specialty for their grad year (Kenny & Duckett 2003) has been
undertaken but there was nothing showing why nurses chose rural and
remote practice after graduate level.
Losing my position in a busy Level 1 tertiary teaching hospital,
resulting from budget cuts, I suddenly found myself working in a
remote area of Western Australia. Never previously considered rural
and remote nursing, feeling that I was too much of a junior nurse, I
had no idea what to expect. I felt I needed more experience and the
completion of post graduate studies with clinical support before I
even thought about it as an option. Being settled with a family was
also a large factor.
The current position I have (Registered Nurse with specialisation in
A&E) I accepted as it was an immediate start and financial
considerations were a priority for our family.
I had no other preparation other than I was going to a place which was
2.5 hours from the nearest regional hospital, a doctor is not always
available (10/14 days; although he is contactable by phone when not
here), about 6 fellow nurses and it had on-site accommodation.
I had grown up in a semi-rural environment as a child, but that was
long ago. An information booklet has been prepared by the National
Rural Health Alliance Inc., titled "A brief guide to nursing in
rural and remote settings" but this was only found during a
literature review and search for this topic. My orientation package
from the West Australian Country Health Service (WACHS), had an
information booklet that was similar: however, I did not get this
until I arrived on my first day.
Underestimating things like: being homesick, the extent to which I
miss my family, familiarity of my home and its surroundings. Studying
post graduate without all the support and resources that are available
in a major centre. What it is like to work, live and socialise with
the people that surround you 24/7 (both nurses and the local
community). Being on call for extended periods of time and unable to
do things that you normally do on days off. Living onsite at the
hospital and being on call 24/7 if needed. Professional and social
isolation The sheer lack of resources, both structural (we do not have
half the resuscitation equipment a regional hospital would have) and
clinical (we only have 1 nurse who is X-ray competent, and no onsite
The skills and variety I have obtained and dealt with is amazing.
I've assessed, consoled, sutured, dressed, backslabbed (Plaster of
Paris and fibreglass) and provided health education/advice and
medication to the community. I've dealt with a 18/40 week pregnant
woman threatening to abort and been appreciated and thanked multiple
times. I haven't been abused verbally or physically, once, the
entire time I've been here so far.
The NUM and clinical nurse are also a wealth of information and
Bringing me to ask questions within the research topic such as; Why
don't more early career nurses choose rural and remote nursing?
Given that there is an extended scope of practice, why wouldn't a
nurse come out and increase their skills and knowledge base? Why are
there negative perceptions of the rural and remote communities,
especially regarding indigenous peoples? Are my reasons for transition
the same as others? What makes others transition to rural and remote
nursing when there are no mitigating factors (e.g. financial) to
consider it as an area of practice? What attracts early career nurses
to rural and remote nursing? Is rural and remote nursing seen as
something you do as a nurse when you are more 'experienced' &
Bennett, B, Barlow, V, Brown, J, Jones, D 2012, 'What do graduate
registered nurses want from jobs in rural/remote Australian
communities?, Journal of Nursing Management, vol.20, pp.485-490.
Hegeny, D, McCarthy, A, Rogers-Clark, C, Gorman, D 2002, 'Why nurses
are attracted to rural and remote practice', The Australian Journal
of Rural Health, vol.10, no.3, pp.178-186.
Kenny, A, & Duckett, S 2003, 'Educating for rural practice',
Issues and Innovations in Nursing Education Journal of Advanced
Nursing, vol.44, no.6, pp.613-622.
Lenthall, S, Wakerman, J, Opie, T, Dunn, S, MacLeod, M, Dollard, M,
Rickard, G, & Knight, S 2011, 'Nursing Workforce in very remote
Australia, characteristics and key issues', Australian Journal of
Rural Health, vol.19, pp.32-37.
Wakeman, J & Davey, C 2008, 'Rural and Remote Health Management:
'The next generation is not going to put up with this...' Asia
Pacific Journal of Health Management, vol.3, vol.1, pp.13-18.
Witham, H 2000, 'Remote and Rural Nursing: An Endangered
Profession?' Australian Nursing Journal, vol.7, no. 9, pp.18-21.
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