Registered nurses working alone in rural and remote Canada

The nursing literature includes descriptions of rural nursing workforces in Canada, the United States of America and Australia. However, inconsistent definitions of rural demography, diverse employment conditions and health care system reorganization make comparisons of these data difficult. In 2007, the Ministry of Health and Long-term Care in Ontario, Canada, transferred responsibility for decision-making and funding to 14 regional governing bodies known as Local Health Integration Networks (LHINs). Little is known about rural-urban variations in the nursing workforces in the LHINs because existing data repositories do not describe them. This study investigated the influence of demographic characteristics, provincial policies, organizational changes and emerging practice challenges on nursing work in a geographically unique rural region. The purpose was to describe the nature of nursing work from the perspective of rural nurse executives and frontline nurses. The study was conducted in 7 small rural and community hospitals in the Hamilton Niagara Haldimand Brant LHIN.

The Canadian nurse, 2004

The Journal of Rural Health, 2011

Context: Examination of factors related to the retention or voluntary turnover of Registered Nurses (RNs) has mainly focused on urban, acute care settings. Purpose: This paper explored predictors of intent to leave (ITL) a nursing position in all rural and remote practice settings in Canada. Based on the conceptual framework developed for this project, potential predictors of ITL were related to the individual RN worker, the workplace, the community context, and satisfaction related to both the workplace and the community(s) within which the RN lived and worked. Methods: A national cross-sectional mail survey of RNs in rural and remote Canada provided the data (n = 3,051) for the logistic regression analysis of predictors of ITL. Findings: We found that RNs were more likely to plan to leave their nursing position within the next 12 months if they: were male, reported higher perceived stress, did not have dependent children or relatives, had higher education, were employed by their primary agency for a shorter time, had lower community satisfaction, had greater dissatisfaction with job scheduling, had lower satisfaction with their autonomy in the workplace, were required to be on call, performed advanced decisions or practice, and worked in a remote setting. Conclusions: The statistical evidence for predictors of ITL supported our framework with determinants related to the individual, the workplace, the community, and satisfaction levels. The importance of community makes this framework uniquely relevant to the rural health context. Our findings should guide policy makers and employers in developing retention strategies.

BMC Nursing

Background Although much research has focused on nurses’ retirement intentions, little is known about nurses who formally retire yet continue to practice, particularly in rural and remote settings where mobilization of all nurses is needed to assure essential health services. To optimize practice and sustain the workforce stretched thin by the COVID-19 pandemic, it is necessary to understand what it means for retired registered nurses (RNs) and licensed practical nurses (LPNs) to work after retirement. This study explored what nursing practice means for RNs and LPNs who have formally retired but continue to practice in rural and remote communities. Methods A pan-Canadian cross-sectional survey conducted in 2014–2015 of nurses in rural and remote Canada provided data for analysis. Textual responses from 82 RNs and 19 LPNs who indicated they had retired but were occasionally employed in nursing were interpreted hermeneutically. Results Retired nurses who continued to practice took on ...

Journal of Rural Health, 2009

ABSTRACT: Context: Concerns have been raised about the sustainability of health care workforces in rural settings. According to the literature, rural nurses’ work satisfaction varies with the resources and supports available to respond to specific challenges. Given the probable effects of stressors on retention, it is essential to understand the unique requirements of nurses in rural practice environments. Purpose: To investigate whether nurses receive the resources and supports necessary to meet the challenges of rural practice. Methods: Semi-structured interviews were conducted with 21 managers and 44 staff nurses in 19 selected rural hospitals in Ontario, Canada. The interviews were taped and transcripts interpreted through a thematic analysis. Major worklife themes were identified and analyzed within a healthy work environment model based on the work of Kristensen. Findings: Three interrelated dimensions of the model were relevant to workforce sustainability: the balance between demands and the resources of the person, the level of social support, and the degree of influence. The availability of resources and supports affected whether the nurses perceived challenges as stimulating or overwhelming. Deficits interfered with practice and the well-being of the nurses and patients. Conclusions: The nurses felt frustrated and powerless when they lacked resources, support, and influence to manage negative situations. Strategies to achieve workforce sustainability include resources to reduce stress in the workplace, education to meet the needs of new and experienced nurses, and offering of employment preferences to the workforce. Addressing resources, support, and influence of rural nurses is essential to alleviate workplace challenges and sustain the rural nursing workforce.

Australian Journal of Rural Health, 2008

The objective of this analysis was to identify the meaning of rurality for registered nurses (RNs) practising in rural and remote Canada. Setting and design: An existing Statistics Canada definition was used to stratify Canada's 10 provinces into urban and rural areas. As part of a national multimethod study, a random sample of RNs in these rural strata, plus all RNs working in outpost settings and northern territories, were surveyed concerning the nature of nursing practice. Content analysis was used to identify themes from an open-ended question: 'How do you define rural/remote?' Refinement of the themes was conducted by the survey team and credibility was supported through investigator triangulation. Participants: Of the 3933 RNs who responded to the survey (68% response rate), 3412 provided a definition of rural/remote. A subsample of 1285 RNs was used for detailed thematic analysis because these respondents provided definitions with a clear referent to rural and/or to remote; the remaining sample was used for verification of themes. Results: Four defining themes were identified by RNs for both rural and remote: community characteristics, geographical location, health human and technical resources, and nursing practice characteristics. Conclusions: The themes can be used as content domains or dimensions of rurality to improve our understanding of how to describe rural communities, including geographical location and nursing practice, from the perspective of RNs.

This paper explores factors that influence rural nurse retention. A comprehensive literature review was used to highlight, examine and evaluate studies that identify factors, including personal characteristics and experiences, in relation to rural nurse retention and job satisfaction. The findings from the literature review suggest rural nurse retention is influenced by level of job satisfaction. The findings also suggest factors, including personal characteristics and experiences, influence job satisfaction. The literature review findings further indicate factors, including personal characteristics and experiences, affect the duration of rural nurse practice. The current rural nursing retention strategies in British Columbia are explored. Based on the findings from the literature review, detailed recommendations for future research and recommendations for rural nursing retention strategies are made. The concepts identified inform health human resources retention strategies, specifically nursing retention in rural areas.

Healthcare Policy | Politiques de Santé

Background and objective: Nurses provide essential primary care (PC) in rural and remote Canada. We examined the practice context and responsibilities of this little-known understudied workforce. Method: Data from Nursing Practice in Rural and Remote Canada II, a 2014 to 2015 pan-Canadian survey, were analyzed. Results: Of 3,822 respondents, 192 identified that PC was their only practice focus (PC-Only), and for 111, it was one focus among others (PC-Plus). Proportionally more PC-Only than PC-Plus nurses had graduate education, were employed in larger communities and had experienced higher job resources and lower job demands. Proportionally fewer PC-Only than PC-Plus nurses followed protocols/decision support tools, dispensed medications and provided emergency services. Proportionally more PC-Only than PC-Plus nurses ordered advanced diagnostic tests/imaging, and fewer PC-Only than PC-Plus nurses performed and interpreted laboratory tests and diagnostic imaging on site. Conclusion: Contributions of the rural and remote nursing workforce to PC are rendered invisible by contemporary characterizations of the PC workplace, limiting evaluation and improvement efforts. Résumé Contexte et objectif : Les infirmières fournissent des soins de santé primaires (SSP) essentiels dans les régions rurales et éloignées du Canada. Nous avons examiné le contexte et les responsabilités de la pratique de cette main-d' oeuvre peu connue et mal étudiée. Méthode : Nous avons analysé des données provenant d' une enquête pancanadienne sur la pratique infirmière dans les régions canadiennes rurales et éloignées, de 2014 à 2015 (Nursing Practice in Rural and Remote Canada II). Résultats : Parmi 3 822 répondants, 192 ont indiqué que les SSP formaient l' essentiel de leur pratique (SSP-seul) et 111 ont indiqué que ces soins formaient une partie de leur pratique (SSP-plus). Toute proportion gardée, plus d'infirmières SSP-seul que SSP-plus ont reçu leur diplôme, ont été employées dans des grandes communautés, ont bénéficié de plus de ressources au travail et ont connu moins d' exigences au travail. Toute proportion gardée, moins d'infirmières SSP-seul que SSP-plus ont utilisé les outils d' aide aux protocoles ou à la décision, ont délivré des médicaments et ont fourni des services d' urgence. Toute proportion gardée, plus d'infirmières SSP-seul que SSP-plus ont prescrit une imagerie ou un test diagnostic poussé et moins d'infirmières SSP-seul que SSP-plus ont effectué et interprété des tests en laboratoire et des imageries diagnostiques sur les lieux. Conclusion : La contribution de la main-d' oeuvre infirmière dans les régions canadiennes rurales et éloignées demeure invisible en raison des caractérisations contemporaines du lieu de travail des SSP, ce qui limite les efforts d'évaluation et d' amélioration.

JONA: The Journal of Nursing Administration, 2002

Because higher-than-average turnover rates for nurses who work in remote and rural areas are the norm, the authors conducted a study to identify professional and personal factors that influenced rural nurses' decisions to resign. Using a mail survey, the authors gathered qualitative and quantitative data from nurses who had resigned from rural and remote areas in Queensland, Australia. Their findings, categorized into professional and rural influences, highlight the importance of work force planning strategies that capitalize on the positive aspects of rural and remote area practice, to retain nurses in nonmetropolitan areas.