The Challenges and Opportunities for Nurses Working in Rural and Remote Settings - Coursework Example

RUNNING HEAD: Rural and Remote Nursing Student Name Student Number Unit Title/Number Rural and Remote Nursing Due Date Unit Coordinator Word Count [2504] Introduction Most countries continue to be urbanized with more industrialization and expansion of economic activities. However, there are still a significant proportion of citizens living in rural and remote areas. There are various challenges that such populations in rural and remote areas face. Among the most common challenges, include access to quality nursing services and general health care (Anne, 2009, p.135). Poor infrastructure results in poor health services in rural and remote areas with issues of isolation, image of rural nurse, and difficult working conditions. Additionally, the position of rural and remote nurse attracts little or no recognition despite its importance in the society. It is also important to note that there are opportunities of rural and remote nursing practices with great diversity in the practices. The provision of accessible, quality, and affordable nursing services is highly dependent of existing structures in the society such as infrastructure. The challenges of rural and remote nursing depend on such structures. Definition of Rural and Remote In relation to nursing and general health care, the definitions of rural and remote continued to be a subject of decade debate. The lack of a standard and acceptable definition of the two terms poses a lot of difficulty for generalization and comparisons. An acceptable criterion for definition includes the use of geographical size, population density, and measured distance from urban centers (Lee & McDonagh, 2010, p.25). Additionally, rural postcodes, the size of commuting zones, and population in terms of people per square kilometer are other criterion for definition. Finally, there are also the need to identify the needs and nursing practices of rural and urban settings. The Diversity of Rural and Remote Nursing Practice The diversity of rural and remote nursing practice is a subject attracting wide research and has a volume of literature from scholars and professional in the medical field. In essence, the diversity seem to dwell most on three main perspectives of accessibility of care, the quality of care, and the sustainability of care (Francis & Mills, 2011, p.52). This paper explores these three diversity dimensions in order to bring about a clear picture of the diversity of rural and remote nursing practice. Accessibility of Care In order for governments to provide accessible nursing in rural and remote areas, they first recognize the need and importance of supply of appropriately trained nurses in such areas. This is evident with the fact that most people in the rural and remote places face various health care problems than in the urban areas (Scharff, 2010, p.261). Most nurses in rural and remote settings also work in community-based settings as opposed to their counterparts who work in acute care hospitals in urban areas. Additionally, low nurse to population ratio in the rural and remote places has a strong negative impact on accessibility of care. Furthermore, registered nurses working in rural and remote settings face greater demands for expansion of role of practice despite the fact they have comparatively low levels of formal education when compared to their urban counterparts (Charlene, 2013). Diversity is even more pronounced with the fact that the registered nurses in such settings have little access to additional clinical equipment to support their practices since administrators reside in urban centers. Diversity in the Quality of Care Authorities greatly underestimate the diversity of rural and remote nursing practices brought about by the complexity of the practices themselves. The underlying point is that of the need to improve the quality of services delivered through improvement of policy and practice changes. The interconnection between the rural nurses and their rural and remote contexts is also important in shaping the nurses’ work and careers (Scharff, 2010, p.260). Demographics that come within the community present a key stage for a great deal in the difference of what the nurses go through in their practices and how it influences the development of their skills and knowledge. The predominant factor in this case is the need for nurses, policy-makers, clinical administrators, and educators to “learn to listen and listen to learn” in such settings (Barnason & Morris, 2011). This will greatly improve the understanding of the prevailing realities of rural and remote nursing practices with the aim of improving policies, the level of administrative practices, and improved quality of education programs that will eventually improve the quality of care through enhanced reflection of the rural and remote realities (Barnason & Morris, 2011). This is usually achievable through creation of rural and remote lens to bring about concise set of questions, processes to aid the management and policy-makers in creation of policies, and practices while at the same time illuminating the strengths of rural and remote practice. Sustainability of Care There are significant predictors of intent to leave in remote and rural nursing environment. Individual variables such as gender, higher perception of stress, lack of dependent children, the need for higher education, and less years of employment in primary agency are some of the variables associated with intent to leave. There are also issues touching on individual levels of satisfaction in expressing nurses’ intent to leave and even more evident especially when individuals face lower levels of satisfaction with the specific community and the actual workplace (Kulig, Stewart, Penz, Forbes, Morgan, & Emerson, 2009, p.434). Registered nurses are likely to plan leaving in the event where they are judged with the responsibility of making advanced decisions or practice, if their acquisition was on call, or typically working in a quite rural and remote environment (Francis & Mills, 2011, p.50). To address this diversity, clinical administrators and policy-makers embark on addressing gender differences and identifying stressors from the perspective of registered nurses while at the same time initiating coordinated consultations with registered nurses strategies that enhance nurses’ retention. Furthermore, the migration pattern that is typical of rural and remote nurses is another factor affecting sustainability of care. Although nurses work in their particular rural areas of their registration, such rural and remote places may depend on the services of nurses educated from other areas to support the rural and remote nurses by offering the necessary registered nurse work force (Francis & Mills, 2011, p.60). However, most government do not value sourcing registered nurses from overseas since there is extremely small proportion of foreign nurses practicing in rural and remote areas. Opportunities for Nursing Practice in Rural and Remote Setting The rural and remote setting and the expectations of nursing practice in such regions does not come any close in minimizing presented and manifested in people’s lives by living up to the goal of nursing that advocates for helping people, communities, and families in a passionate manner to enable them attain optimal wellness and independence. This one important value brings satisfaction to rural and remote nurses since serving communities, families, and people in a passionate manner brings about career fulfillment and satisfaction (Lee & McDonagh, 2010, p.23). This contribution to community well-being makes nurses view themselves as not “less important” since their practice has attachment and connectedness of unique and meaningful characteristics. There is also the need to improve awareness of the value and importance of a rural nursing concept and theory in basics of nursing education. This offers rural and remote nurses with the opportunity to develop and refine the specialty of rural and remote nursing in postgraduate levels of learning. There is also the opportunity of nurses having a rich heritage of resiliency, resourcefulness, and adaptability, and creativity when working in rural and remote setting (Mills, Birks, & Hegney, 2010, p.34). This implies that being a rural and remote nurse provides one with special opportunity for nurses to have a proper method of dealing with what they encounter while at the same time developing living with the consequences. The setting also provides an opportunity for the rural and remote nurse to practice in an area of many challenges and rewards. This implies that the nurse is a generalist in the true sense of the word by working in a variety of settings across the life span provided and presented by the nurses’ ability to practice thoroughly and integrally (Anne, 2009, 317). This constant factor in nurses’ life and career is exclusively available in rural and remote settings. Additionally, the rural and remote setting is useful in providing nursing care in a variety of settings, across the life span with a holistic people centered approach always mindful of the community strengths and limitations. Typically, the rural and remote setting provides nurses with the chance to practice “nursing as it should be”. Furthermore, nurses practicing in rural and remote settings will have the opportunity to be nimble and responsive in dealing with situations and circumstances of issues in the process of recognizing them as consequence of communication patterns and role independence. This enables the nurses to develop understanding on how to deal with issues of barriers in communication and patterns of role independence, a good tool that facilitates efficiency in mingling with people of various backgrounds (Montgomery, 2009, p.253). There is also the ability of nurses to be culturally safe by learning various values and cultural beliefs of the community to enable them to perform their activities in a more effective and efficient manner. Finally, there is the ability of nurses to adjust the nursing care based on community demographics and needs of the people. This also creates confidentiality and trust for patients since nurses practicing in the rural and remote environments deal with patients they know in person and have daily interactions. This point is also supported by the fact that nurses will gain an understanding and integration of community capacity, economic setting, community assets, intersectoral collaborations, and politics of the area (Lenthall, Wakerman, Opie, Dollard, Dunn, Knight, 2009, p.210). Having knowledge of these facets of the community improves nurses’ ability to dispense their practices in a more effective manner. Challenges for Nursing Practice in Rural and Remote Setting There are a number of challenges facing nursing practices in rural and remote settings. The widely researched challenges can be identifiable in five categories of recruitment and retention, education, being ‘the nurse’ in a rural or remote community, recognition and/or attention, and particular challenges for Aboriginal nurses and communities. The following sections discuss these categories of challenges in detail. Recruitment and Retention The recruitment and retention of rural and remote areas is a problem across the globe. In fact, many countries across the globe are facing serious shortages of nurses in their healthcare sectors. This challenge is particularly acute in rural and remote areas. It is also important to note that nurses practicing in rural and remote communities are disproportional in their numbers when compared to the number of people they serve in the regions (Francis & Mills, 2011, p.53). The entire challenge of recruitment and retention is evident with the fact that professional demands are highly considerable and complex. These demands are a result of individual isolation that is perceived to be compounded by professional isolation, very harsh working environments, and poor means of transport, and isolation from family and friends (Burns, Dudjak, & Greenhouse, 2009). This poses the challenge of retaining nurses in such rural and remote environments. Education Most authors argue that nurses practicing in remote and rural areas possess some good degree of autonomy and creativity. This conforms to the clinical demand for high level of knowledge. This demand for knowledge becomes even higher in situations of professional isolation where having access to the relevant education is lacking. Providing educational programs for nurses practicing in rural areas has not been the focus of most governments in addressing rural health. There is also no clear definition of what constitutes the ‘core nursing content’ in the bid to prepare students in practicing nursing in rural and remote settings (Lenthall, Wakerman, Opie, Dunn, Macleod, & Dollard, 2011, p.35). This lack of educational programs is so wanting in the sense that nurses in rural and remote areas need to have excellent generalist skills to provide members of the community with emergency care for trauma injuries, conditions related to cardiopulmonary, and in extreme cases obstetric-neonatal care. It is therefore important for government agencies, regional health authorities, learning institutions, and nursing associations to have an integrated collaboration to enhance the provision of learning programs for nurses practicing in rural and remote settings. Recognition and Attention There is a wide argument that urban nursing practitioners and clinical policy-makers do not knowledge of the realities of rural and remote healthcare provision. Rural and remote nurses experience the most cited situations when they transfer patients to larger facilities in urban areas. In such situations, rural and urban areas experience problems of lack of appreciation of weather patterns in their regions of practice and negative comments of their ability to assess patients before arriving at the decision to transfer them to urban areas (Baernholdt, Jennings, Merwin, & Thornlow, 2010, p.1351). Failure to recognize and appreciate the realities of rural settings, nurses practicing in such settings may feel unsupported and undervalued. Additionally, policies defined for urban practice can be unsuitable for application in rural and remote settings. There is also the issue of limited research on rural and remote nurses that make the practice ‘invisible’ and thus a great challenge to the rural and remote nurse. This is evident with the fact that there is limited literature on the study of occupational stressors in rural and remote nursing. However, in the event of research, the report is unpublished, especially in the cases of description of patient care, nursing situation, and general case studies of the nursing practice in rural and urban areas (Birks, Mills, Francis, Coyle, Davis, & Jones, 2010). Citing from history of rural and remote nursing, the practitioners did not believe themselves as doing anything of value and thus the lack of need to analyze and record about their practices (Anne, 2009, 215). All these aspects have had a hand in rural and urban nursing not attaining the required recognition as a specialty of much importance in the society. Being ‘The Nurse’ in a Rural and Remote Community Research indicates that there are informal social structures predominating the rural and remote areas, less hectic pace of life is a characteristic, and the tendency of ‘connectedness’ between people is are common characteristics of typical rural and remote areas. Additionally, with small populations, there is the possibility of people knowing each other and thus developing a different social dynamics from those of urban areas (Hunsberger, Bauman, Blythe, & Crea, 2009, p.21). Although it is an enticement of working in rural areas, it is important to note that the situation is a double-edged sword in the sense that the informal social structures project nurses to a high public visibility in small communities and thus presenting them with challenges of keeping their individual autonomy. It is also difficult for nurses to maintain confidentiality within small communities due to informal networks. Conclusion This paper discussed the concepts of rural and remote nursing practices with more focus on the opportunities for nursing practice in this setting, diversity of rural and remote nursing practice, and challenges for nursing practice in this setting. Among the diversity, dimensions discussed as typical of rural and remote setting of nursing practice include sustainability of care, quality of care, and accessibility of care. On the other hand, the discussed opportunities of practicing nursing in these settings include career fulfillment, ability to integrate culture, ability to adjust nursing according to community demographics and its people, and the ability to deal with difficult situations faced during practice. Finally, the paper also discussed lack of adequate education programs, poor recruitment and retention, recognition and attention, and being the ‘rural and remote nurse’ as some of the challenges of nursing practice in rural and remote settings. Reference List Anne, B. (2009). Advanced Practice Nursing: Essential Knowledge for the Profession. Ontario: Jones & Bartlett Learning Baernholdt, M., Jennings, B. M., Merwin, E., & Thornlow, D. (2010). What does quality care mean to nurses in rural hospitals? 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The status of rural nursing in Australia: 12 years on. Collegian, 17(1), 30-37. Montgomery, J. (2009). The issues shared by professionals living and working in rural communities in British Columbia. Canadian Journal of Rural Medicine, 8, 255–260. Scharff, J. (2010). The distinctive nature and scope of rural nursing practice: Philosophical bases. In H. J. Lee, & C. A. Winters (Eds.), Rural nursing: Concepts, theory and practice (3rd ed., pp. 249–268). New York, NY: Springer. Read More