Rural and Remote Nursing in Rural Areas - Essay Example

Rural and Remote Nursing in Rural Areas Nursing is nonetheless the noblest profession yet the most challenging when it comes to rural areas of Australia. The benefits of rural nursing life are manifold, as government is providing several incentives to the nurses who are taking interest in practicing in rural areas. However, nursing and taking care of the sick in the rural areas has been going on since centuries yet many have now acknowledged the fact that they have to adopt different methods in nursing as compared to their practice methods in metropolitan areas. Health Department of Western Australia too states that nurses devoting themselves in the service of rural areas are independent and so are expected to perform and give better results than nurses employed in metropolitan areas. Rural nurses fill the gap of medical practitioners who show their inability and unwillingness to work in rural areas. There is not one definition of rural nursing, for Blue, rural nurses, “work is primarily in health care settings outside of the major metropolitan and urban areas.” (Handley 1996, p.2) Kreger states that, “rural nursing is the practice of nurses who work in environments with limited access to medical support”, (Hegney et al 1997) whereas Hegney et al (2000, p.183) states “rural nursing is nursing practiced in environments where ... no medical practitioners are employed full-time in a hospital, but are located within the town, or in community health or district nursing service located outside a capital city or other major urban environments (that is less than 80,000).” Rural nurses are expected to be very resourceful in health profession and have to take on multiple tasks. They have to perform in the areas where they have very limited access to support and very limited medical provisions therefore they attain general skills instead of specialized skills. They have to expose themselves to more stress and lack of adequate training. Though nurses prefer medicines for ill patients yet they have to get themselves emotionally attached with the rural folk and take on more humanistic approach. The most common problems being faced by nurses include feeling of isolation and limited medical resources at their disposal. Moreover they have a rare chance to get themselves specialized and also face legal implications that hinder in the path of their expanded role. The unfortunate part is that though they have been serving rural areas since the years of white colonization, their services have been most of the time ignored. There are two types of nurses who are working in the rural areas- rural nurses and remote area nurses. Due to the isolation from other medical practitioners, practice of remote area nurses is different than the metropolitan nurses, as they have to adjust themselves according to the rural environment. Remote area nurses are now developing complete health approach for the rural population like looking after their physical, spiritual and emotional lives adhering to their social belief and practices. Many authors and intellectuals felt the need for legitimizing the extended roles being carried out by nurses. Johnston held the opinion that, “the full legitimated status [of nurses] as autonomous professionals remains as strong as it was during the early days of the emerging modern nursing professions and many (mostly male doctors, hospital administrators, and politicians) continue to resist and be vehemently opposed to any thought that nurses should take destiny into their own hands.” (Gott, 2000, p. 151) Johnston tries to focus the point that nurses lack that competency and skills as required by fully professionals and cannot make correct and sound judgment, they are subordinators of medical officers and have duty to obey them, and they need to perform their duties under the supervision of medical officers. Rural and remote area nurses are not authorized to perform any action independently. But in number of cases when they are required to make decision independently of medical officers, they have to face legal barriers. (Gott, 2000, p. 51) Nurses are also now demanding autonomy in their area of work but not all wanted to become independent practitioners. Nurses are unequally distributed in metropolitan areas as well as remote areas and rural areas. There are approximately 959.6 remote area nurses per 100,000 population, 1262.1 metropolitan nurses per 100,000 population and 1702.2 rural nurses for same number of population. (Bushy & Kruks, 2000, p. 208) Representation of nurses in the rural areas is 69.2 per cent as compared to any other practicing health professionals and they can be found in every department of health sector be it public or private in major areas of services like in community health programs, rehabilitation centers, caring for the senior citizens and physically or mentally challenged patients. (Grbich, 1996) The figures suggested by NRHA (2001) showed 57.4 per cent among people engaged in health services in Australia were nurses including unlicensed nurses, personal care assistants and nursing assistants. But this is also highlighted that actual number of licensed nurses was less in number. (NRHA, 2001) It was also found that the force comprising rural nurses was working as part time as compared to their counterparts in metropolitan or remote areas. According to Hegney et al, (1997) these nurses are generally between 35 to 45 years of age but AARN (1998) reported the age of rural nurses between 25 to 58 years with the majority of the group between 45 to 49 years. The problem witnessing in the nursing profession is the shortage and this shortfall accounts to number of factors, which are the hallmark of the social and rural life and experts opine that situation will only get worse by 2010. (Johnson, Billingsley & Costa 2006) When the population would be growing in age, the social scenario would see the decline and more shortage of registered nurses and many other health care personals. The studies have also revealed that number of factors such as low pay, staff shortages, overwork, physical and emotional exhaustion, frustration and undervaluation of their work are hampering the enthusiasm level among rural nurses. (Dr. Jolly, 2007) This shortage would have direct impact on the health care of rural population who are more exposed to occupations, which are not conducive to their health and lead to unhealthy environment. Nurses also lack that skills to overcome the expectations of the rural folk who find themselves most of the time at razor’s edge, in other words, they are more exposed to diseases and are at risk when compared with urbanities. They are uneducated and show little importance about their health status. From the government side too, there are hurdles in three levels: financing, execution of planning and in finally getting the health care services at the doors of the villagers. The effect of the shortage of nurses on public health is most crucial when it comes to impact it has on the overall costs, quality and amount of the health related services villages required. Rural Australians are not one homogenous group but are living in different settlements having their own economic standing, their own occupation and culture, and to delve into as diverse culture and economic arena of Australians is very difficult task if nurses are in rare supply. (Gott, 2000, p. 145) Though the fresh air and green environment of rural and remote areas can lead to the healthy life yet farm life can be very stressful as animals, machineries used in farms, chemicals can be very risky and might pose health hazard to the people. Children are more at risk from quad bikes, and tractors. Over and above natural disasters like draught, which is a common phenomenon in villages pose more health risk to the people. Suppose in one village of 1000 people, if 100 are succumbed to one or the other illness or injury and there is just one nurse per 10 patients then to cater 100 patients will be a big problem; it is quite natural many of the patients would remain either neglected or unattended. Shortage of staff in hospitals leads to lapses in the care of patients like changing their bandages or bathing them. With more of patients and lesser number of staff, there is also lack of interaction and emotional and psychological response to mentally disturbed patients. When nurses are overloaded with heavier task, it is quite natural for them to commit mistakes, which could be risky and would create an impression of mismanaged administration. Lack of care can make the patients prone to infections, bedsores, wrong dozes of drugs and many other complications, which could have been prevented. As rural nurse, I felt I am enjoying very low status in the occupational hierarchy; the health authorities have never tried to understand the complexity involved in practice especially among rural population. I also have very less decision making power creating problem in emergency situation and over and above unfriendly shift work takes away all the energy level and many times like others I decided to opt out of the nursing profession. It is an urgent need on the part of the government to adopt concrete and effective steps to encourage more and more people to adopt nursing their profession. The need of the hour is to provide incentives to nurses financially, morally and emotionally. Nurses willing to enter into rural areas should be encouraged by enhancing their skills, providing them with adequate infrastructure, equipping them with medical facilities, arranging their proper stay and giving them professional growth. And it should start from the training level. Nursing students at undergraduate level should get exposure to the rural environment. They should be educated on the needs of the rural population, their social aspirations, and occupational hazards. The students should be given financial support when they are placed in the rural environment and for the students from rural background should be given adequate facilities to get them acquainted with knowledge and skills to handle any adverse conditions. Emphasis should also be laid on the strategies for funding at rural re-entry programs and qualitative evaluation programs should be carried out to check their performance at every level. (Neill & Kerry, 2002) Australian government should deal with the various issues affecting nurses in rural and remote areas and provisions should be made to provide them adequate training and coordination at education level. Nurses should be bestowed with responsibilities’ to share their burden of health related other services like educating the rural people on benefits of health and development. Australian government also provides fund for health and education and other care services and nurses can play a very important role in these areas and also for developing and coordinating various other policy measures of government. To meet the shortage, the Australian government has raised the number of undergraduate nurses. In 2006, government committed to recruit 1000 more nurses and also introduced many scholarships to encourage nurses like Commonwealth Undergraduate Rural and Remote Nursing Scholarship Scheme and NiGP Initiative re–entry scholarship and many other reforms have contributed towards making a great difference in the working environment of nurses. (Dr. Jolly, 2007) And now the role of nurses has also been legitimized in New South Wales by first appointments by the Australian Government. (Dr. Jolly, 2007) The World Health Organization Report on “World health” in 2000 emphasized on the point that effective health system has an ability to bring measures to ensure overall health of an individual and whole system should be built on one fundamental theory that is theory based on health creation. (World Health Organization, 2000) Rather than just putting all focus on illness, nurses should be taught to ensure good physical and mental health. A “social health model” so designed would bring out both social and economic health status and would have direct impact on the lives of people. Number of small rural hospitals has removed their bed-based services to encourage educative programs at community level. The importance on community-based programs would not only reduce the total cost of health care but also reduce the burden of nurses, as it would entail more services at home and bring more women into services. This would create new grounds to give new lease of life to people who are cut off from the main stream of urbanities yet are part of our lives and it would also encourage nurses to enter into the rural life and make difference in their lives and again built the image of nursing as noblest of all professions. REFERENCE LIST Association for Australian Rural Nurses. 2001. Association for Australian Rural Nurses submission to the National Nursing Education Review. Australian Nursing Council Inc. (1992) ANCI Competencies. Bushy A. & Crooks, K. B. 2000. Orientation to Nursing in the Rural Community. California: Sage Publications. Grbich, C. 1996. Health in Australia, sociological concepts and issues. Sydney: Prentice Hall. Gott, M. Nursing Practice, Policy and Change. Oxon: Radcliffe Publishing. Dr. Jolly, R. 2007. Practice nursing in Australia. Retrieved on August 1, 2008 from W.W.W: http://www.aph.gov.au/library/pubs/rp/2007-08/08rp10.htm Handley, A. 1996 Australian Rural Nurses: Education, Training and Support. University of South Australia: Association for Australian Rural Nurses Inc. Hegney, D., Pearson, A. & McCarthy, A. 1997. The role and function of the rural nurse in Australia. Canberra: Royal College of Nursing, Australia. Hegney, D. 1997. The differences of rural nursing practice. 5th National Conference of the Association for Australian Rural Nurses, "Rural Nursing: Celebrating Diversity" Conference Proceedings, 1-3 Feb, pp. 9-24. Hegney, D. Rodgers-Clarke, C., Gorman, D., Baker, S. & McCarthy, A. (2000). Factors influencing the recruitment and retention of nurses in rural and remote areas in Queensland. Toowoomba: University of Southern Queensland. Johnson J.E., Billingsley M.C. & Costa L.L. 2006. Xtreme Nursing and the Nursing Shortage. Accident and Emergency Nursing,9(1): 54. Neill, J. & Taylor, K. 2002. Undergraduate Nursing Students' Clinical Experiences In Rural And Remote Areas: Recruitment Implications. Australian Journal of Rural Health, 10(5): 239-243. National Rural Health Alliance. 2001 NRHA Submission to the National Review of Nursing Education. NRHA, Deakin. Styles, C. R. 2006. An Epidemic of Abuse and Violence: Nurse on the Front Line. Accident and Emergency Nursing. 9(1): 14. World Health Organization (WHO). World Health Report 2000 Press Release, 2000 http://www.who.int/whr/2000/en/press_release.htm Read More