Nursing in the Rural Area A WELL-DESERVED SECOND LOOK

Rural nurses are particularly endangered by the current and worsening shortage in nurses. As it is, rural nursing is already beset with issues that range from a lack of professional practice system, the need for larger incentives for nurses to work in the rural areas, a general unwillingness to live in these areas among the nurses and the foreseen depletion of the supply of rural nurses. Possible solutions and approaches have been proposed.

Approximately 20% or 54 million U.S. residents live in locations categorized as rural (Bushy, 2006). These residents are distributed across 80% of the nation's total land area. About 99 or fewer residents occupy every square mile in these areas and experience the shortage of nurses more acutely than in urban areas. Moreover, they have generally lower annual income, less education and poorer health status than urban residents. Local health care providers cannot compete with the offerings of wages, start-up bonuses and benefits by urban counterparts. The situation is even more difficult in frontier areas where residents are fewer, particularly in the matter of wages. Financial shortage also limits educational opportunities in small hospitals. And the inadequate number of nurses hampers the recruitment of physicians and thus restricts access to care by local residents. These residents must spend more to see specialty or even basic health care providers in urban areas for services not found or are inadequate in their area (Bushy). 9 IR-S & IR-P

Nurses who consider working in rural areas need to know the scope of nursing practice in these areas, the community's norms and behaviors and the consequences of the choice to work there (Bushy, 2006). They need to see the need for new changes in education and the existing systems, which require multi-dimensional strategies and partnerships. These partners are educators, researchers, the rural communities and policy makers. All these are equally necessary to confront the situation of rural nursing. And there is no single or simple solution to its inherent problems. The rewards are, however, great to those who remain dedicated as long as they view the career realistically (Bushy). A survey participant quoted (Litchfield & Ross, 2000), "a rural nurse lives and breathes rural air… there is dust and dirt and mud and grit in her work." 1 DQ, 7 IR-S & IR-P

Body

Workforce, Employment Issues

A national survey conducted among 84 nurses in New Zealand in 2000 identified the workforce and employment issues in their practice (Litchfield & Ross, 2000). The mean age of the almost-entirely female respondents was 46.3. Almost half of them were in their 40s and 30.6% were 50 years old and older. Most of them were from New Zealand or Europe at 89.4%. All of them had basic general nurse registration. Few had a formal or specialty preparation in rural nursing or any of its components. Only 5.9% of them had a bachelor's degree. More than half of them lived in the rural area and had limited use of computer technology. Workforce issues concern recruitment and retention, education and career structure. Nurses' work was fragment. A lack of clear professional practice system in the recent health service context in the rural area must also be addressed (Litchfield & Ross). 11 IR-S, IR-P

Knowledge and Skills

The Health Department of Western Australia stated that "nurses working in rural and remote area of Western Australia are often sole practitioners… expected to function at a higher level than nurses & #8230; in metropolitan areas (DEST, 2001)." Medical practitioners are reluctant to work in small rural areas for these reasons. At the same time, health services are unable to employ health professionals because of the cost it entails. The knowledge and skills required in rural nursing are determined by the employers and the particular needs of the local community. They, in turn, require rural nurses to possess broad knowledge and skills base. Devoted rural nurses must practice extended roles in order to fill the gap and for the service to exist (DEST). 1 DQ. 5 IR-S, IR-P

Policy Interventions

A 2006 national and international survey revealed the importance of large financial incentives in motivating nurses to work in the rural areas (Blaauw et al., 2010). These were rural nurses from Kenya, South Africa and Thailand. The study used discreet choice experiment or DCE data. The use of DCE-based data has proved reliable in conducting human resource research in low-and-middle-income countries. A 10% increase in salary was not a strong incentive. Improved housing and accelerated promotion were somewhat stronger motivations. Preferential access to training and career advancement opportunities were much better and...

Changes in management culture were not too important to South African respondents who were young graduates who preferred varying management styles. Some would want personal and supportive managers, while the rest opted for the traditional hierarchy type for discipline and proper use of resources (Blaauw et al.). 9 IR-S, IR-P
These findings call for both policy interventions appropriating a lot more financial resources than are currently provided in these countries (Blaauw et al., 2010). Preferential training was attractive for its future economic potential. Certain benefits, like car allowances in South Africa, have become enormously inviting on account of the social prestige associated with them. Nurses who came from the rural areas were likely to choose a placement there (Blaauw et al.). 4 IR-S, IR-P

Homecare Nurses in Western Quebec

A study on the attitudes of rural homecare nurses found the need for a palliative homecare team and context-specific professional development for them (Arnaert et al., 2009). Respondents were five nurses who attitudes towards palliative care in the rural community of Western Quebec were investigated. Homecare nurses are an important part of a continuous, personalized and holistic care. The data gathered from the findings were categorized under six headings. These were "experiencing community embedded-ness, maintaining patients' quality of life, collaborating with a multidisciplinary team, experiencing emotional and physical isolation, acknowledging the need for professional development and dealing with organizational issues (Arnaert et al.)." 1 DQ, 5 IR-S, IR-P

The foreseen continued increase in the need for a comprehensive, high-quality palliative homecare underscores the significance of this study (Arnaert et al., 2009). One way is the organization of a team, which can serve as a peer support network and as a provider of accessible education and training. Although the needs of each rural community are unique, the researchers believe that the results generally represent the attitudes of rural homecare nurses (Arnaert et al.) 3 IR-P, IR-S

Rural Health Clinics' Efficiency

Another research sought to examine the relative contribution of nurse practitioners to the productivity of these clinics (Ortiz et al., 2010). It used data gathered from the medical cost report and the area resource file from the Bureau of Health Professions in 2007. The data were drawn from the reports and files of 3,565 rural health clinics. Findings showed that these investigated clinics maximized the use of health care professionals in most cost-effective ways to provide health services. These professionals included nurse practitioners, physicians and their assistants. Other contributors to efficiency included organizational culture and managerial systems and techniques (Ortiz et al.). 6 IR-P, IR-S

Attitudes towards Living and Working in Rural Areas

A cohort study on these attitudes among former nursing students who later rendered rural community service reflected a general enthusiasm to work but not to live in the rural area (CREHS, 2009). The respondents were 377 cohort members from 7 nursing schools in Gauteng and the North West provinces of South Africa. Their media age was 31. The study was conducted from 2008 to 2009. The purpose was to determine if the respondents rendering community service achieved their dream. It also sought to discover ways of encouraging more nurses to work in rural areas (CREHS). 6 IR-S, IR-P

On the whole, the respondents agreed that working in the rural area would be beneficial to them. They believed they could earn more money, quickly advance in their career, and gain support from colleagues in rural areas (CREHS, 2009). At the same time, they also thought that working in the rural area would be stressful. Living in the area was a different matter. Overall, they disagreed that rural life is quality, appealing or enjoyable. While students from the North West generally agreed that rural lifestyle was appealing, those from Gauteng and universities disagreed (CREHS). 6 IR-S, IR-P

Threats to Future Supply of Rural Nurses

The shortage of registered nurses in the rural areas looms and is likely to worsen as current ones retire and active ones move to large, urban areas to work (Skillman et al., 2009). Statistics suggest that the shortage would exceed a million by 2020 nationwide. As it is, access to health care in these areas is already limited, such as in the poor distribution of health care workers, such as registered nurses. Rural registered nurses at present are also older by 6 years than those in 1980. Most of them are 45 years old on the average. About 20% are 55 years old or older. And despite increased per-capita living, big numbers of registered nurses…