The practice of registered nurses in rural and remote areas of Australia: Case study research

This study aimed to delineate the roles and responsibilities of Registered Nurses (RNs) working in rural and remote areas of Australia and to explore the clinical and educational preparation required to fulfil such roles and responsibilities. Whilst much research exists surrounding rural and remote nursing, few studies have looked in depth at the roles and responsibilities and necessary preparation for rural and remote nursing. Indeed, much of the literature encompasses rural and remote nurse data within the wider metropolitan workforce. There is limited research which clearly defines the rural and remote populations being studied. This study, however, clearly delineates those nurses working in rural and remote locations by the Australian Standard Geographical Classification – Remote Areas system (ASGC-RA). It is known that nursing is facing a workforce crisis with many nurses due to retire in the next ten to 15 years. It is also known that this is worse in rural and remote areas in which the average age of the workforce is higher and there are issues with recruitment and retention of nurses. Thus, there is a need to understand the practice of RNs, preparation for the role and challenges that need to be addressed in order that such workforce issues can be addressed. The study was carried out utilising Yin’s case study research design. A multiple embedded case study design was selected as appropriate to explore and explain in greater detail the practice of Registered Nurses. The study was undertaken in two States of Australia, Queensland (QLD) and New South Wales (NSW). The philosophical paradigm in which the study is situated is that of social constructivism in which there is a belief that knowledge is generated through experiences and interactions with the social world. The study comprised three phases of data collection and analysis. The first, a content analysis of documents relating to the context of nursing and more specifically rural andremote nursing, second, a content analysis of an online questionnaire and third, a thematic analysis of semi-structured interviews revealing five major themes. Data from the three phases were converged through pattern matching and empirical propositions were derived from the data. Alongside many replicated findings the study also generated new findings. Major new findings included the influence of expectation on practice, perceived inadequate managerial understanding and support of the rural and remote RN role, an inability to fulfil the Primary Health Care (PHC) model of practice, the level of experience necessary to work in rural and remote areas, lack of preparation in mental health and maternity, an inability to access professional development, limited collaboration and networking opportunities, and misperceptions held by metropolitan staff. The Theory of Cognitive Dissonance was applied to the findings to explain the practice of the RN working in rural and remote areas. Through this theory it is evident that a number of implications and recommendations can be proposed in the areas of practice, organisation, education, policy and future research.