Shortage of Rural and Remote Nursing Workforce
The scope of practice in nursing is driven by the context in which the nurses work. Geographical descriptors are dull in describing the setting in which rural nursespractice. However, rural nurses in Australia is generally refers to all nursing and midwifery roles carried out outside the main metropolitan regions such as Sydney, Adelaide, Perth, Melbourne, Canberra, Newcastle, Brisbane and Gold Coast.Rural nursing context is determined by factors such as small communities with limited access to facilities, the community’s expectations of their local nurse, the social, cultural and economic features of the community and the obtainability of other care capability such as medical and medical evacuation as well as allied and relief staff (Kruske et al., 2008). Other entities who live and function in rural areas such as retirees also influence the roles of the rural nurses. Rural nursing may therefore include nursing practices in established rural hubs,Aboriginal and Torres Strait Island communities, mining and farming communities around Australia and all remote settlements. The health care sites embrace multi-purpose centers, Aboriginal and/or Torres Strait Island medical services, community health, small country hospitals, aged care as well as primary health (Mills, Birks & Hegney, 2010). This report establishes the challenges faced by rural nurses, the key influences of shortage in rural and remote nursing workforce and the impacts of this aspect on various stakeholders. It also discusses an operational approach already put in place to enhance rural and remote nursing. The report is directed towards the Australian government and aims to increase nursing workforce and advance the experience of all participants in health care settings in Australian rural and remote areas.
An Overview of Rural and Remote Nursing
Australia is often described as a prosperous country, yet several Australians are underprivileged and have poor health. People who live in rural and remote areas of Australia have a shorter life expectancy as compared to those living in major cities. Generally, health status declines with increasing remoteness. These inequalities may be caused by limited access to health services and facilities, exposure to relatively harsher environment and occupational hazards, lower socioeconomic status and employment opportunities. Rural and remote communities in Australia thus have a great need for health care services yet recruitment of health professionals in these regions is very problematic (Francis, 2012). Many health care providers want to work in parts where there are less occupational hazards and language barriers, leaving rural areas understaffed. Additionally, there is an inability by health care services to employ the range of professionals required to provide care services to these communities (Bourke et al., 2012).
The staff who make up the rural workforce include nurses, medical doctors, allied health personnel, indigenous health workers and pharmacists. Inopportunely, the diversity and the number of health care professionals is inversely proportional to remoteness (Onnis & Pryce, 2016). The level of vacancies for health care professionals reported in rural and remote areas in Australia also rise with increasing remoteness. Rural health professionals have a broader scope of practice, diverse skills and more autonomy then their urban counterparts (Francis, 2012). It is almost impossible to deal only with one’s area of expertise for instance, emergency department nurse in rural zones. These workers also experience professional isolation and find it hard to seek out developmental programs for their profession.
Factors Influencing Rural and Remote Nursing Workforce
Geographical location and Professional Isolation
Rural environments are varied as they include a range of ostensibly unrelated land uses that is distant from the urban centers. These comprise of dairy farming, forestry, fruit growing regions, mining, seaside tourist resorts, wheat and sheep keeping zones and also horticulture practicing areas. The only unifying definition of a rural area is that it is based far from the urban sections of a country. The characteristics of rural areas encompass sparsely distributed populations over large distances, extensive land uses and social and economic diversity. This leads to professional isolation and lone working as well as inconveniences in carrying out one’s daily chores due to the long distances between places. Professional segregation leads to underdevelopment of skills by the said professional. In rural areas, there is very limited accessibility to development programs aimed to enhance one’s growth in their career. The professionals therefore have to travel to acquire further education and developmental opportunities (Bindon, 2017). In addition, interaction with other specialists in an individual’s field is highly difficult. This means that there is inadequate exchange of ideas, experiences and new ways to improve one’s quality of work (Dreaming—Editorials, 2011). It also impacts on the decisions made by the professional concerning their craft.
Lone working nurses in rural regions may be exposed to violence from the communities they work in, ranging from verbal abuses to life threatening assaults due to lack of immediate support from colleagues and other people. Despite the fact that rural and remote nurses enjoy a sense of independence in their work settings, there is always a risk of insecurity and poor management from the employer (Opie et al., 2010). These factors discourage many qualifying and registered nurses from applying for jobs in rural and remote areas although there are numerous employment opportunities in these regions. The fact that rural practice is viewed as a life time commitment is also been a disincentive by many graduates to take up the challenge of working in rural and remote areas (Gorton, 2012).
The environment in rural areas is often harsh and with it comes occupational hazards.Climate change in these regions threaten to aggravate the economic, social and health disparities already experienced by the people. Remote zones are particularly susceptible to undergoing heat waves, bush fires and increasingly long periods of drought caused by changes in climate. Many rural communities in Australia are not equipped to deal with the effects of increasing temperatures. Climate changes and harsh environmental conditions have led to further relocation of Australians from rural to urban centers, thereby leaving these areas even more sparsely populated. While all Australians experience climate change in their regions of residency, rural and remote communities have it worse (AU, 2016). This is a major dissuasion by nurses to work in these areas due to inconveniences and uncomfortability that is associated with the environmental conditions of these regions (Lenthal et al., 2011).
Rural and remote areas requires health practitioners to be capable of functioning in resource-poor regions with inadequate collegial support in addition to having a widespread knowledge base and being highly skilled (Francis, 2012). This is important because a rural nurse is expected to perform a range of functions and work across aged, acute, palliative, primary health service provision, mental health, emergency, peri-operative and other departments as is required of them. The nurse thus needs a generalist approach with traits such as resilience, flexibility, reflectivity and adaptability (Scharff, 2010). Even though there is a deficiency of highly trained nurses in rural and remote areas, the other staff such as medical doctors and allied personnel are less. Nurses make up about 65 percent of the rural health care workforce, further necessitating acquisition of a wider scope of knowledge and skills (Francis, 2012). Inmany instances, however, nurses have specialized skills and knowledge for only a certain field, for instance in mental health. This is therefore a lot to ask of a professional who has spent a substantial portion of his or her education life in a specified area. Most nurses therefore opt to seek job prospects in their field of expertise.It is difficult for many rural health professionals to maintain a currency in their skills and the required knowledge base. There is also an inability to obtain substitute relief while backfilling is a major challenge.
Conflict of Values
Rural and remote nurses most a time have to conform to the values, the way of life, the customs and beliefs of the communities in which they work in. Their functioning is vastly influenced by the characteristics of these communities and the societal expectations of them. In these communities, personal and professional matters are not easily separated. This could be a challenge for the nurse especially in situations where the community expectations of him or her do not agree with their personal values.
The hospitals in which nurses are working could share the same values with the community in which they are situated making the nurse feel even more alienated. If the nurse decides to surrender their values and practice nursing in accordance with the community’s and the institution’s values they end up feeling conflicted. This brings about emotions of constant frustration and dissatisfaction with their works (Baernholdt et al., 20010). Consequently, this divergence in values and priorities compromise patient care and both parties may end up discontented with the services provided. Additionally, the nurse may end up resigning from their occupation in search of better satisfying outcomes (Bragg & Bonner, 2014). Conflicting values could be a principal causal agent for nurses not to seek out job opportunities in rural and remote areas.
Impacts of Shortage in Nursing Workforce in Rural and Remote Areas
Patient care in rural areas is compromised by staffing issues and insufficient nursing personnel. The patients do not acquire utmost quality in the services they are provided with since the scarce nurses cannot afford to dedicate all their time to one patient (Bragg & Bonner, 2014). With a decreased number of nurses in community hospitals, patients face an increased rate of adverse outcomes, increased operating and labor costs while the care they ultimately receive may neither be efficient nor effective.
Burnout for Nurses
Delivery of quality care to in hospitals is a complex issue and necessitates coordinated efforts from a range of health care professionals. Unavailability of the required hospital personnel increases the nurse’s work load each and every day which can lead to exhaustion and job related stress (burnout)(Marek, Schaufeli & Maslach, 2017). As a result of burnout, nurses are unable to provide efficient and effective care for the patients which leads to a displeasure with their work (Lu &Gursoy, 2016). Rural and remote regions also experience high morbidity rate as compared to the urban centers which may lead to the nurse spending even more time at the hospital. Therefore the nurses working in rural areas may lag behind in social matters (Opie et al., 2010). There is also a high mortality rate in these areas which may affect the nurse negatively emotionally as he or she wonders if she could have been of more help (Lenthall et al., 2009).
Shortage of nurses in a health care institution renders the organization unable to provide high quality health services efficiently. This reduces the quantity of patient care which damages the reputation of the institution to the outside world. Subsequently, the institute may not be able to employ more staff because a reduction in quantity of patient care also means a decline in the income of the organization. This means that recruiting more personnel would not be a good idea for the institution as it may not have the ability to pay them satisfactory remuneration
Community and the Government
Reduced number of patients cared for or a neglect of some patients due to inadequate nursing personnel results in an increased mortality rate which affects both the community and the government. The community with understaffed health care professionals has to endure a continuous loss of loved ones as a result of sicknesses. The society has no control over these matters except probably by providing traditional herbs which may not be effective. The government also suffers as a result of this increased mortality rate which is one of the major reasons it has put effort into trying to design programs focused on meeting the health requirements of rural and remote regions of the country over the past several years (Baernholdt, 2012).
Approach to Increase Rural and Remote Nurses
The National Strategic Framework for Rural and Remote Health
This framework was developed by the Rural Heath Standing Committee (RHSC) which was formed under the Australian Health Ministers’ Advisory Council (AHMAC) to offer advice on and to advance national matters necessary in health improvement. It was establishedwith the esteemed input of the National Rural Health Alliance and other rural health stakeholders. The aim of the National Strategic Framework for Rural and Remote Health is to enhance health outcomes and increase return on investments for the remote and rural Australians (Barclay, Phillips & Lyle, 2018). It encompasses a full range of health services provided in rural and remote settings which include aged care services, treatment, prevention and screening, early intervention and delivery of specific health care services such as mental health, dental amenities, maternity health, primary health care, preventative services and hospital and emergency care (Australian Government, 2010). Additionally, it is cognizant of the various groups of people in the rural and remote regions of Australia including the Aboriginal and Torres Strait Islander people, the older individuals, people suffering from chronic diseases, children and families, people from diversified linguistic and cultural backgrounds as well as the refugees. The framework was developed as tool for government use (AHMC, 2012).
Impacts of the Framework
- The framework is helpful in identifying the issues which require the most attention concerning rural and remote health.
- It is an evidence of how the government supports the improvement of health in rural and remote Australia
- It helps attracts more investment in rural areas through recognition of opportunities
- Helps attract more job seekers in the health sector to the rural areas as they notice that the government is ready to assist them in development by improvement of rural and remote health
However the framework is only a theoretical view of what is needed to promote rural and remote health and the actions that should be taken. It does not provide a concrete evidence of an action (s) that was actually undertaken and resulted to improved health in these regions.
Improvement in the Framework
Financial incentive: For the framework to be even more effective mentioning of an increased salary or other financial handouts for the rural and remote nurses would be very beneficial.Many people around the world are greatly motivated by money and nurses are no exception. They could be motivated by other factors as well but money still plays a role in this inspiration. Thus financial incentive would attract a larger number of nursing job applicants in rural and remote Australia (Aziz, 2009).
Professional Development Programs: inclusion of establishment of professional development programs would be a vital step towards improvement of the framework. Most nurses are aware of the professional isolation and seclusion that could be linked to working in rural and remote regions. Plans to develop programs where they can interact with other nurses and share ideas would therefore go a long in diminishing isolation. Additionally, they would be inspired by the idea of additional educational opportunities for the furtherance of their knowledge and skills in their chosen career (Greenhill, Mildenhall & Rosenthal, 2009). Moreover, ability to interact with other nurses and develop oneself professionally reduces the probability of burnout at work and delay of imminent exhaustion. It enables them to wake up every day feeling inspired and with a purpose.
In summary, it is evident that there is a shortage of nursing workforce in rural and remote Australia. This report has also established that other staff in the field of health care are also deficient in the Australian rural and remote regions. The number and diversity of health care professionals in rural areas is inversely proportional to remoteness. As the remoteness increases the number of nurses and other personnel in the health care sector decreases. This is a major problem in rural areas in terms of health as the care of the patient is compromised. The patient does not receive as much attention from the nurses as they should or as they deserve since the nurse cannot give all his or her time to a single patient. It also reduces the quantity of patients served by the institution which may consequently not generate enough to employ more workers. The mortality rate of patients in rural and remote areas is thus high which is negatively impacts the government and the community. Insufficient nursing personnel in rural and remote areas of Australia is due to the disadvantages experienced in the rural regions of the country. These include harsh environment, occupational hazards, professional isolation and conflicting values between the nurse and the community. Many nurses will automatically choose to work in surroundings in which they are comfortable and in places where they can interact with colleagues and develop themselves professionally. The National Strategic Framework for Rural and Remote Health is the approach which has been identified as putting efforts towards improving health in Australian rural and remote areas.
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