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McCallum AM, Vandenberg HER, Penz KL. Help Wanted, Experience Preferred, Stamina a Must: A Narrative Review of the Contextual Factors Influencing Nursing Recruitment and Retention in Rural and Remote Western Canada from the Early Twentieth Century to 2023. Can J Nurs Res 2024; 56:134-150. [PMID: 37802101 PMCID: PMC11032004 DOI: 10.1177/08445621231204962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023] Open
Abstract
Rural and remote communities of Western Canada have struggled to recruit and retain nursing professionals since the turn of the twentieth century. Existing literature has identified the unique challenges of rural nursing due to the shifting context of rural and remote nursing practice. The objective of this narrative review is to explore the history of rural and remote nursing to better understand the contextual influences shaping rural nursing shortages in Western Canada. This narrative review compared 27 sources of scholarly and historical evidence on the nature of rural nursing practices and recruitment and retention methods following the First World War until 2023. The findings suggest that the complex nature of rural nursing practice is a consistent challenge that has intersected with the long-standing power inequities that are inherent in rural marginalization, political influences, the nursing profession, social structures, and organizational design, to perpetuate rural nursing shortages throughout the past century. Integration and collaboration are needed to reduce systemic marginalization and develop effective and sustainable solutions to reduce nursing shortages in rural and remote areas of Western Canada.
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Affiliation(s)
| | | | - Kelly L. Penz
- University of Saskatchewan College of Nursing, Saskatoon, SK, Canada
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Yassi A, Barker S, Lockhart K, Taylor D, Harris D, Hundal H, Grant JM, Okpan AI, Pollock S, Sprague S, Sing CK. Urban-rural divide in COVID-19 infection and vaccination rates in healthcare workers in British Columbia, Canada. CANADIAN JOURNAL OF RURAL MEDICINE 2023; 28:47-58. [PMID: 37005988 DOI: 10.4103/cjrm.cjrm_24_22] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Introduction Healthcare workers (HCWs) play a critical role in responding to the COVID-19 pandemic. Early in the pandemic, urban centres were hit hardest globally; rural areas gradually became more impacted. We compared COVID-19 infection and vaccine uptake in HCWs living in urban versus rural locations within, and between, two health regions in British Columbia (BC), Canada. We also analysed the impact of a vaccine mandate for HCWs. Methods We tracked laboratory-confirmed SARS-CoV-2 infections, positivity rates and vaccine uptake in all 29,021 HCWs in Interior Health (IH) and all 24,634 HCWs in Vancouver Coastal Health (VCH), by occupation, age and home location, comparing to the general population in that region. We then evaluated the impact of infection rates as well as the mandate on vaccination uptake. Results While we found an association between vaccine uptake by HCWs and HCW COVID-19 rates in the preceding 2-week period, the higher rates of COVID-19 infection in some occupational groups did not lead to increased vaccination in these groups. By 27 October 2021, the date that unvaccinated HCWs were prohibited from providing healthcare, only 1.6% in VCH compared with 6.5% in IH remained unvaccinated. Rural workers in both areas had significantly higher unvaccinated rates compared with urban dwellers. Over 1800 workers, comprising 6.7% of rural HCWs and 3.6% of urban HCWs, remained unvaccinated and set to be terminated from their employment. While the mandate prompted a significant increase in uptake of second doses, the impact on the unvaccinated was less clear. Conclusions As rural areas often suffer from under-staffing, loss of HCWs could have serious impacts on healthcare provision as well as on the livelihoods of unvaccinated HCWs. Greater efforts are needed to understand how to better address the drivers of rural-related vaccine hesitancy.
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Affiliation(s)
- Annalee Yassi
- School of Population and Public Health, University of British Columbia; Medical Practitioners Occupational Safety and Health (mPOSH), Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Stephen Barker
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen Lockhart
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Devin Harris
- Interior Health, Kelowna, British Columbia; Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Harsh Hundal
- Interior Health, Kelowna, British Columbia, Canada
| | - Jennifer M Grant
- Medical Practitioners Occupational Safety and Health (mPOSH), Vancouver Coastal Health; Department of Pathology and Laboratory Medicine, Vancouver Coastal Health; Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arnold Ikedichi Okpan
- School of Population and Public Health, University of British Columbia; Medical Practitioners Occupational Safety and Health (mPOSH), Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Sue Pollock
- School of Population and Public Health, University of British Columbia, Vancouver; Interior Health, Kelowna, British Columbia, Canada
| | - Stacy Sprague
- Employee Safety, Health and Wellness, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Chad Kim Sing
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia; Medicine, Quality and Safety, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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Gingerich A, Van Volkenburg K, Maurice S, Simpson C, Roots R. Urban ideals and rural realities: Physiotherapists navigating paradox in overlapping roles. MEDICAL EDUCATION 2021; 55:1183-1193. [PMID: 33617663 DOI: 10.1111/medu.14476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/19/2021] [Accepted: 02/13/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Rural practitioners who develop a sense of belonging in their community tend to stay; however, belonging means neighbours become patients and non-clinical encounters with patients become unavoidable. Rural clinical experiences expose students to overlapping personal and professional relationships, but students cannot be duly prepared to navigate them because ethical practice standards primarily reflect urban, and not rural, contexts. To inform such educational activities, this study examines rural physiotherapists' strategies for navigating overlapping relationships. METHODS Constructivist grounded theory guided iterative recruitment of 22 physiotherapists (PTs) living and practising in rural, northern or remote (RNR) communities in British Columbia, Canada, and analysis of their experiences navigating overlapping relationships. RESULTS PTs routinely navigate overlapping relationships while mindful of practice standards, neighbourly and community expectations, personal well-being and patient welfare. While off-duty, they balance opposing expectations and manage various responsibilities to achieve contradictory goals such as being a professional who protects patient confidentiality while being an active and cordial community member. While on-duty, they face ethical dilemmas where deciding not to treat acquaintances potentially denies access to care but allows for clearer personal-professional boundaries and deciding to treat contravenes (urban) practice standards but could allow for customised patient care based on knowledge gained through both clinical and social interactions. CONCLUSION Overlapping relationships are a rural norm. Urban ethical practice standards imposed on rural contexts put RNR practitioners in a paradoxical situation where clinical and social interactions must be but cannot be partitioned. Examining the identified strategies through the lens of paradox theory shows sophisticated cognitive framing of the conflicting and interrelated aims inherent to living and practising in RNR communities. Consequently, introducing a paradox mindset in educational activities could be explored as a way to prepare students for the ethically complex overlapping relationships that they will need to navigate during RNR clinical experiences.
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Affiliation(s)
- Andrea Gingerich
- Division of Medical Sciences, University of Northern British Columbia, Prince George, BC, Canada
| | - Kevala Van Volkenburg
- Division of Medical Sciences, University of Northern British Columbia, Prince George, BC, Canada
| | - Sean Maurice
- Division of Medical Sciences, University of Northern British Columbia, Prince George, BC, Canada
| | - Christy Simpson
- Department of Bioethics, Dalhousie University, Halifax, NS, Canada
| | - Robin Roots
- Physical Therapy, University of British Colombia, Prince George, BC, Canada
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Cosgrave C. The Whole-of-Person Retention Improvement Framework: A Guide for Addressing Health Workforce Challenges in the Rural Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2698. [PMID: 32295246 PMCID: PMC7216161 DOI: 10.3390/ijerph17082698] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/03/2020] [Accepted: 04/12/2020] [Indexed: 12/11/2022]
Abstract
People living in rural places face unique challenges due to their geographic isolation and often experience poorer health outcomes compared to people living in major cities. The struggle to attract and retain an adequately-sized and skilled health workforce is a major contributing factor to these health inequities. Health professionals' decisions to stay or leave a rural position are multifaceted involving personal, organisational, social and spatial aspects. While current rural health workforce frameworks/models recognise the multidimensional and interrelated influences on retention, they are often highly complex and do not easily support the development of strategic actions. An accessible evidence-informed framework that addresses the complexity but presents the evidence in a manner that is straightforward and supports the development of targeted evidence- and place-informed retention strategies is required. The 'Whole-of-Person Retention Improvement Framework' (WoP-RIF) has three domains: Workplace/Organisational, Role/Career and Community/Place. The necessary pre-conditions for improving retention through strengthening job and personal satisfaction levels are set out under each domain. The WoP-RIF offers a person-centred, holistic structure that encourages whole-of-community responses that address individual and workforce level needs. It is a significant response to, and resource for, addressing avoidable rural health workforce turnover that rural health services and communities can harness in-place.
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Affiliation(s)
- Catherine Cosgrave
- Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Docker St, Wangaratta, VIC 3677, Australia
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Cosgrave C, Malatzky C, Gillespie J. Social Determinants of Rural Health Workforce Retention: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030314. [PMID: 30678350 PMCID: PMC6388117 DOI: 10.3390/ijerph16030314] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/13/2019] [Accepted: 01/21/2019] [Indexed: 11/29/2022]
Abstract
Residents of rural and remote Australia have poorer health outcomes than their metropolitan counterparts. A major contributor to these health disparities is chronic and severe health workforce shortages outside of metropolitan areas—a global phenomenon. Despite emerging recognition of the important influence of place-based social processes on retention, much of the political attention and research is directed elsewhere. A structured scoping review was undertaken to describe the range of research addressing the influence of place-based social processes on turnover or retention of rural health professionals, to identify current gaps in the literature, and to formulate a guide for future rural health workforce retention research. A systematic search of the literature was performed. In total, 21 articles were included, and a thematic analysis was undertaken. The themes identified were (1) rural familiarity and/or interest, (2) social connection and place integration, (3) community participation and satisfaction, and (4) fulfillment of life aspirations. Findings suggest place-based social processes affect and influence the retention of rural health workforces. However, these processes are not well understood. Thus, research is urgently needed to build robust understandings of the social determinants of rural workforce retention. It is contended that future research needs to identify which place-based social processes are amenable to change.
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Affiliation(s)
- Catherine Cosgrave
- Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Docker St Wangaratta, 3677 Victoria, Australia.
| | - Christina Malatzky
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove campus, Brisbane, 4059 Queensland, Australia.
| | - Judy Gillespie
- School of Social Work, Faculty of Health and Social Development, The University of British Columbia, Okanagan campus, Kelowna, BC V1V 1V7, Canada.
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Smith S, Sim J, Halcomb E. Nurses' experiences of working in rural hospitals: An integrative review. J Nurs Manag 2018; 27:482-490. [PMID: 30204275 DOI: 10.1111/jonm.12716] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/16/2018] [Accepted: 09/06/2018] [Indexed: 11/29/2022]
Abstract
AIM To critically analyse the international literature describing the experiences of nurses working in rural hospitals. BACKGROUND Nursing shortages in rural areas is an ongoing issue. Given the significant role nurses play in the delivery of rural health care, a sufficient workforce is essential. However, maintaining this workforce is challenging. Understanding the experiences of nurses working in rural hospitals is essential to inform strategies around job satisfaction and staff retention. EVALUATION An integrative review was conducted. Six primary sources were included related to the experiences of nurses working in rural hospitals. RESULTS Four themes emerged, namely: (a) Professional Development; (b) Workplace stressors; (c) Teamwork; and (d) Community. CONCLUSION There is a need for further research exploring the experiences of nurses working in rural hospitals and its impact on job satisfaction, turnover intention and patient safety. IMPLICATIONS FOR NURSING MANAGEMENT This review highlights some key issues impacting nurses' working in rural hospitals. This understanding can be used by nurse managers to inform strategies for recruitment and retention of nurses in these areas.
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Affiliation(s)
- Sarah Smith
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jenny Sim
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Elizabeth Halcomb
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
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Fields BE, Bell JF, Bigbee JL, Thurston H, Spetz J. Registered nurses' preferences for rural and urban jobs: A discrete choice experiment. Int J Nurs Stud 2018; 86:11-19. [PMID: 29958138 DOI: 10.1016/j.ijnurstu.2018.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 04/17/2018] [Accepted: 05/22/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recruitment and retention of nurses is an ongoing challenge for employers in rural areas worldwide. There is limited information available regarding influences on nurses' job choice in the U.S. and little understanding of how nurses make trade-offs between desired and less desirable job characteristics when choosing between jobs. OBJECTIVES The purpose of this research was to examine the hospital job preferences of registered nurses in the U.S. The specific objectives of the study were: 1) To identify the relative importance of key job attributes on registered nurse job choice, and 2) To predict the impact of changes in the levels of attributes on the probability of registered nurses choosing one job over another. DESIGN AND SETTING A discrete choice experiment was developed and applied in the U.S. using California as a study site. PARTICIPANTS 190 registered nurses currently working in nursing or intending to return to work in nursing from urban, large-, small- and isolated-rural communities. METHODS The survey instrument was developed through a literature review and semi-structured interviews with nurse experts, utilizing a hypothetical job in a hospital medical / surgical unit. Experimental design principles were applied to create a discrete choice experiment which was pilot tested with urban and rural nurses. The survey was mailed to a random sample of 1000 licensed registered nurses in California. A mixed logit model was used to estimate nurses' preferences for different levels of the job attributes. Willingness to pay estimates and simulations of job uptake rates were calculated. RESULTS Eight factors were identified as important to job choice: earnings, nursing voice in management, tuition reimbursement, scheduling, patient care team, leadership, location and nursing sensitive patient care outcomes. Respondents valued a cohesive patient care team (coefficient 1.95, [SE 0.23]) and a strong nursing voice in management (coefficient 1.56, [SE 0.22]) highest. A job in a large urban inland location was negatively valued (coefficient -0.69, [SE 0.25]). Around 72% of respondents chose to stay in their current job when this choice was offered. While earnings were important, nurses were willing to sacrifice earnings to secure other valued job characteristics when choosing between jobs. CONCLUSIONS Study findings provide information on how job characteristics are valued by nurses in California. Findings suggest job seekers may be 65-75 percent more likely to choose a job when valued job characteristics are present. Our findings are particularly relevant to rural hospitals with limited financial resources.
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Affiliation(s)
- Bronwyn E Fields
- School of Nursing, California State University, Sacramento, CA, United States.
| | - Janice F Bell
- Betty Irene Moore School of Nursing, University of California, Davis, CA, United States
| | - Jeri L Bigbee
- Betty Irene Moore School of Nursing, University of California, Davis, CA, United States
| | - Holly Thurston
- Penn State College of Nursing, University Park, PA, United States
| | - Joanne Spetz
- Philip R. Lee Institute for Health Policy Research, University of San Francisco, CA, United States
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Ashley C, Peters K, Brown A, Halcomb E. Work satisfaction and future career intentions of experienced nurses transitioning to primary health care employment. J Nurs Manag 2018; 26:663-670. [DOI: 10.1111/jonm.12597] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Christine Ashley
- School of Nursing; Faculty of Science, Medicine and Health; University of Wollongong; NSW Australia
| | - Kath Peters
- School of Nursing & Midwifery; Western Sydney University; Penrith NSW Australia
| | - Angela Brown
- School of Nursing; Faculty of Science, Medicine and Health; University of Wollongong; NSW Australia
| | - Elizabeth Halcomb
- School of Nursing; Faculty of Science, Medicine and Health; University of Wollongong; NSW Australia
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Ashley C, Halcomb E, Peters K, Brown A. Exploring why nurses transition from acute care to primary health care employment. Appl Nurs Res 2017; 38:83-87. [PMID: 29241525 DOI: 10.1016/j.apnr.2017.09.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/06/2017] [Accepted: 09/03/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Christine Ashley
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave Wollongong, NSW 2522, Australia.
| | - Elizabeth Halcomb
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave Wollongong, NSW 2522, Australia.
| | - Kath Peters
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Angela Brown
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave Wollongong, NSW 2522, Australia.
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MacLeod MLP, Stewart NJ, Kulig JC, Anguish P, Andrews ME, Banner D, Garraway L, Hanlon N, Karunanayake C, Kilpatrick K, Koren I, Kosteniuk J, Martin-Misener R, Mix N, Moffitt P, Olynick J, Penz K, Sluggett L, Van Pelt L, Wilson E, Zimmer L. Nurses who work in rural and remote communities in Canada: a national survey. HUMAN RESOURCES FOR HEALTH 2017; 15:34. [PMID: 28535773 PMCID: PMC5442670 DOI: 10.1186/s12960-017-0209-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 05/11/2017] [Indexed: 05/07/2023]
Abstract
BACKGROUND In Canada, as in other parts of the world, there is geographic maldistribution of the nursing workforce, and insufficient attention is paid to the strengths and needs of those providing care in rural and remote settings. In order to inform workforce planning, a national study, Nursing Practice in Rural and Remote Canada II, was conducted with the rural and remote regulated nursing workforce (registered nurses, nurse practitioners, licensed or registered practical nurses, and registered psychiatric nurses) with the intent of informing policy and planning about improving nursing services and access to care. In this article, the study methods are described along with an examination of the characteristics of the rural and remote nursing workforce with a focus on important variations among nurse types and regions. METHODS A cross-sectional survey used a mailed questionnaire with persistent follow-up to achieve a stratified systematic sample of 3822 regulated nurses from all provinces and territories, living outside of the commuting zones of large urban centers and in the north of Canada. RESULTS Rural workforce characteristics reported here suggest the persistence of key characteristics noted in a previous Canada-wide survey of rural registered nurses (2001-2002), namely the aging of the rural nursing workforce, the growth in baccalaureate education for registered nurses, and increasing casualization. Two thirds of the nurses grew up in a community of under 10 000 people. While nurses' levels of satisfaction with their nursing practice and community are generally high, significant variations were noted by nurse type. Nurses reported coming to rural communities to work for reasons of location, interest in the practice setting, and income, and staying for similar reasons. Important variations were noted by nurse type and region. CONCLUSIONS The proportion of the rural nursing workforce in Canada is continuing to decline in relation to the proportion of the Canadian population in rural and remote settings. Survey results about the characteristics and practice of the various types of nurses can support workforce planning to improve nursing services and access to care.
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Affiliation(s)
- Martha L. P. MacLeod
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC V2N 4Z9 Canada
| | - Norma J. Stewart
- College of Nursing, University of Saskatchewan, Health Sciences Building, E Wing, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Judith C. Kulig
- Faculty of Health Sciences, University of Lethbridge, 4401 University Dr W, Lethbridge, AB T1K 6T5 Canada
| | - Penny Anguish
- Northern Health Authority, 510-1488 4th Avenue, Prince George, BC V2L 4Y2 Canada
| | - Mary Ellen Andrews
- College of Nursing, University of Saskatchewan, Health Sciences Building, E Wing, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Davina Banner
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC V2N 4Z9 Canada
| | - Leana Garraway
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC V2N 4Z9 Canada
| | - Neil Hanlon
- Department of Geography, School of Health Sciences and Northern Medical Program, University of Northern British Columbia, 3333 University Way, Prince George, BC V2N 4Z9 Canada
| | - Chandima Karunanayake
- University of Saskatchewan, 104 Clinic Place, P.O. Box 23, Saskatoon, SK S7N 2Z4 Canada
| | - Kelley Kilpatrick
- Centre de Reserche, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Assomption Boulevard, Montreal, QC H1T 2M4 Canada
| | - Irene Koren
- School of Nursing, Laurentian University, 935 Ramsey Lake Rd, Sudbury, ON P3E 2C6 Canada
| | - Julie Kosteniuk
- University of Saskatchewan, 104 Clinic Place, P.O. Box 23, Saskatoon, SK S7N 2Z4 Canada
| | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, 5869 University Ave, Halifax, NS B3H 4R2 Canada
| | - Nadine Mix
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC V2N 4Z9 Canada
| | - Pertice Moffitt
- North Slave Research Centre, Aurora College, Bag 9700, 5004-54th St, Yellowknife, NT X1A 2R3 Canada
| | - Janna Olynick
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC V2N 4Z9 Canada
| | - Kelly Penz
- College of Nursing, University of Saskatchewan, 4400 4th Avenue, Regina, SK S4T 0H8 Canada
| | - Larine Sluggett
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC V2N 4Z9 Canada
| | - Linda Van Pelt
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC V2N 4Z9 Canada
| | - Erin Wilson
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC V2N 4Z9 Canada
| | - Lela Zimmer
- School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, BC V2N 4Z9 Canada
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Young SK, Young TK. Assessing clinical support and inter-professional interactions among front-line primary care providers in remote communities in northern Canada: a pilot study. Int J Circumpolar Health 2016; 75:32159. [PMID: 27633080 PMCID: PMC5025523 DOI: 10.3402/ijch.v75.32159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/19/2016] [Accepted: 08/20/2016] [Indexed: 11/14/2022] Open
Abstract
Background Primary care in remote communities in northern Canada is delivered primarily by nurses who receive clinical support from physicians in regional centres and the patient transportation system. To improve continuity, quality and access to care in remote northern communities, it is important to understand the perspectives of front-line providers and the complex challenges they face. Objective To design and implement a survey of primary care providers to identify issues relating to inter-professional communication, clinical support and patient evacuation. Methods In collaboration with the territorial government and regional health authority partners, we developed a 21-item self-administered questionnaire survey, which could be completed online. The survey was sent to 218 physicians and nurses who were employed in the Northwest Territories (NWT) at the time of the survey and were involved in sending patients out of the community and/or receiving patients. The survey also contained an open-ended question at the end seeking comments regarding primary health care. Results The overall low response rate of 39% among nurses and 19% among physicians threatens the validity of the quantitative results. The majority of providers were satisfied with their ability to communicate with other providers in a timely manner, their freedom to make clinical decisions and their overall experience practicing in the NWT. The patient transfer system appears to work from both the sender and receiver perspectives. However, a common theme reported by nurses was that physicians providing clinical advice, especially short-term locums, were not familiar with the local situation, whilst physicians at the receiving end remarked that the clinical information provided to them often lacked clarity. Conclusions Important lessons were learnt from the pilot study, especially in better engagement of providers in planning and dissemination. The questionnaire design and the online method of delivery were acceptable. Although important issues were identified, a larger definitive survey is needed to investigate them in the future.
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Affiliation(s)
| | - T Kue Young
- School of Public Health, University of Alberta, Edmonton, Canada;
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Canavati SE, Lawpoolsri S, Quintero CE, Nguon C, Ly P, Pukrittayakamee S, Sintasath D, Singhasivanon P, Peeters Grietens K, Whittaker MA. Village malaria worker performance key to the elimination of artemisinin-resistant malaria: a Western Cambodia health system assessment. Malar J 2016; 15:282. [PMID: 27206729 PMCID: PMC4875644 DOI: 10.1186/s12936-016-1322-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 05/03/2016] [Indexed: 11/15/2022] Open
Abstract
Background Village malaria workers (VMWs) and mobile malaria workers (MMWs) are a critical component of Cambodia’s national strategy to eliminate
Plasmodium falciparum malaria by 2025. Since 2004, VMWs have been providing malaria diagnosis through the use of rapid diagnostic tests and free-of-charge artemisinin-based combination therapy in villages more than 5 km away from the closest health facility. They have also played a key role in the delivery of behaviour change communication interventions to this target population. This study aimed to assess the job performance of VMWs/MMWs, and identify challenges they face, which may impede elimination efforts. Methods A mixed-methods assessment was conducted in five provinces of western Cambodia. One hundred and eighty five VMW/MMW participants were surveyed using a structured questionnaire. Qualitative data was gathered through a total of 60 focus group discussions and 65 in-depth interviews. Data triangulation of the qualitative and quantitative data was used during analysis. Results Overall, VMWs/MMWs met or exceeded the expected performance levels (80 %). Nevertheless, some performance gaps were identified. Misconceptions regarding malaria transmission and prevention were found among workers. The recommended approach for malaria treatment, directly-observed treatment (DOT), had low implementation rates. Stock-outs, difficulties in reaching out to migrant and mobile populations, insufficient means of transportation and dwindling worker satisfaction also affected job performance. Discussion VMW/MMW job performance must be increased from 80 to 100 % in order to achieve elimination. In order to do this, it is recommended for the national malaria programme to eliminate worker malaria knowledge gaps. Barriers to DOT implementation and health system failures also need to be addressed. The VMW programme should be expanded on several fronts in order to tackle remaining performance gaps. Findings from this evaluation are useful to inform the planning of future activities of the programme and to improve the effectiveness of interventions in a context where artemisinin drug resistance is a significant public health issue.
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Affiliation(s)
- Sara E Canavati
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand. .,Centre for Biomedical Research, Burnet Institute, Melbourne, Australia.
| | - Saranath Lawpoolsri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Cesia E Quintero
- Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
| | - Chea Nguon
- The National Center For Parasitology, Entomology and Malaria Control, Ministry of Health, Corner Street 92, Trapaing Svay Village, Sankat Phnom Penh Thmey, Khan Sensok, Phnom Penh, Cambodia
| | - Po Ly
- The National Center For Parasitology, Entomology and Malaria Control, Ministry of Health, Corner Street 92, Trapaing Svay Village, Sankat Phnom Penh Thmey, Khan Sensok, Phnom Penh, Cambodia
| | - Sasithon Pukrittayakamee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand
| | - David Sintasath
- Malaria Consortium Asia, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajavidhi Road, Room 805, Bangkok, 10400, Thailand
| | - Pratap Singhasivanon
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Koen Peeters Grietens
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.,Partners for Applied Social Sciences (PASS) International, Tessenderlo, Belgium
| | - Maxine Anne Whittaker
- Division of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia.,The University of Queensland School of Public Health, Herston, QLD, 4006, Australia
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Mbemba G, Gagnon MP, Paré G, Côté J. Interventions for supporting nurse retention in rural and remote areas: an umbrella review. HUMAN RESOURCES FOR HEALTH 2013; 11:44. [PMID: 24025429 PMCID: PMC3847170 DOI: 10.1186/1478-4491-11-44] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 08/29/2013] [Indexed: 05/22/2023]
Abstract
CONTEXT Retention of nursing staff is a growing concern in many countries, especially in rural, remote or isolated regions, where it has major consequences on the accessibility of health services. PURPOSE This umbrella review aims to synthesize the current evidence on the effectiveness of interventions to promote nurse retention in rural or remote areas, and to present a taxonomy of potential strategies to improve nurse retention in those regions. METHODS We conducted an overview of systematic reviews, including the following steps: exploring scientific literature through predetermined criteria and extracting relevant information by two independents reviewers. We used the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) criteria in order to assess the quality of the reports. FINDINGS Of 517 screened publications, we included five reviews. Two reviews showed that financial-incentive programs have substantial evidence to improve the distribution of human resources for health. The other three reviews highlighted supportive relationships in nursing, information and communication technologies support and rural health career pathways as factors influencing nurse retention in rural and remote areas. Overall, the quality of the reviews was acceptable. CONCLUSIONS This overview provides a guide to orient future rural and remote nurse retention interventions. We distinguish four broad types of interventions: education and continuous professional development interventions, regulatory interventions, financial incentives, and personal and professional support. More knowledge is needed regarding the effectiveness of specific strategies to address the factors known to contribute to nurse retention in rural and remote areas. In order to ensure knowledge translation, retention strategies should be rigorously evaluated using appropriate designs.
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Affiliation(s)
- Gisèle Mbemba
- Hôpital St-François d’Assise, Research Center of the Centre Hospitalier Universitaire de Québec, 10 rue de l’Espinay, D6-727, G1L 3L5, Québec, QC, Canada
| | - Marie-Pierre Gagnon
- Hôpital St-François d’Assise, Research Center of the Centre Hospitalier Universitaire de Québec, 10 rue de l’Espinay, D6-727, G1L 3L5, Québec, QC, Canada
| | - Guy Paré
- Department of Information Technology, 3000, chemin de la Côte-Sainte-Catherine, HEC Montréal, H3T 2A7, Montréal, QC, Canada
| | - José Côté
- Faculty of Nursing Sciences, Pavillon Marguerite-d'Youville, C.P. 6128 succ. Centre-ville Université de Montréal, H3C 3J7, Montréal, QC, Canada
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Jayasuriya R, Whittaker M, Halim G, Matineau T. Rural health workers and their work environment: the role of inter-personal factors on job satisfaction of nurses in rural Papua New Guinea. BMC Health Serv Res 2012; 12:156. [PMID: 22691270 PMCID: PMC3471005 DOI: 10.1186/1472-6963-12-156] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 05/28/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Job satisfaction is an important focal attitude towards work. Understanding factors that relate to job satisfaction allows interventions to be developed to enhance work performance. Most research on job satisfaction among nurses has been conducted in acute care settings in industrialized countries. Factors that relate to rural nurses are different. This study examined inter-personal, intra-personal and extra-personal factors that influence job satisfaction among rural primary care nurses in a Low and Middle Income country (LMIC), Papua New Guinea. METHODS Data was collected using self administered questionnaire from rural nurses attending a training program from 15 of the 20 provinces. Results of a total of 344 nurses were available for analysis. A measure of overall job satisfaction and measures for facets of job satisfaction was developed in the study based on literature and a qualitative study. Multi-variate analysis was used to test prediction models. RESULTS There was significant difference in the level of job satisfaction by age and years in the profession. Higher levels of overall job satisfaction and intrinsic satisfaction were seen in nurses employed by Church facilities compared to government facilities (P <0.01). Ownership of facility, work climate, supervisory support and community support predicted 35% (R2 =0.35) of the variation in job satisfaction. The factors contributing most were work climate (17%) and supervisory support (10%). None of these factors were predictive of an intention to leave. CONCLUSIONS This study provides empirical evidence that inter-personal relationships: work climate and supportive supervision are the most important influences of job satisfaction for rural nurses in a LMIC. These findings highlight that the provision of a conducive environment requires attention to human relations aspects. For PNG this is very important as this critical cadre provide the frontline of primary health care for more than 70% of the population of the country. Many LMIC are focusing on rural health, with most of the attention given to aspects of workforce numbers and distribution. Much less attention is given to improving the aspects of the working environment that enhances intrinsic satisfaction and work climate for rural health workers who are currently in place if they are to be satisfied in their job and productive.
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Affiliation(s)
- Rohan Jayasuriya
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Maxine Whittaker
- School of Population Health, University of Queensland, Brisbane, Australia
| | - Grace Halim
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Tim Matineau
- Liverpool School of Hygiene and Tropical Medicine, Liverpool, United Kingdom
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Gillespie J, Redivo R. Personal-professional boundary issues in the satisfaction of rural clinicians recruited from within the community: findings from an exploratory study. Aust J Rural Health 2012; 20:35-9. [PMID: 22250875 DOI: 10.1111/j.1440-1584.2011.01249.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The objective of this paper is to highlight, from within a broad study of recruitment/retention, findings that identify personal-professional boundaries as key challenges for rural child and youth mental health clinicians recruited from within the community. DESIGN Two mixed methods online questionnaires followed by semistructured telephone interviews with a small subset of respondents were administered to clinicians, team leaders, supervisors and managers whose practice responsibilities encompass rural settings in three regions of British Columbia, Canada. PARTICIPANTS Forty-four clinicians and 27 team leaders/managers participated in the survey while eight clinicians and one team leader/manager participated in the semistructured interviews. Half the clinician respondents were recruited from within the community. Of those recruited from outside the community, half had prior experience living or working in a rural community. MAIN OUTCOME MEASURES Levels of satisfaction with lifestyle, practice and preparation for practice were compared across categories of respondents identified earlier. Open-ended comments were coded by theme and also compared across categories of respondents. RESULTS While expressing their higher levels of satisfaction with rural lifestyle and professional practice, clinicians recruited from within rural communities report significant initial and ongoing stress related to personal-professional boundaries and dual relationships. They also report lower levels of satisfaction with orientation and preparation for practice relevant to dealing with these stressors. CONCLUSION Prior attachment to rural communities, increasingly viewed as an effective recruitment and retention strategy, requires better preparation and ongoing supports to enable practitioners to deal with dual relationships and the personal-professional boundary issues that are a direct consequence of their attachments.
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Affiliation(s)
- Judy Gillespie
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada.
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Abstract
RÉSUMÉLa recherche sur le vieillissement en milieu rural s’est développée considérablement depuis la publication du livre,Aging in Rural Canada(Butterworths, 1991). Le but de cet article est double : de fournir une rétrospective sur les questions de viellissement en milieu rural tirée de ce livre, et une revue de la littérature canadienne sur le vieillissement en milieu rural depuis sa publication. L’examen met en évidence les nouvelles orientations dans les définitions conceptuelles du « rural », et dans les questions de l’engagement social, l’indépendance, les réseaux familiaux et sociaux et les services ruraux et la santé. Deux perspectives principales de recherche sont évidents. Le point de vue ou l’optique d’analyse de la marginalisation se concentre sur les personnes âgées en milieu rural ayant des problèmes de santé, mais n’a pas inclus celles qui sont marginalisées par la pauvrété ou le sexe. L’optique d’analyse du vieillissement sain se concentre sur les contributions et l’engagement, mais a omis la recherche sur les relations sociales et la qualité de l’interaction familiale. Le rapport comprend un appel s’interroger sur l’interaction entre les gens et leur lieu de vie et à comprendre les enjeux de la diversité en milieu rural et le processus de vieillissement en milieu rural.
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Stewart NJ, D'Arcy C, Kosteniuk J, Andrews ME, Morgan D, Forbes D, Macleod MLP, Kulig JC, Pitblado JR. Moving on? Predictors of intent to leave among rural and remote RNs in Canada. J Rural Health 2011; 27:103-13. [PMID: 21204977 DOI: 10.1111/j.1748-0361.2010.00308.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CONTEXT Examination of factors related to the retention or voluntary turnover of Registered Nurses (RNs) has mainly focused on urban, acute care settings. PURPOSE This paper explored predictors of intent to leave (ITL) a nursing position in all rural and remote practice settings in Canada. Based on the conceptual framework developed for this project, potential predictors of ITL were related to the individual RN worker, the workplace, the community context, and satisfaction related to both the workplace and the community(s) within which the RN lived and worked. METHODS A national cross-sectional mail survey of RNs in rural and remote Canada provided the data (n = 3,051) for the logistic regression analysis of predictors of ITL. FINDINGS We found that RNs were more likely to plan to leave their nursing position within the next 12 months if they: were male, reported higher perceived stress, did not have dependent children or relatives, had higher education, were employed by their primary agency for a shorter time, had lower community satisfaction, had greater dissatisfaction with job scheduling, had lower satisfaction with their autonomy in the workplace, were required to be on call, performed advanced decisions or practice, and worked in a remote setting. CONCLUSIONS The statistical evidence for predictors of ITL supported our framework with determinants related to the individual, the workplace, the community, and satisfaction levels. The importance of community makes this framework uniquely relevant to the rural health context. Our findings should guide policy makers and employers in developing retention strategies.
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Affiliation(s)
- Norma J Stewart
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Forjaz MJ, Prieto-Flores ME, Ayala A, Rodriguez-Blazquez C, Fernandez-Mayoralas G, Rojo-Perez F, Martinez-Martin P. Measurement properties of the Community Wellbeing Index in older adults. Qual Life Res 2010; 20:733-43. [DOI: 10.1007/s11136-010-9794-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2010] [Indexed: 10/18/2022]
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