Tracks to Postgraduate Rural Practice: Longitudinal Qualitative Follow-Up of Nursing Students Who Undertook a Rural Placement in Western Australia
Abstract
:1. Introduction
2. Materials and Methods
2.1. Ethical Considerations
2.2. Data Collection and Analysis
3. Results
3.1. Participant and Course Information
Summary of Work Locations at Final Interview
3.2. Thematic Analysis
3.2.1. Satisfaction with Rural Placements
- A.
- Feeling valued
‘I wanted to stay way after my shift finished… real community feel… I really wanted to join in’.(A_UWA_I2_PG6)
‘Just given the chance… just having someone believe in your ability made you feel confident… I think that sort of is a country mentality ’cause you found that more there than you do in the city’.(A_UWA_I1_UC3)
- B.
- Support mechanisms
- C.
- Professional skill development
‘I just found that I learned significantly more on my rural placements and just saw things that you would never see in the metro area… it is a lot of general stuff which is great because you get to see a wide variety of things’.(E_UND_I2_PG1)
‘I feel a more connected way of looking at things… why they want to get back, what’s important to them, they want to be back with their family, they don’t want to be in hospital away from everybody… the drive for them to get better, the quietness and the reluctance to talk about it because they don’t want you to keep them in there longer’.(A_UWA_I2_PG6)
- D.
- Personal skill development
‘It helps your development as a professional, but it also helps you personally as well – it makes you a more rounded person, different experiences outside of what you’re used to… I never even considered rural until I went on student placement’.(C_UND_I3_PG6)
‘Being away from home and being away from my family… that was really the first time I was away from home by myself for an extended period, so I felt it was good in terms of independence and learning about the working lifestyle… It’s made me think there’s a lot out there to see and learn, take on any opportunity—you have to just go and give it a try whether it be in the metro or rural area… it definitely made me more confident in trying different things’.(F_UND_I3_PG5)
- E.
- Considerations of rural placements
‘Students can’t afford to just go somewhere else and not be working for that period and then have to pay for accommodation there as well’.(J_UND_I2_PG2)
‘I think it should be mandatory to do rural placements—(university) makes it so easy—free accommodation, really supportive, you’ve got someone there supporting you or just a phone call away’.(E_UND_I2_PG1)
3.2.2. Challenges of Employment over Time
- A.
- Graduate programs
‘When I was applying for grad connect you had three preferences and in the first round the applications get sent off to your first preference. And then theoretically anyone who doesn’t get a place in first round goes to second round, but in practice there is so much more applications than there are spaces that it fills up in the first round and that’s all there is… So for that reason I didn’t apply to a rural or regional hospital because the majority of them have two places or maybe eight places, it seemed like too much of a crapshoot’.(J_UND_I2_PG2)
- B.
- Insecurity of employment
‘Just playing it by ear and see what opportunities come up and go from there. It’s difficult to get permanent contracts in the public sector’.(F_UND_I3_PG5)
’I meet a lot of senior nurses… they all struggle to get permanent jobs…and they are senior and I’m junior, still better than nothing, I’ll hang on to it’.(I_UWA_I2_PG6)
3.2.3. Considerations regarding ‘Going Rural’ for Work
- A.
- Family considerations
‘I think maybe if I was single and I’d moved out there by myself I would have been fine with the lifestyle but when you have attachments in Perth it’s not so easy… I did enjoy working rurally but what I realised is that it doesn’t quite fit with my life’.(J_UND_I2_PG2)
‘I’ve tried to get my partner to move regionally but he won’t, so the next best thing is to have a job where I’m still based in Perth so it’s really kind of the best of both worlds’.(H_ECU_I3_PG3)
‘To do my first year in metro and to have the support of my family nearby, I’m very family orientated. Doing rural as my very first year as a grad I think would have been very challenging, but that’s not to say that I won’t now take a job in a rural area’.(E_UND_I3_PG4)
‘I like rural nursing… but it’s a big sacrifice to give up my lifestyle and family’.(I_UWA_I2_PG6)
‘I feel that we do lack here being able to improve our learning in a tertiary hospital, because we’ve obviously got limited facilities here and the hospital is so short staffed. But I live here with my family…and we don’t want to live in the city and I don’t think at this stage we would go any further rural until my child was at boarding school or finished high school’.(B_USQ_I3_PG3)
- B.
- Skill requirements to work rurally
‘It seems like rural nurses need more experience and more skills so it seemed if you work in the metro you have the support and learning development, and they can take you on with little experience’.(J_UND_I3_PG3)
‘I have asked when I had my professional development interview whether there’s any possibility of doing a three- or four-week stint in Perth to do like a supernumery to see how they do things and to upskill that way but I haven’t heard anything from that… at the moment they don’t have the staff’.(B_USQ_I3_PG3)
‘[Working rurally] that was my big long-term goal, but I think in nursing to work rural and remote you actually need to be really experienced and have quite a lot of clinical skills under your belt… so I pretty much need to keep going. Now I’m going for the next five years and see what happens… and I think the fact that you’re limited without having any tertiary experience becomes more apparent as you become more experienced’.(D_USQ_I_PG3)
- C.
- Influence of rural placement
‘That prac definitely influenced and reassured me that I can be away for a period of time and make friends and be well supported… integrating yourself into a community and understanding what that place is about is really nice… and all the regional pracs that I did assisted with this decision to do rural and appreciating and understanding it a bit better. Even the skills I learned up there… those skills I’ve retained and use now’. ‘If you have that understanding and that empowerment from that very early stage of my nursing career it sets you up to know that you can move away and it will be ok’.(E_UND_I3_PG4—nurse now working in a rural fly-in-fly-out role)
‘Before my grad program I did those couple of jobs in the country… Yeah, I just felt confident in living away from home to work because I’d had those experiences in <location*>, I just feel like in that way it increased my confidence to go out there and give things a go in the country’.(F_UND_I3_PG5)
‘I never even considered rural until I went on my student placement’. ‘That initial placement in <location*> just really just opened things up for me, it really changed my life it really did…it really helped shape me as a person and as a professional. All up I’ve gone to <location*> including being a student… I’ve gone back four times…and that’s all from just that placement’. ‘I just found the lifestyle so nice, I loved working for a small country hospital, everyone knew everyone, I loved getting to know the patients, to walk to work, everyone was so friendly, I made so many friends that I’m still friends with today… just a really nice lifestyle, that’s why I keep coming back’. (Nurse that went back to work in rural placement town after graduating)’.(C_UND_I3_PG6)
‘It’s kind of nice knowing that you don’t have to commit to staying rurally if you don’t find that it is what you want but you can fully embrace the time that you’re there and still get a lot out of it’.(A_UWA_I2_PG6)
4. Discussion
4.1. Satisfaction with Rural Placements
4.2. Decision-Making: Influences on Rural Practice
4.2.1. Influence of Rural Placement on Rural Practice
4.2.2. Professional Considerations
4.2.3. Personal Considerations
5. Summary
6. Limitations
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Participant | University | Interview 1 Year | Interview 2 Year | Interview 3 Year |
---|---|---|---|---|
A | UWA | 2016 | 2021 | - |
B | USQ | 2016 | 2018 | 2021 |
C | UND | 2015 | 2017 | 2021 |
D | USQ | 2016 | 2019 | 2021 |
E | UND | 2016 | 2018 | 2021 |
F | UND | 2016 | 2018 | 2021 |
G | ECU | 2018 | 2019 | - |
H | ECU | 2018 | 2018 | 2021 |
I | UWA | 2015 | 2019 | - |
J | UND | 2016 | 2019 | 2020 |
Key Findings, Barriers and Enablers | Implications for Policy and Practice |
---|---|
Rural Intention | |
Satisfaction with a rural placement was enhanced by diverse skill development, autonomy of practice, and by social and professional support as part of the clinical team and wider community. | Clinical facilitators and preceptors should focus on those factors which are known to enhance placement satisfaction and enhance confidence through providing opportunities both clinically and socially. |
Quiet periods and discontinuity of preceptors adversely impacted rural placement satisfaction. | Provide professional development opportunities for rural preceptor roles which include awareness of specific issues related to students on rural placements. Increase continuity of preceptors for those on rural placement. Support from Nurse Unit Managers (NUM) in allocating preceptors to students appropriately would be of value. |
Participants spoke of their rural placement as an enabler of confidence to move away from their place of origin. | Enable broader immersion in the rural ‘lifestyle’, including opportunities to ‘give things a go’ and to meet new people. Incorporate social experiences as an important element of rural placements as well as opportunities for longer placements. |
Rural Employment | |
Rural graduate programs did not seem to be encouraged as a valuable option for some students while at university. | Enhance relationships in rural nurse recruitment pathways, including between country health services and universities. |
Some students and graduates from metropolitan areas perceived that they lacked the necessary skills and experience to work rurally. | Ensure that rural practice opportunities are seen as attainable and valuable by new graduates with information on appropriate programs imparted to nursing students at the time of their rural placement as well as through campus nurse academics. |
Nurses had difficulties applying for rural graduate programs without compromising alternative graduate program opportunities. | Improve the graduate program application process to ensure that graduates can express their rural choices more freely without this being detrimental to their overall likelihood of success in the attainment of a graduate program. |
Family and partner education and work considerations were mentioned by most participants with respect to making decisions about employment location, whether they were of urban or rural origin. For metropolitan-based nurses, a partner’s work was a frequently cited barrier to taking a rural position despite having an interest in working rurally. Conversely, nurses with a rural background who had been rurally trained spoke of staying in their current location due to partner and family needs. | It is important to consider the issues of family and partner needs when working to attract nursing staff to rural areas. Providing positions to suit a variety of family situations may be one solution. Rural Health West provide ‘Partner Education Grants’, which provide partners of rural healthcare practitioners with funding to train and enhance their employability in rural areas. This and other such programs could be more widely advertised to new graduates and students. |
Job insecurity due to short-term and casual contracts may make it harder to relocate, settle and integrate fully into a new community. | Consider longer-term employment contracts with key stages of development to be attained to continue employment. This should include the development of assured pathways for rural nursing careers from a graduate level, and programs that encourage and support nurses who are interested in rural nursing experiences. |
Rural Retention | |
There was a lack of satisfaction with support and professional development opportunities in rural practice, which may impact upon retention. | Ensure that rural graduate positions offer quality support and training. Develop career pathways that ensure ongoing access to professional development and career-broadening for nurses working in rural areas. |
Rural graduate nurses feared de-skilling or diverging in competency and skill compared to their metropolitan counterparts. Some expressed a desire for short-term secondments to metropolitan tertiary hospitals to develop further professional skills. | Provide enhanced professional development opportunities, including training for those interested in preceptorship and research the potential for implementing novel strategies used in rural areas interstate and overseas. These include short-term ‘swaps’ or secondments to metropolitan areas (a ‘swap’ would provide added benefits for the metropolitan nurse to experience rural nursing), online skill-sharing sessions and ‘buddy’ mentoring between rural and metropolitan nurses to discuss experiences and share knowledge through two-way learning. |
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Share and Cite
Crossley, C.; Collett, M.; Thompson, S.C. Tracks to Postgraduate Rural Practice: Longitudinal Qualitative Follow-Up of Nursing Students Who Undertook a Rural Placement in Western Australia. Int. J. Environ. Res. Public Health 2023, 20, 5113. https://doi.org/10.3390/ijerph20065113
Crossley C, Collett M, Thompson SC. Tracks to Postgraduate Rural Practice: Longitudinal Qualitative Follow-Up of Nursing Students Who Undertook a Rural Placement in Western Australia. International Journal of Environmental Research and Public Health. 2023; 20(6):5113. https://doi.org/10.3390/ijerph20065113
Chicago/Turabian StyleCrossley, Caroline, Marjorie Collett, and Sandra C. Thompson. 2023. "Tracks to Postgraduate Rural Practice: Longitudinal Qualitative Follow-Up of Nursing Students Who Undertook a Rural Placement in Western Australia" International Journal of Environmental Research and Public Health 20, no. 6: 5113. https://doi.org/10.3390/ijerph20065113