Rural and small urban differences in work satisfaction with autonomy and nurse-physician interaction among acute care registered nurses

Recent studies on job satisfaction and on magnet hospitals have emphasized the importance of nursing practice environments that encourage nurse autonomy and nurse-physician collaboration. However, little is known about acute care Registered Nurses' (RNs) satisfaction with these attributes in rural and small urban hospital settings, and whether community or hospital size is related to this satisfaction. To address these issues, a secondary analysis of data from the survey component of a national study The Nature of Nursing Practice in Rural and Remote Canada was conducted. Objectives were: (1) to examine satisfaction with autonomy and nurse-physician interaction among acute care RNs working in hospitals in communities that vary in size (rural vs. small urban); and (2) to identify the worklife attributes that are most important to acute care RNs working in these communities. Measures of dependent variables included the Autonomy subscale and the Nurse-physician Interaction subscale from the Index of Work Satisfaction (Stamps, 1997). Analysis of variance was used to test hypotheses. Examination of important nursing worklife attributes included a thematic content analysis of an open-ended survey question: “What is the most important thing to you about your nursing position?” This study found that the rural RNs had significantly higher levels of autonomy and nurse-physician interaction than the small urban RNs. These findings suggest that size of an organization or hospital setting does have an influence on the level of autonomous practice and collaborative interaction between nurses and physicians. The thematic categories that emerged from the analysis of the rural and small urban responses included: the importance of acute care nursing practice, the organizational climate of the work environment, and sources of occupational predictability. An additional category that emerged solely from the analysis of the rural responses was the importance of nursing in a rural community. The results of this study have added to the limited knowledge on the nature of acute care nursing practice in rural and small urban hospital settings in Canada. This study has also provided important data that may inform national policy development related to the recruitment and retention of RNs in rural and small urban settings

The transition experience of rural older persons with advanced cancer and their families: a grounded theory study

BACKGROUND: Transitions often occur suddenly and can be traumatic to both patients with advanced disease and their families. The purpose of this study was to explore the transition experience of older rural persons with advanced cancer and their families from the perspective of palliative home care patients, bereaved family caregivers, and health care professionals. The specific aims were to: (1) describe the experience of significant transitions experienced by older rural persons who were receiving palliative home care and their families and (2) develop a substantive theory of transitions in this population. METHODS: Using a grounded theory approach, 27 open-ended individual audio-taped interviews were conducted with six older rural persons with advanced cancer and 10 bereaved family caregivers. Four focus group interviews were conducted with 12 palliative care health care professionals. All interviews were transcribed verbatim, coded, and analyzed using Charmaz\u27s constructivist grounded theory approach. RESULTS: Within a rural context of isolation, lack of information and limited accessibility to services, and values of individuality and community connectedness, older rural palliative patients and their families experienced multiple complex transitions in environment, roles/relationships, activities of daily living, and physical and mental health. Transitions disrupted the lives of palliative patients and their caregivers, resulting in distress and uncertainty. Rural palliative patients and their families adapted to transitions through the processes of Navigating Unknown Waters . This tentative theory includes processes of coming to terms with their situation, connecting, and redefining normal. Timely communication, provision of information and support networks facilitated the processes. CONCLUSION: The emerging theory provides a foundation for future research. Significant transitions identified in this study may serve as a focus for improving delivery of palliative and end of life care in rural areas. Improved understanding of the transitions experienced by advanced cancer palliative care patients and their families, as well as the psychological processes involved in adapting to the transitions, will help health care providers address the unique needs of this vulnerable population

sj-docx-1-cjn-10.1177_08445621231204962 - Supplemental material for 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

Supplemental material, sj-docx-1-cjn-10.1177_08445621231204962 for 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 by Amanda M. McCallum, Helen E. R. Vandenberg and Kelly L. Penz in Canadian Journal of Nursing Research</p

Feasibility of a Remotely Delivered Strength and Balance Training Program for Older Adults with Cancer

Falls are a major issue among older adults with cancer and lead to interruptions in cancer treatment. Resistance and balance training can prevent falls in older adults, but minimal evidence is available regarding the older cancer population, who often have unique risk factors. We used a pre–post design to assess the feasibility of a remotely delivered exercise program that progressed in difficulty and its efficacy on lower body strength, balance, and falls in older adults with cancer who had prior in-person exercise experience. Twenty-six older adults with cancer completed the intervention. Attendance rate for the virtual component was 97.6% and for the independent component was 84.7%. Participants perceived the program as rewarding and enjoyable (100%), felt this program prepared them to exercise on their own (92%), were confident to continue exercising on their own (81%), and would recommend the program to other patients (100%). The median balance score at baseline and end-of-study was 4 (IQR = 0). The median chair-stand time decreased from 9.2 s (IQR = 3.13) to 7.7 s (IQR = 4.6). A statistically significant difference in lower body strength (r = 0.68, p = 0.001) was detected post-intervention. The findings from this study can inform the design of a larger randomized trial.Applied Science, Faculty ofNon UBCNursing, School ofReviewedFacultyResearcherOthe

Nurses who work in rural and remote communities in Canada: a national survey

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