Rural Home Care Nursing During COVID-19

BACKGROUND

The SARS-CoV-2 (COVID-19) pandemic continues to be a challenging time for the nursing profession globally. Research indicates that the care of patients with COVID-19 has caused significant psychological stress for nurses. Although much of the world's attention has been on nurses working in emergency departments and intensive care units, the pandemic also posed significant challenges for nurses providing home care services in rural communities.

PURPOSE

The purpose of this work was to describe the experiences of rural Canadian home care nurses during the early stages of the COVID-19 pandemic.

METHODS

The data for this analysis was derived from a study that explored the continuing education needs of rural home care nurses. Since the data collection for the primary objective occurred in the early stages of the COVID-19 pandemic, COVID-19 related themes were created using interpretive description methodology. Snowball and purposive sampling were used to recruit rural home care registered nurses who were employed in the central and southern areas of a western Canadian province.

RESULTS

Six themes were constructed from the data including: Nurses Must Work, Constant State of Flux, Threatened Safety, Loss of Learning Opportunities, Fearing the Unknown, and Hindsight is Easy.

CONCLUSION

The experiences of rural home care nurses during COVID-19 reflects the chaos, uncertainty, and fear that was felt globally. Based on the findings of this study, recommendations for future pandemic planning are suggested.

Mental health nursing practice in rural and remote Canada: Insights from a national survey

Access to and delivery of quality mental health services remains challenging in rural and remote Canada. To improve access, services, and support providers, improved understanding is needed about nurses who identify mental health as an area of practice. The aim of this study is to explore the characteristics and context of practice of registered nurses (RNs), licensed practical nurses (LPNs), and registered psychiatric nurses (RPNs) in rural and remote Canada, who provide care to those experiencing mental health concerns. Data were from a pan-Canadian cross-sectional survey of 3822 regulated nurses in rural and remote areas. Individual and work community characteristics, practice responsibilities, and workplace factors were analysed, along with responses to open-ended questions. Few nurses identified mental health as their sole area of practice, with the majority of those being RPNs employed in mental health or crisis centres, and general or psychiatric hospitals. Nurses who indicated that mental health was only one area of their practice were predominantly employed as generalists, often working in both hospital and primary care settings. Both groups experienced moderate levels of job resources and demands. Over half of the nurses, particularly LPNs, had recently experienced and/or witnessed violence. Persons with mental health concerns in rural and remote Canada often receive care from those for whom mental health nursing is only part of their everyday practice. Practice and education supports tailored for generalist nurses are, therefore, essential, especially to support nurses in smaller communities, those at risk of violence, and those distant from advanced referral centres.

Continuing Education for Home Care Nurses: An Integrative Literature Review

With the wide range of clinical skills and responsibilities that home care nurses (HCNs) are expected to perform, it is important they are supported with access to relevant continuing nursing education (CNE) to perform their job safely and effectively. An integrative literature review was conducted to explore the current evidence on CNE for HCNs. Medline and CINAHL were searched and 13 articles that met the criteria were reviewed. The analysis identified three themes: (1) learning strategies (simulation, virtual gaming, elearning, traditional learning); (2) challenges (staffing, time, access, skill) and opportunities (incentive to stay employed, decreased burnout); and (3) learning needs (palliative, patient and family needs, older adults and dementia, acute nursing skills). Nurses who provide care to patients in their homes have very complex roles and responsibilities. In order to keep patients and nurses safe, standards of education for HCNs, beyond their basic education program, must be developed. These educational standards must be designed to address the complex medical needs of patients while making the educational opportunities accessible and value-added. Improving the CNE experience for HCNs has the potential to increase patient safety, improve care outcomes, increase nurse competence, improve retention, and decrease nurse burnout.

The importance of organizational commitment in rural nurses' intent to leave

Aims

To examine determinants of intention to leave a nursing position in rural and remote areas within the next year, for Registered Nurses or Nurse Practitioners (RNs/NPs) and Licensed Practical Nurses (LPNs).

Design

A pan‐Canadian cross‐sectional survey.

Methods

The Nursing Practice in Rural and Remote Canada II survey (2014–2015) used stratified, systematic sampling and obtained two samples of questionnaire responses on intent to leave from 1,932 RNs/NPs and 1,133 LPNs. Separate logistic regression analyses were conducted for RNs/NPs and LPNs.

Results

For RNs/NPs, 19.8% of the variance on intent to leave was explained by 11 variables; and for LPNs, 16.9% of the variance was explained by seven variables. Organizational commitment was the only variable associated with intent to leave for both RNs/NPs and LPNs.

Conclusions

Enhancement of organizational commitment is important in reducing intent to leave and turnover. Since most variables associated with intent to leave differ between RNs/NPs and LPNs, the distinction of nurse type is critical for the development of rural‐specific turnover reduction strategies. Comparison of determinants of intent to leave in the current RNs/NPs analysis with the first pan‐Canadian study of rural and remote nurses (2001–2002) showed similarity of issues for RNs/NPs over time, suggesting that some issues addressing turnover remain unresolved.

Impact

The geographic maldistribution of nurses requires focused attention on nurses' intent to leave. This research shows that healthcare organizations would do well to develop policies targeting specific variables associated with intent to leave for each type of nurse in the rural and remote context. Practical strategies could include specific continuing education initiatives, tailored mentoring programs, and the creation of career pathways for nurses in rural and remote settings. They would also include place‐based actions designed to enhance nurses' integration with their communities and which would be planned together with communities and nurses themselves.

Rural and Remote Licensed Practical Nurses' Perceptions of Working Below Their Legislated Scope of Practice

Over the past two decades in Canada, licensed or registered practical nurses (LPNs) have experienced an extension of their educational preparation and scope of practice. Simultaneously, there has been an increase in the number of LPNs employed in rural and remote communities. These changes have influenced the practice environment and LPNs' perceptions of their work. The aim of this article is to examine what factors predict rural and remote LPNs' perceptions of working below their legislated scope of practice and to explore their perceptions of working below scope. The findings arise from a national survey of rural and remote regulated nurses, in which 77.3% and 17.6% of the LPNs reported their practice as within and as below their legislated scope of practice, respectively. Three factors, age, stage of career and job-resources related to autonomy and control, predicted that LPNs would perceive themselves to be working below their scope of practice. These results suggest that new ways to communicate nurses' scope of practice are needed, along with supports to help rural and remote LPNs more consistently practice to their legislated scope of practice. Without such changes, the LPN role cannot be optimized and disharmony within rural and remote settings may be exacerbated.

Perceptions of sense of community and community engagement among rural nurses: Results of a national survey

BACKGROUND

Variations in rural nurses' sense of community and engagement in rural communities are poorly understood, although there is evidence that these are linked to community cohesion and perceived community resilience.

OBJECTIVE

The aim of our research was to develop descriptive profiles of rural nurses who exhibit a sense of community and community engagement at low, average, and high levels, based on occupational, personal, community, and regional characteristics. These results were linked to levels of cohesion and resilience.

DESIGN

A survey questionnaire, including established scales, demographic information, and information about rural nursing practice was administered to rural nurses.

SETTINGS

Rural communities in all provinces and territories in Canada outside the commuting zone of urban areas with 10,000 or more inhabitants.

PARTICIPANTS

Multi-level systematic stratified sampling was employed for the national survey. A subsample of 2116 Registered Nurses, Nurse Practitioners, and Licensed Practical Nurses comprised the participants for this analysis.

METHODS

The analysis was conducted in two stages: (1) in the first subset, those (n = 2116) whose primary work community was rural, remote, or rurban with less than 10,000 inhabitants were grouped into a nine-group typology based on low, average, and high tertiles of Psychological Sense of Community and Community Engagement. The second subset (n = 993) represented those in three groups: low-low, average-average, and high-high scores on the two indices. Significant differences between the three groups were identified based on occupational, personal, community, and regional characteristics. Chi Square, ANOVA, and correlation tests were applied as required.

RESULTS

Nurses with low scores on both Psychological Sense of Community and Community Engagement were more likely to be from larger communities, single or divorced and living and working in the North. Those with average scores on both scales have been in their nursing positions for more than 20 years, are middle aged and are satisfied with their home community. Nurses in the third group have high scores on both indicators; they are more likely to be from a smaller childhood communities, married or living common-law, and are in the late middle age group.

CONCLUSIONS

By focusing on the key variables or traits of nurses, modifiable recruitment and retention practices can be implemented. For example, it is important to recruit nurses who are from smaller communities. Other initiatives for nurses include matching community activities with the age and stage of the family and developing a welcoming strategy for the workplace and community for newly arrived nurses.