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.

Integrating Subjective and Objective Dimensions of Resilience in Fire-Prone Landscapes.

Resilience has become a common goal for science-based natural resource management, particularly in the context of changing climate and disturbance regimes. Integrating varying perspectives and definitions of resilience is a complex and often unrecognized challenge to applying resilience concepts to social-ecological systems (SESs) management. Using wildfire as an example, we develop a framework to expose and separate two important dimensions of resilience: the inherent properties that maintain structure, function, or states of an SES and the human perceptions of desirable or valued components of an SES. In doing so, the framework distinguishes between value-free and human-derived, value-explicit dimensions of resilience. Four archetypal scenarios highlight that ecological resilience and human values do not always align and that recognizing and anticipating potential misalignment is critical for developing effective management goals. Our framework clarifies existing resilience theory, connects literature across disciplines, and facilitates use of the resilience concept in research and land-management applications.

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

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.

Immunization Rejection in Southern Alberta: A Comparison of the Perspectives of Mothers and Health Professionals.

Qualitative grounded theory was used to compare and contrast the understanding and decision-making process of non-immunizing mothers and health professionals' perceptions of these mothers' understanding and decision-making process. The sample comprised 8 mothers with purposefully unimmunized children under the age of 6 years and 12 health professionals. Semi-structured interviews were conducted and the data generated were analyzed using data immersion, memo-writing, and 3 stages of coding. The mothers and health professionals identified similar, interrelated factors influencing the mothers' decision, categorized into 4 groups: emotions, beliefs, facts, and information. Three primary themes were evident: the health professionals emphasized the influence of religion in decision-making to a greater extent than did the mothers, the meaning of evidence appeared to differ for mothers and health professionals, and mothers revealed a mistrust of health professionals. Immunization is a public health issue; collaboration and understanding are necessary to promote positive health outcomes in children.

Les auteures se sont fondées sur une théorie qualitative à base empirique pour comparer l'analyse et la démarche des mères qui décident de ne pas faire vacciner leurs enfants, à l'idée que s'en font les professionnels de la santé. L'échantillon comprend 8 mères ayant délibérément omis de faire vacciner leurs enfants de moins de six ans et 12 professionnels de la santé. Les auteures ont mené des entrevues semi-directives dont les données ont été analysées suivant une méthode fondée sur l'immersion, la prise de notes et trois étapes de codage. Les deux groupes évoquent des facteurs semblables et interdépendants pour expliquer la décision des mères, qu'on peut répartir en quatre catégories: émotions, convictions, faits et information. Trois grands thèmes en ressortent: les professionnels de la santé insistent davantage que les mères sur l'influence de la religion dans la prise de décision; les mères et les professionnels de la santé semblent accorder un sens différent aux données probantes; les mères expriment une certaine méfiance à l'égard des professionnels de la santé. La vaccination est un enjeu de santé publique; la promotion de résultats de santé positifs chez les enfants doit reposer sur la collaboration et la compréhension des enjeux.

Aboriginal science symposium: enabling Aboriginal student success in post-secondary institutions.

CONTEXT: Research in the sciences is now beginning to acknowledge what many Aboriginal educators and students have experienced or witnessed in educational curricula, a general dismissal of Indigenous knowledge as being considered scientifically 'worthy'. This is the result of educational institutions', and the systems within which they are placed, failure to teach from broad cultural orientations. Aboriginal persons are under-represented in post-secondary education programs, with a similar disparity in the limited number of Aboriginal persons holding careers in health, science and engineering occupations. ISSUES: The University of Lethbridge is attempting to increase the number of Aboriginal students who successfully complete programs in a variety of areas. To that end, the Support Program for Aboriginal Nursing Students (SPANS) commenced in Fall 2007 in order to increase the numbers of Aboriginal students who enter and complete the 4 year nursing program. At one time there were as few as 2-3 Aboriginal nursing students across the 4 years of the program. Since SPANS began there are now 34 students of Aboriginal background across all 4 years of the nursing program. This is noteworthy because statistically there are only 1200 Aboriginal Registered Nurses in Canada, a daunting statistic that is alarming low. One of the objectives of SPANS is to enhance the nursing faculty and clinical instructors' understanding of Aboriginal science so that it can be integrated into the current curriculum. With this aim, an Aboriginal Science Symposium was held in May 2009 to bring nursing faculty together with other University faculty and experts in Aboriginal science. The symposium attempted to highlight the links between programs in nursing and health sciences and the need for integration with Aboriginal science. The 3 specific symposium objectives were to: (1) generate an understanding of traditional scientific knowledge; (2) bridge Aboriginal and Western scientific thought, toward and; (3) understand ways of implementing and raising awareness of how Aboriginal knowledge and understanding of science can be applied to help inform and improve teaching in all educational science settings. LESSONS LEARNED: From keynote addresses, panel group discussions, and breakout sessions, participant responses to the symposium objectives coalesced into 4 themes: (1) Aboriginal ways of knowing: informing Western science curricula; (2) Elders and community, enhancing science education; (3) Aboriginal student experience in the science classroom; and (4) strategies and advice to meet the needs of the Aboriginal science student.

Work setting, community attachment, and satisfaction among rural and remote nurses.

OBJECTIVES: To describe community satisfaction and attachment among rural and remote registered nurses (RNs) in Canada. DESIGN AND SAMPLE: Cross-sectional survey of rural and remote RNs in Canada as part of a multimethod study.The sample consisted of a stratified random sample of RNs living in rural areas of the western country and the total population of RNs who worked in three northern regional areas and those in outpost settings. A subset of 3,331 rural and remote RNs who mainly worked in acute care, long-term care, community health, home care, and primary care comprised the sample. MEASURES: The home community satisfaction scale measured community satisfaction, whereas single-item questions measured work community satisfaction and overall job satisfaction. Community variables were compared across practice areas using analysis of variance, whereas a thematic analysis was conducted of the open-ended questions. RESULTS: Home care and community health RNs were significantly more satisfied with their work community than RNs from other practice areas. RNs who grew up in rural communities were more satisfied with their current home community. Four themes emerged from the open-ended responses that describe community satisfaction and community attachment. CONCLUSIONS: Recruitment and retention strategies need to include mechanisms that focus on community satisfaction, which will enhance job satisfaction.

Being a woman: perspectives of low-german-speaking mennonite women.

Understanding the beliefs and knowledge related to women's sexuality is important when working with unique religious groups in order to provide culturally appropriate care. An exploratory, descriptive qualitative study generated knowledge, beliefs, and practices related to menstruation, ovulation, and family planning among Low German-speaking (LGS) Mennonite women (n = 38). There is a pervasive silence that surrounds sexuality among this group, who have a limited understanding of the physiological changes they experience. Honoring religious principles and family and community expectations through acceptable female behavior is essential. Adherence to religious principles varies by family but is not shared with the group to avoid disfavor.

Development and psychometric evaluation of the Job Demands in Nursing Scale and Job Resources in Nursing Scale: Results from a national study.

AIM: To develop and test the psychometric properties of the Job Resources in Nursing (JRIN) Scale and the Job Demands in Nursing (JDIN) Scale. DESIGN: Cross-sectional survey. METHODS: A three-phase process of instrument development and psychometric evaluation was employed: Phase 1: development of a 42-item JRIN Scale and 60-item JDIN Scale through extensive literature review, expert consultation and an iterative content evaluation; Phase 2: pilot survey of 89 nurses and use of item discrimination analysis to estimate the internal consistency reliability of each subscale and reduce the length of each scale; Phase 3: Modified scales were tested in a nationwide survey of 3,822 rural/remote nurses, including use of exploratory factor analysis. RESULTS: The 24 items related to job resources favoured a six-factor structure, accounting for 63% of the variance, Cronbach's alpha 0.88. The 22 items related to job demands favoured a six-factor structure, accounting for 59% of the variance, Cronbach's alpha 0.84.

Rural and Remote Registered Nurses' Perceptions of Working Beyond Their Legislated Scope of Practice.

Registered nurses (RNs) enact their scope of practice in everyday practice through the influences of client needs, the practice setting, employer requirements and policies and the nurse's own level of competence (Canadian Nurses Association 2015). A scope of practice is "dynamic and responsive to changing health needs, knowledge development and technological advances" (International Council of Nurses 2013). In Canada, RNs' scope of practice is set out through provincial and territorial legislation and provincial regulatory frameworks, which are broadly consistent, but vary across provinces (Schiller 2015). Provincial and territorial regulatory bodies articulate the RN scope through frameworks that include expected standards as well as, in some jurisdictions, limits and conditions upon practice (British Columbia College of Nursing Professionals 2018), and which are commonly referred to as a licensed or registered scope of practice. Rural and remote practice is starting to be explicitly acknowledged within nurses' legislated scopes of practice through the identification of certified practices for RNs in specific rural and remote practice settings, following approved education (British Columbia College of Nursing Professionals 2018).

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.

Community resiliency as a measure of collective health status: perspectives from rural communities.

Community resiliency is a theoretical framework useful for describing the process used by communities to address adversity. A mixed-method 2-year case study was conducted to gather information about community resiliency in 2 rural communities. This article focuses on the themes generated from qualitative interviews with 55 members of these communities. The participants viewed community as a place of interdependence and interaction. The majority saw community resiliency as the ability to address challenges. Characteristics included physical and social infrastructure, population characteristics, conceptual characteristics, and problem-solving processes. Barriers included negative individual attitudes and lack of infrastructure in rural communities. Nurses could play a key role in enhancing the resiliency of rural communities by developing and implementing programs based on the Community Resiliency Model, which was supported in this study.

Childbearing beliefs among Low-German-speaking Mennonite women.

BACKGROUND: Low-German-speaking (LGS) Mennonites are a conservative religious group that has migrated from Eastern Europe to Canada and then to countries such as Mexico. They are now returning to Canada in large numbers. They adhere to religious principles based upon a literal interpretation of the Bible. This conservative religious group provides opportunities for nurses and midwives to implement culturally competent care. AIM: The purpose of this article is to discuss LGS Mennonite women's childbearing knowledge and beliefs to develop and implement care that considers and includes their conservative religious beliefs. METHODS: An exploratory, descriptive study was conducted to generate information through open-ended interviews with 38 LGS Mennonite women about their knowledge, beliefs and practices related to childbearing. Data collection and analysis occurred simultaneously; emerging themes were discussed by the research team to ensure a contextual understanding of the data. FINDINGS: The participants engage in proscribed practices ('turning the baby') and adhere to specific dietary measures (increasing dairy products) during pregnancy to ensure a healthy birth outcome. During the post-partum, extensive support is provided by other Mennonite women to assist the mother and newborn during this important transition. CONCLUSION: Building trust and working in a respectful manner with religious groups such as the LGS Mennonites are a cornerstone of culturally competent nursing practice.

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.

"We definitely are role models": Exploring how clinical instructors' influence nursing students' attitudes towards older adults.

The world's population is getting older, which will inevitably cause increased demands for nurses to provide high quality care to this demographic. Attitudes have been shown to influence the quality of care that older adults receive. It is therefore important to gain a better understanding of what influences nursing students' attitudes towards older adults. This article reports on one of three inter-connected research questions of a mixed methods study that explored the relationship between clinical instructors' attitudes and nursing students' attitudes towards older adults. Semi-structured interviews were conducted with 6 clinical instructors and 13 nursing students. Interview data was analyzed using thematic analysis. A conceptual model was developed from the research findings, which revealed that nursing instructors are seen as strong role models for their students, and as role models, they influence students through demonstrations, expectations and support. As a result, nursing students mirror the attitudes of their instructors towards older adults. Findings from this study highlight the strong connection between nursing instructors' and students' attitudes. This has important implications for nursing education including strategies that instructors can employ to enhance students' attitudes towards older adults. Insights from this study also have the potential to improve the quality of care that future nurses provide to older adults.

Experiences of rural and remote nurses assisting with disasters.

BACKGROUND: Globally, disasters are on the rise. Nurses play a significant role in responding to such events but little is known about rural and remote nurses' experiences. METHODS: A national cross-sectional survey of regulated nurses (registered nurses, registered psychiatric nurses, licensed practical nurses and nurse practitioners) in rural and remote Canada provided the data (n=2465) for the logistic regression of predictors of assisting with a disaster event within the last five years. The types of disaster events were also examined and open-ended responses were explored to reveal nurses' perspectives. RESULTS: Nurse type, age, region of employment, employment status, number of rural communities worked, distance to advanced referral centre, remote community, personal-professional boundaries, burnout and work engagement were significant factors related to assisting with a disaster event. Open-ended data alluded to the importance of pre-disaster preparation, and the difficulties experienced when personal-professional relationships are impacted during a disaster. CONCLUSIONS: Nursing education curricula needs to include information about disasters and the nurse's role. Continuing education opportunities and preparation for nurses should be offered in the workplace. Psychosocial supports to assist rural nurses who attend to disasters in their workplace will help them deal with issues such as the blurring of personal-professional relationships.

Exploratory factor analysis and reliability of the Primary Health Care Engagement (PHCE) Scale in rural and remote nurses: findings from a national survey.

Aim The study purpose was to provide evidence of validity for the Primary Health Care Engagement (PHCE) Scale, based on exploratory factor analysis and reliability findings from a large national survey of regulated nurses residing and working in rural and remote Canadian communities. BACKGROUND: There are currently no published provider-level instruments to adequately assess delivery of community-based primary health care, relevant to ongoing primary health care (PHC) reform strategies across Canada and elsewhere. The PHCE Scale reflects a contemporary approach that emphasizes community-oriented and community-based elements of PHC delivery. METHODS: Data from the pan-Canadian Nursing Practice in Rural and Remote Canada II (RRNII) survey were used to conduct an exploratory factor analysis and evaluate the internal consistency reliability of the final PHCE Scale. Findings The RRNII survey sample included 1587 registered nurses, nurse practitioners, licensed practical nurses, and registered psychiatric nurses residing and working in rural and remote Canada. Exploratory factor analysis identified an eight-factor structure across 28 items overall, and good internal consistency reliability was indicated by an α estimate of 0.89 for the final scale. The final 28-item PHCE Scale includes three of four elements in a contemporary approach to PHC (accessibility/availability, community participation, and intersectoral team) and most community-oriented/based elements of PHC (interdisciplinary collaboration, person-centred, continuity, population orientation, and quality improvement). We recommend additional psychometric testing in a range of health care providers and settings, as the PHCE Scale shows promise as a tool for health care planners and researchers to test interventions and track progress in primary health care reform.

Violence in rural communities: youth speak out!

INTRODUCTION: The current available literature does not present the viewpoints of rural youths regarding the meaning of violence. DESIGN: A mixed method exploratory, descriptive study was conducted to generate information from rural youth about violence. The qualitative phase of the exploratory, descriptive study is reported here. RESULTS: Interviews with fifty-two youth (20 males and 32 females), ranging in age from 11 to 19 years in grades 7-12 in the public school system were conducted in two rural communities. The participants initially defined violence as a physical act with intent to harm, but did not consider weapon carrying as an issue in their communities. They identified alcohol consumption as a trigger for violence and described planned fights that occurred away from school grounds. Physical fights were not limited to the male students. The youth openly stated that violence exists in rural communities and felt isolated from adults with regard to understanding the youths' experiences with violence. CONCLUSION: It is important to generate information about violence directly from rural youth. Programs to reduce violence that include the youth are important to pursue.

Insights from a national study.

Aboriginal registered nurses have been identified as an essential group in the delivery of health services in First Nations communities. Despite this, there is a lack of information about this group of nurses in Canada. This article presents information about this group taken from two components of a national study, The Nature of Nursing Practice in Rural and Remote Canada: documentary analysis and a national survey of nurses. The aboriginal nurse participants were predominantly female, between the ages of 40 and 49, diploma prepared and with licensure for less than 10 years. The survey data showed 41.4 per cent returned to their home communities to work. The participants noted how they enjoyed the challenges of rural and remote nursing and wanted to raise their families in these small communities. They have been able to create supportive work environments, particularly with their nursing colleagues. The nurses are committed to working in rural and remote communities.

Development and psychometric evaluation of the Primary Health Care Engagement (PHCE) Scale: a pilot survey of rural and remote nurses.

AIM: To report the development and psychometric evaluation of a scale to measure rural and remote (rural/remote) nurses' perceptions of the engagement of their workplaces in key dimensions of primary health care (PHC). BACKGROUND: Amidst ongoing PHC reforms, a comprehensive instrument is needed to evaluate the degree to which rural/remote health care settings are involved in the key dimensions that characterize PHC delivery, particularly from the perspective of professionals delivering care. METHODS: This study followed a three-phase process of instrument development and psychometric evaluation. A literature review and expert consultation informed instrument development in the first phase, followed by an iterative process of content evaluation in the second phase. In the final phase, a pilot survey was undertaken and item discrimination analysis employed to evaluate the internal consistency reliability of each subscale in the preliminary 60-item Primary Health Care Engagement (PHCE) Scale. The 60-item scale was subsequently refined to a 40-item instrument. FINDINGS: The pilot survey sample included 89 nurses in current practice who had experience in rural/remote practice settings. Participants completed either a web-based or paper survey from September to December, 2013. Following item discrimination analysis, the 60-item instrument was refined to a 40-item PHCE Scale consisting of 10 subscales, each including three to five items. Alpha estimates of the 10 refined subscales ranged from 0.61 to 0.83, with seven of the subscales demonstrating acceptable reliability (α ⩾ 0.70). The refined 40-item instrument exhibited good internal consistency reliability (α=0.91). The 40-item PHCE Scale may be considered for use in future studies regardless of locale, to measure the extent to which health care professionals perceive their workplaces to be engaged in key dimensions of PHC.