Factors associated with intended and effective settlement of nursing students and newly graduated nurses in a rural setting after graduation: A mixed-methods review

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Abstract

Objectives

To identify factors that influence the initial plan and final decision to choose a rural area as first employment location in final-year nursing students or newly graduated nurses.

Design

We conducted a mixed-methods review of the literature, including both published and gray literature, using established criteria. Two reviewers performed data extraction of relevant information independently.

Data sources

We retrieved empirical studies from the following databases: PubMED, Embase, CINAHL (EBSCO), Web of Science (SCI and SSCI), The Cochrane Library, Business Source Premier (EBSCO), ERIC, Proquest and PsychInfo. We also searched for empirical studies in the technical and gray literature and reviewed journals related to rural health. Additionally, we conducted searches in websites such as the Center for Health Workforce Planning and Analysis, as well as Google and Google Scholar search engines.

Results

Of the 523 studies thus screened, 15 were included for data extraction. We identified more than 40 factors associated with initial plans and final decision to settle in a rural area among nursing graduates.

Conclusions

Only limited literature is currently available on the factors associated with the intention of nursing students or newly graduated nurses of practicing in rural areas and on the relationship between intention and effective behavior. This review highlights the needs for further research in this field.

Résumé

Objectifs

Recenser les facteurs qui influencent l’intention ou la décision des finissant(e)s de sciences infirmières et des infirmiers(ères) récemment diplômés de s’établir en région pour y pratiquer suite à leur diplomation.

Devis

Une revue de la littérature de méthodes mixtes a été effectuée. Nous avons inclus les études publiées dans les bases de données ainsi que la littérature grise, selon des critères d’inclusion préétablis. L’extraction des données a été effectuée par deux réviseurs indépendants.

Sources

Les bases de données suivantes ont été explorées: PubMED, Embase, CINAHL (EBSCO), Web of Science (SCI and SSCI), The Cochrane Library, Business Source Premier (EBSCO), ERIC, Proquest and PsychInfo. Nous avons aussi criblé la littérature grise au Center for Health Workforce Planning and Analysis, ainsi que via les moteurs de recherche Google et Google Scholar.

Résultats

Sur les 523 études évaluées, nous en avons retenues 15 pour l’extraction des données. Plus de 40 facteurs reliés à l’intention et à la décision de pratiquer en région rurale chez les étudiant(e)s de sciences infirmières, et chez les diplômé(e)s récent(e)s, ont été identifiés.

Conclusion

Il n’existe que peu de littérature sur les facteurs reliés à l’intention et à la décision des infirmières de travailler en région éloignée, suite à leur diplomation. Les liens entre l’intention et l’adoption du comportement ciblé, soit le travail en région éloignée, n’ont été que peu explorés jusqu’à maintenant. Cette revue souligne donc la nécessité d’approfondir la recherche sur le sujet.

Introduction

Recruitment of nurses is an important issue in Canada, especially in rural areas, where the practice is very specific and presents many challenges. Nurses play a crucial role in providing health services in these areas, but the general preference of work location for newly graduated nurses is in urban or affluent areas (Serneels et al., 2007). Choosing between an urban and a rural environment for a first place of employment is a complex decision for newly graduated nurses because its outcome can impact upon the rest of their life. Personal motivation, along with other professional and environmental factors, underlies this important decision.

The objective of this mixed-methods review is thus to identify the factors that influence the initial plan and final decision of final-year nursing students or newly graduated nurses to choose a rural area as their first employment location.

Section snippets

Background

The relative distribution of the primary health care workforce in rural and remote regions is inequitable, with a very low concentration of qualified professionals in some severely deprived areas (Sibbald et al., 2002). Rural health is different from urban health due to social, cultural, socio-political elements (Romanow, 2002, Sedgwick and Yonge, 2008). Recruiting and attracting nurses to less populated areas and remote settings thus represent a constant challenge for many developed countries,

Methods

We conducted a systematic search in the following databases: PubMED, Embase, CINAHL (EBSCO), Web of Science (SCI and SSCI), The Cochrane Library, Business Source Premier (EBSCO), ERIC, Proquest and PsychInfo. Our research was not limited to any specific time period.

We also searched empirical studies in the gray literature and we reviewed journals related to rural health such as the Canadian Journal of Rural Medicine (1996–2011), the Online Journal of Rural Nursing (2000–2011), and the Rural and

Results

The search strategy generated a total of 728 publications. Duplicates were then removed, leaving 523 publications. From these references, 462 were excluded based on the title and abstract and 61 were retained for full-text review by two independent reviewers, of which 14 were ultimately included in the review for further data extraction (Fig. 1). We consulted the references of these publications, which led to the inclusion of one additional publication. Additional references were collected by

Characteristics of the studies included

The studies included are exclusively from Anglo-Saxon countries: eight studies are from Australia (Courtney et al., 2002, Dalton et al., 2008, Lea and Cruickshank, 2005, McNair et al., 2005, Orpin and Gabriel, 2005, Playford et al., 2006, Playford et al., 2010, Schoo et al., 2008), six from the USA (Bushy and Leipert, 2005, Gordon and Denton, 1992, Lea et al., 2008, McDonough et al., 1992, Rhyne et al., 2006, Wood, 1998) and one from the United Kingdom (Sibbald et al., 2002). All 15 studies

Factors associated with intention of settling in a rural area

As mentioned above, the aim of this review was to identify factors related to nursing students and newly graduated nurses’ intention and decision to go work in a rural setting. We also considered the factors influencing the intention to go rural, since the behavior of an individual is directly predicted by its intention to adopt the target behavior (Fishbein and Ajzen, 1975). The findings are summarized in Table 1.

Among the 15 studies included, six were concerned with the intention of settling

Factors associated with the decision to settle in a rural area

Factors that influence the effective settlement of newly graduated nurses in a rural area are quite similar to the previously mentioned factors that influence intention. Students’ background in rural schools (Gordon and Denton, 1992, Playford et al., 2010, Schoo et al., 2008, Wood, 1998) or students’ rural origins (Bushy and Leipert, 2005, Playford et al., 2006, Wood, 1998), which are factors strongly related to intention, are also linked with their settlement in rural areas. The study by Bushy

Quality appraisal of the included studies

Table 3, Table 4 report the quality appraisal score for each study included in this review. Quality appraisal of the studies herein included was done in order to evaluate the scope of the findings. For studies exclusively dealing with the intention of settling in rural regions (Table 3), quality appraisal with the MMAT (Pluye et al., 2011) revealed that three studies (out of six) met all quality criteria listed according to their respective design. The three others responded only partially to

Discussion

From the findings of this mixed-methods review, several personal, professional and organizational factors are likely to be linked to the intention of going to rural regions and the final decision to do so in nursing students and recently graduated nurses. A background of attending rural schools and prior experience of living in a rural area are strongly linked to intention to go rural and settlement in rural area after graduation. The location of family members and spouse or partner is also an

Strengths and limitations

The main strength of this study is that it systematically identifies the key factors influencing the intention of moving to a work location in rural areas and the final decision to do so, an undertaking that few studies had carried out so far. In this respect, these results will be very useful for the second phase of this project which is underway, namely the development of a questionnaire to measure the intention of settling in rural areas among nursing students. This questionnaire will

Conclusion

This review allowed us to identify the main factors influencing the intention of nurses of practicing in rural regions and their ultimate settlement in a rural setting after their graduation. While various measures are currently implemented by some governments and health care decision-makers to address the shortage of manpower, it might be useful to consider more especially the personal aspects highlighted in this review. However, more research is needed to better understand how these personal

Acknowledgments

We would like to thank Carole Brault for her help in developing the literature search strategy. We are grateful to Dr. Richard Poulin for his kind review of this manuscript, his insight and his helpful suggestions.
Conflict of interest

None declared.
Funding

This work was supported by a grant from the Canadian Institutes of Health Research (Grant #200911PHE-217005-PHE-CFBA-111141).
Ethical approval

Ethical approved was received from the Research Ethics Board Committee of the Centre Hospitalier

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