Factors associated with intended and effective settlement of nursing students and newly graduated nurses in a rural setting after graduation: A mixed-methods review
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
References (36)
The theory of planned behavior
Organizational Behavior and Human Decision Processes
(1991)- et al.
The impact of rural clinical placement on student nurses’ employment intentions
Collegian
(2002) - et al.
Re-thinking approaches to undergraduate health professional education: interdisciplinary rural placement program
Collegian
(2003) - et al.
The impact of clinical placement location on nursing students’ competence and preparedness for practice
Nurse Education Today
(2004) - et al.
Factors that influence the recruitment and retention of graduate nurses in rural health care facilities
Collegian
(2005) - et al.
The lure of the bush: do rural placements influence student nurses to seek employment in rural settings?
Collegian
(2008) - et al.
The rural pipeline: building a strong nursing workforce through academic and service partnerships
Nursing Clinics of North America
(2011) - et al.
Undergraduate nursing students’ preparedness to “go rural”
Nurse Education Today
(2008) Effects of educational focus on a graduate nurse's initial choice of practice area
Journal of Professional Nursing
(1998)- et al.
Rural and remote mental health placements for nursing students
Australian Journal of Rural Health
(2000)
Recension des principaux facteurs d’attraction, d’installation et de maintien des médecins en régions éloignées
Cahiers de sociologie et de démographie médicale
Factors that influence students in choosing rural nursing practice: a pilot study
Rural and Remote Health
Rural placements in Tasmania: do experiential placements and background influence undergraduate health science student's attitude toward rural practice?
Rural and Remote Health
Synthesising qualitative and quantitative evidence: a review of possible methods
Journal of Health Services Research & Policy
Telehealth and the recruitment and retention of physicians in rural and remote regions: a Delphi study
Canadian Journal of Rural Medicine
Belief, Attitude, Intention, and Behavior: An Introduction to Theory and Research
Telehealth to support practice in remote regions: a survey among medical residents
Telemedicine Journal and e-Health
Supporting health professional through information and communication technologies: a systematic review of the effects of information and communication technologies on recruitment and retention
Telemedicine Journal and e-Health
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