Exploring the Multifaceted and Multifunctional Roles and Activities of Rural Nurse Managers
Main Article Content
Abstract
Research on rural nursing has produced limited insight into the complex dynamic of roles and activities fulfilled by rural nurse managers (RNMs). Hence there is a need to explore, understand and delineate these roles to help provide appropriate managerial support and training to improve their capability. This study sought to develop greater understanding of the roles and tasks performed by RNMs, drawing on nurses’ own experiences and understandings. It used in-depth interviews with selected nurse managers working in rural and remote health-care facilities in South Australia. This provided detailed information about RNMs’ roles, responsibilities, tasks, decision making and patterns of work. Meanings were sought from the everyday activities of RNMs who drew distinctions between their roles and those of counterparts working in metropolitan facilities. Both clinical and managerial activities were highlighted but with roles described as ‘expanded,’ ‘extended’ and ‘jack of all trades’ illustrating the multiplicity of activities performed by a single RNM. The nature of rural and remote health-care facilities places special responsibilities on RNMs, creating stress deriving from role conflict and ambiguity. Recommendations are made regarding ways in which the work of RNMs can be better supported whilst addressing the complexities of their jobs. More appreciation of the job stresses needs to be considered when providing support to RNMs who face particular challenges through working in rural and remote areas. Greater understanding of their roles and daily activities can lead to better management oversight and support, but the multifaceted health issues in these areas remain challenging.
Keywords:
Nurse managers, clinical role, management role, rural, remote, South Australia
Article Details
How to Cite
CHISENGANTAMBU-WINTERS, Christine; ROBINSON, Guy M; EVANS, Nina.
Exploring the Multifaceted and Multifunctional Roles and Activities of Rural Nurse Managers.
Medical Research Archives, [S.l.], v. 12, n. 10, oct. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5838>. Date accessed: 15 nov. 2024.
doi: https://doi.org/10.18103/mra.v12i10.5838.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Doucette JN. Transforming the role of the nurse manager: A call to action. J Nurs Admin. 2017;47(10):S2. Doi:10.1097/NNA.0000000000000527
2. Little L, Wagner J, Boal AS. Responsibility and authority of nurse leaders. In J Wagner (ed.), Leadership and influencing change in nursing. University of Regina Press, Regina, Sask., Chapter 12. 2018.
3. Lowe G, Plummer V, Boyd L. Nurse practitioner integration: Qualitative experiences of the change management process. J Nurs Manage. 2018;26(8):992-1001.
4. McSherry R, Pearce P, Grimwood K, McSherry W. The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care. J Nurs Manage. 2012;20(1):7-19.
doi:10.1111/j.1365-2834.2011.01349.x
5. Winters CA. (ed.). Rural nursing: Concepts, theory, and practice. Springer Publishing, New York, sixth edition. 2021.
6. Smith JG, Plover CM, McChesney MC, Lake ET. Isolated, small, and large hospitals have fewer nursing resources than urban hospitals: Implications for rural health policy. Public Health Nurs. 2019;36(4):469–477. doi: 10.1111/phn.12612
7. Whiteing N, Barr J, Rossi DM. The practice of rural and remote nurses in Australia: A case study. J Clin Nurs. 2022;31(11-12):1502-1518. https://doi.org/10.1111/jocn.16002
8. Hegney D. Dealing with distance: Rural and remote area nursing. In J Daly, S Speedy, D Jackson (eds.) Contexts of Nursing: An introduction. Elsevier Australia, Chatswood, NSW, pp.213-228. 2006.
9. Wood PJ. Historical imagination and issues in rural and remote area nursing. Australian J Adv Nurs. 2010;27(4):54-61.
10. Roberts P, Guenther J. Framing rural and remote: Key issues, debates, definitions, and positions in constructing rural and remote disadvantage. In P Roberts, M Fuqua (eds.) Ruraling education research, pp. 13-27. Springer, Singapore. 2021.
11. Smith, S., Sim, J., & Halcomb, E. Nurses’ experiences of working in rural hospitals: An integrative review. J Nurs Manage. 2019;27(3):482-490.
doi: 10.1111/jonm.12716
12. McGrail MR, Russell, DJ, Humphreys JS. Index of access: a new innovative and dynamic tool for rural health service and workforce planning. Aust Health Rev. 2016; 41:492-498. doi: 10.1071/AH16049
13. Bourke L, Taylor J, Humphreys, JS, Wakerman J. “Rural health is subjective; everyone sees it differently”: Understandings of rural health among Australian stakeholders. Health and Place. 2013; 24:65-72. doi: 10.1016/j.healthplace.2013.08.005
14. Bourke L, Humphreys JS, Wakerman J, Taylor J. Understanding rural and remote health: a framework for analysis in Australia. Health and Place. 2012. 18(3), 496-503.
doi: 10.1016/j.healthplace.2012.02.009
15. Kagi E, Rasiah R, Moran M. Experiences of primary health care nurses advancing their careers in a remote Western Australian location. Aust J Rural Health. 2023;31(1):41-51. doi: 10.1111/ajr.12904
16. Wakerman J, Bourke L, Humphreys JS, Taylor J. Is remote health different to rural health? Rural Remote Health. 2017;17(2):3832. doi: 10.22605/RRH3832
17. Carey TA, Fauth JM, Tremblay GC. Rethinking evaluation for improved health outcomes: implications for remote Australia. Am J Eval. 2020;41(2):234-254. doi: 10.1177/1098214018824040.
18. Malatzky C, Bourke L. Re-producing rural health: Challenging dominant discourses and the manifestation of power. J Rural Stud. 2016;45:157-164. doi: 10.1016/j.jrurstud.2016.03.005
19. Larkins S, Evans R. Greater support for generalism in rural and regional Australia. Aust Fam Physician. 2014;43:487-490.
doi: pubmed.ncbi.nlm.nih.gov/25006615/
20. Thomas AL, Wakerman J, Humphreys JS. Ensuring equity of access to primary health care in rural and remote Australia - what core services should be locally available? International Journal for Equity in Health. 2015;14:111. doi: 10.1186/s12939-015-0228-1.
21. Dignam D, Duffield C, Stasa H, Gray J, Jackson D, Daly J. Management and leadership in nursing: An Australian educational perspective. J Nurs Manage. 2012;20(1):65-71,
doi: 10.1111/j.1365-2834.2011.01340.x.
22. Bish M, Kenny A, Nay R. Perceptions of structural empowerment: Nurse leaders in rural health services. J Nurs Manage. 2014;22(1):29-37. doi: 10.1111/jonm.12029
23. Hart SM, Warren AM. Understanding nurses’ work: Exploring the links between changing work, labour relations, workload, stress, retention and recruitment. Econ Ind Democracy. 2015;36(2):305-329. doi: 10.1177/0143831X13505119
24. Malatzky C, Cosgrave, C, Gillespie J. The utility of conceptualisations of place and belonging in workforce retention: A proposal for future rural health research. Health and Place. 2020;62:102279. doi: 10.1016/j.healthplace.2019.102279
25. Bourke L, Dunbar T, Murakami‐Gold L. Discourses within the roles of Remote Area Nurses in Northern Territory (Australia) government‐run health clinics. Health Soc Care Comm. 2021. 29(5), 1401-1408. doi: 10.1111/hsc.13195
26. Onnis L. Clinician-to-manager transitions in remote health work contexts: Lessons from a pilot study. 33rd ANZAM Conference. Cairns, Australia. 2019. https://researchonline.jcu.edu.au/61254/
27. Barclay L, Phillips A, David L. Rural and remote health research: Does the investment match the need? Aust J Rur Health. 2018;26:74–7. doi: 10.1111/ajr.12429
28. Paliadelis P. Nurse managers don’t get the corner office. J Nurs Manage. 2013;21(2):377-386. doi: 10.1111/j.1365-2834.2012.01405.x
29. Chisengantambu C, Robinson GM, Evans N. Nurse managers and the sandwich support model. J Nurs Manage. 2018;26(2):192-199.
doi: 10.1111/jonm.12534
30. Kenny A, Allenby A. Implementing clinical supervision for Australian rural nurses. Nurse Educt in Pract. 2013;13(3):165-169.
doi: 10.1016/j.nepr.2012.08.009
31. Muirhead S, Birks M. Roles of rural and remote registered nurses in Australia: an integrative review. Australian J Adv Nurs. 2020;37(1):21-33. doi: 10.37464/2020.371.5
32. Russell D, McGrail M, Humphreys J. Determinants of rural Australian primary health care worker retention: A synthesis of key evidence and implications for policymaking. Aust J Rural Health. 2017;25(1):5–14. doi: 10.1111/ajr.12294
33. Cox CA. Nurse manager job satisfaction and retention: A home healthcare perspective. Nurs Manage. 2019;50(7):17-23. doi:10.1097/01.NUMA.0000558512.58455.68
34. Govasli L, Solvoll BA. Nurses' experiences of busyness in their daily work. Nurs Inq. 2020;27(3):e12350. doi: 10.1111/nin.12350
35. Smith S, Lapkin S, Halcomb E. Sim J. Job satisfaction among small rural hospital nurses: A cross‐sectional study. J Nurs Scholarship. 2023;55(1):378-387. doi: 10.1111/jnu.12800
36. Smith S, Lapkin S, Sim J, Halcomb E. Nursing care left undone, practice environment and perceived quality of care in small rural hospitals. J Nurs Manage. 2020;28(8):2166-2173. doi: 10.1111/jonm.12975
37. Griffiths P, Recio-Saucedo A, Dall'Ora C, Briggs J, Maruotti A, Meredith P, Smith GB, Ball J. The association between nurse staffing and omissions in nursing care: A systematic review. J Adv Nurs. 2018;74(7):1474–1487. doi: 10.1111/ jan.13564
38. Australian Institute of Health and Welfare (AIHW) Rural and Remote Health. 2019. https://www.aihw.gov.au/getmedia/838d92d0-6d34-4821-b5da-39e4a47a3d80/Rural-remote-health.pdf.aspx?inline=true
39. Parry Y, Button D. Nursing and tensions within the Australian health care system. In NJ Wilson, P Lewis, L Hunt, L Whitehead (eds.) Nursing in Australia: contemporary professional and practice insights. Routledge, Abingdon, Oxon. and New York, pp. 11-20. 2020.
40. Smith T, McNeil K, Mitchell R, Boyle B, Ries N. A study of macro-, meso-and micro-barriers and enablers affecting extended scopes of practice: the case of rural nurse practitioners in Australia. BMC Nursing. 2019;18(1):14. doi: 10.1186/s12912-019-0337-z
41. Lenthall S, Dade Smith J. Remote health practice. In J Dade Smith (ed.) Australia’s rural, remote and indigenous health. Elsevier, Chatswood, NSW., pp. 285–315. 2016.
42. Cheon HS, Yrani T. Multiplicity within and between: Addressing multiple roles through role profiles in couples, Journal of Creativity in Mental Health. 2018;13(1):31-42. doi: 10.1080/15401383.2017.1343165
43. Hanlon N, Kearns R. Health and rural places. In: M Shucksmith, DL Brown (eds.) Routledge International Handbook of Rural Studies. Routledge: Abingdon, Oxon., pp. 92-100. 2016.
44. Mathew S, Fitts MS, Liddle Z, Bourke L, Campbell N, Murakami-Gold L, Russel, DJ, Humphreys J.S, Mullholand E, Zhao Y. and Jones MP. Telehealth in remote Australia: a supplementary tool or an alternative model of care replacing face-to-face consultations? BMC Health Services Research. 2023;23(1):341. doi: 10.1186/s12913-023-09265-2
45. Fast O, Rankin J. Rationing nurses: Realities, practicalities, and nursing leadership theories. Nurs Inq. 2018;25(2):e12227. doi: 10.1111/nin.12227
46. Chisengantambu C. Decision making by rural nurse managers: A study of the decision-making processes by nurse managers working in rural health in situations in South Australia. Unpublished PhD thesis, University of South Australia, Whyalla, South Australia. 2016.
47. Guerrero-Castañeda RF, Menezes TMDO, Ojeda-Vargas MG. Characteristics of the phenomenological interview in nursing research. Revista Gaucha de Enfermagem. 2017;38(2):e67458. doi: 10.1590/1983-1447.2017.02.67458
48. Gunawan J, Aungsuroch Y, Marzilli C, Fisher ML, Sukarna A. A phenomenological study of the lived experience of nurses in the battle of COVID-19. Nurs Outlook. 2021;69(4):652-659.
doi: 10.1016/j.outlook.2021.01.020
49. Nowell LS, Norris JM, White DE, Moules NJ. Thematic analysis: Striving to meet the trustworthiness criteria. Int J Qual Meths. 2017;16(1),1609406917733847.
doi: 10.1177/1609406917733847
50. Jackson J, Nowell L. ‘The office of disaster management’ nurse managers' experiences during COVID‐19: A qualitative interview study using thematic analysis. J Nurs Manage. 2021);29(8):2392-2400. doi: 10.1111/jonm.13422
51. Wakerman J, Humphreys J, Russell D, Guthridge S, Bourke L, Dunbar T, Zhao Y, Ramjan M, Murakami-Gold L, Jones MP. Remote health workforce turnover and retention: What are the policy and practice priorities? Hum Resour Health. 2019);17(1),99. doi: 10.1186/s12960-019-0432-y
52. MacKay SC, Smith A, Kyle RG, Beattie M. What influences nurses’ decisions to work in rural and remote settings? A systematic review and meta-synthesis of qualitative research. Rural Remote Health. 2021;21:6335. doi: 10.22605/RRH6335
53. Udod S, Care WD, Marie Graham J, Henriquez N, Ahmad N. From coping to building nurse manager resilience in rural workplaces in western Canada. J Nurs Manage. 2021:29(7):2115-2122. doi: 10.1111/jonm.13350
54. Udod S, Cummings GG, Care WD, Jenkins M. Role stressors and coping strategies among nurse managers. Leadership in Health Services. 2017);30(1): 29-43. doi: 10.1108/LHS-04-2016-0015
55. Chisengantambu-Winters C, Robinson GM, Evans N. Developing a Decision-Making Dependency (DMD) model for nurse managers. Heliyon. 2020;6:e03128. doi: 10.1016/j.heliyon.2019.e03128
56. Lenthall S, Ivanhoe T, Stothers K. Remote area nursing. In: NJ Wilson, P Lewis (eds.) Nursing in Australia: contemporary professional and practical insights. Routledge, Abingdon, Oxon. and New York. 2021. pp. 191-200.
57. El Haddad M, Wilkinson G, Thompson L, Faithfull‐Byrne A, Moss C. Perceptions of the impact of introducing administrative support for nurse unit managers: A qualitative evaluation. J Nurs Manage. 2019;27(8):1700-1711. doi: 10.1111/jonm.12860
58. Owens K.M, Keller S. Exploring workforce confidence and patient experiences: A quantitative analysis. Patient Experience Journal. 2018;5(1):13. doi: 10.35680/2372-0247.1210
59. Thomas, S, Wakerman J, Humphreys J. What does it cost to provide equity of access to high quality, comprehensive primary health care in rural Australia? A pilot study. Rural Remote Health. 2017;17:4019. doi: 10.22605/RRH4019
60. Cox CA. Nurse manager job satisfaction and retention: A home healthcare perspective.
Nurs Manage. 2019;50(7):16-23.
61. Szumer RTO, Arnold M. The ethics of overlapping relationships in rural and remote healthcare. A narrative review. Journal Bioethic Inq. 2023;20(2):181-190. doi: 10.1007/s11673-023-10243-w
62. McElroy M, Wicking K, Harvey N, Yates K. What challenges and enablers elicit job satisfaction in rural and remote nursing in Australia: An integrative review. Nurse Educ Prac. 2022;103454. doi: 10.1016/j.nepr.2022.103454
63. Alston L, McFayden L, Sen Gupta T, Payne W, Smith J. Creating a sustainable and supportive health research environment across rural and remote Australia: a call to action. Med J Australia. 2023;219:S27-S30. doi: 10.5694/mja2.52027
64. Morell AL, Kiem S, Millsteed MA, Pollice A. Attraction, recruitment and distribution of health professionals in rural and remote Australia: early results of the Rural Health Professionals Program. Hum Resour Health. 2014;12:1-6. doi: 10.1186/1478-4491-12-15
65. Department of Health. National Preventive Health Strategy 2021– 2030. Commonwealth of Australia: Canberra. 2021.
66. Smith JA, Canuto, K, Canuto K, Campbell N, Schmitt D, Bonson J, Smith L, Connolly P, Bonevski B, Rissel C, Aitken R. Advancing health promotion in rural and remote Australia: Strategies for change. Health Promotion Journal of Australia. 2022;33(1):3-6. doi: 10.1002/hpja.569
67. Feather RA, Ebright PR. How staff RNs perceive nurse manager roles. Open Journal of Leadership. 2013;2(03):63-67. doi: 10.4236/ojl.2013.23008
68. Office of the National Rural Health Commissioner. The National Rural and Remote Nursing Generalist Framework 2023-2027. Australian Government, Canberra, 2023.
69. Beks H, Clayden S, Versace VL. Translating aspects of The National Rural and Remote Nursing Generalist Framework 2023–2027 into practice: opportunities and considerations. Australian Health Review. 2023;47(5):626-628. doi: 10.1071/AH23098
70. Rossiter R, Phillips R, Blanchard D, van Wissen K, Robinson T. Exploring nurse practitioner practice in Australian rural primary health care settings: A scoping review. Aust J Rural Health. 2023;31(4):617-630. doi: 10.1111/ajr.13010
71. Robinson T, Govan L, Bradley C, Rossiter R. Transforming health care delivery: The role of primary health care nurses in rural and remote Australia. Aust J Rural Health. 2024:32(3):592-596. doi: 10.1111/ajr.13120
72. Koon AD, Hoover J, Sgonthalia S, Rosser E, Gore A, Rao KD. In-service nurse mentoring in 2020, the year of the nurse and the midwife: learning from Bihar, India. Global Health Action. 2020;13(1):1823101. doi: 10.1080/16549716.2020.1823101.
73. Stewart RA. Building a rural and remote health workforce: an overview of effective interventions. Med J Australia. 2023;219:S3-S4. doi; 10.5694/mja2.52033
74. Hartung SQ, Miller M. Rural nurse managers’ Perspectives into better communication practices. J Commun Health Nurs. 2018;35(1):1-11. doi: 10.1080/07370016.2018.1404829
75. Zheng LX, Walsh EI, Sutarsa IN. Provision of health services for elderly populations in rural and remote areas in Australia: A systematic scoping review. Aust J Rural Health. 2023;31(5):805-825. doi: 10.1111/ajr.13016
76. Anderson J, Malone L. Suitability of the multi-purpose service model for rural and remote communities of Australia. Asia Pacific Journal of Health Management. 2014;9(3):14-18.
77. Beks H, Clayden S, Shee AW, Binder MJ, O’Keeffe S, Versace VL. Evaluated nurse-led models of care implemented in regional, rural, and remote Australia: A scoping review. The Collegian. 2023;30:769-778. doi: 10.1016/j.colegn.2023.05.004
78. Rose H, Skaczkowski G, Gunn KM. Addressing the challenges of early career rural nursing to improve job satisfaction and retention: Strategies new nurses think would help. J Adv Nurs. 2023;79(9):3299-3311. doi: 10.1111/jan.15636
79. Australian College of Nursing (ACN). Healthy ageing in the nursing workforce. 2019. https://www.acn.edu.au/the-hive-2019/healthy-ageing-nursing-workforce
2. Little L, Wagner J, Boal AS. Responsibility and authority of nurse leaders. In J Wagner (ed.), Leadership and influencing change in nursing. University of Regina Press, Regina, Sask., Chapter 12. 2018.
3. Lowe G, Plummer V, Boyd L. Nurse practitioner integration: Qualitative experiences of the change management process. J Nurs Manage. 2018;26(8):992-1001.
4. McSherry R, Pearce P, Grimwood K, McSherry W. The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care. J Nurs Manage. 2012;20(1):7-19.
doi:10.1111/j.1365-2834.2011.01349.x
5. Winters CA. (ed.). Rural nursing: Concepts, theory, and practice. Springer Publishing, New York, sixth edition. 2021.
6. Smith JG, Plover CM, McChesney MC, Lake ET. Isolated, small, and large hospitals have fewer nursing resources than urban hospitals: Implications for rural health policy. Public Health Nurs. 2019;36(4):469–477. doi: 10.1111/phn.12612
7. Whiteing N, Barr J, Rossi DM. The practice of rural and remote nurses in Australia: A case study. J Clin Nurs. 2022;31(11-12):1502-1518. https://doi.org/10.1111/jocn.16002
8. Hegney D. Dealing with distance: Rural and remote area nursing. In J Daly, S Speedy, D Jackson (eds.) Contexts of Nursing: An introduction. Elsevier Australia, Chatswood, NSW, pp.213-228. 2006.
9. Wood PJ. Historical imagination and issues in rural and remote area nursing. Australian J Adv Nurs. 2010;27(4):54-61.
10. Roberts P, Guenther J. Framing rural and remote: Key issues, debates, definitions, and positions in constructing rural and remote disadvantage. In P Roberts, M Fuqua (eds.) Ruraling education research, pp. 13-27. Springer, Singapore. 2021.
11. Smith, S., Sim, J., & Halcomb, E. Nurses’ experiences of working in rural hospitals: An integrative review. J Nurs Manage. 2019;27(3):482-490.
doi: 10.1111/jonm.12716
12. McGrail MR, Russell, DJ, Humphreys JS. Index of access: a new innovative and dynamic tool for rural health service and workforce planning. Aust Health Rev. 2016; 41:492-498. doi: 10.1071/AH16049
13. Bourke L, Taylor J, Humphreys, JS, Wakerman J. “Rural health is subjective; everyone sees it differently”: Understandings of rural health among Australian stakeholders. Health and Place. 2013; 24:65-72. doi: 10.1016/j.healthplace.2013.08.005
14. Bourke L, Humphreys JS, Wakerman J, Taylor J. Understanding rural and remote health: a framework for analysis in Australia. Health and Place. 2012. 18(3), 496-503.
doi: 10.1016/j.healthplace.2012.02.009
15. Kagi E, Rasiah R, Moran M. Experiences of primary health care nurses advancing their careers in a remote Western Australian location. Aust J Rural Health. 2023;31(1):41-51. doi: 10.1111/ajr.12904
16. Wakerman J, Bourke L, Humphreys JS, Taylor J. Is remote health different to rural health? Rural Remote Health. 2017;17(2):3832. doi: 10.22605/RRH3832
17. Carey TA, Fauth JM, Tremblay GC. Rethinking evaluation for improved health outcomes: implications for remote Australia. Am J Eval. 2020;41(2):234-254. doi: 10.1177/1098214018824040.
18. Malatzky C, Bourke L. Re-producing rural health: Challenging dominant discourses and the manifestation of power. J Rural Stud. 2016;45:157-164. doi: 10.1016/j.jrurstud.2016.03.005
19. Larkins S, Evans R. Greater support for generalism in rural and regional Australia. Aust Fam Physician. 2014;43:487-490.
doi: pubmed.ncbi.nlm.nih.gov/25006615/
20. Thomas AL, Wakerman J, Humphreys JS. Ensuring equity of access to primary health care in rural and remote Australia - what core services should be locally available? International Journal for Equity in Health. 2015;14:111. doi: 10.1186/s12939-015-0228-1.
21. Dignam D, Duffield C, Stasa H, Gray J, Jackson D, Daly J. Management and leadership in nursing: An Australian educational perspective. J Nurs Manage. 2012;20(1):65-71,
doi: 10.1111/j.1365-2834.2011.01340.x.
22. Bish M, Kenny A, Nay R. Perceptions of structural empowerment: Nurse leaders in rural health services. J Nurs Manage. 2014;22(1):29-37. doi: 10.1111/jonm.12029
23. Hart SM, Warren AM. Understanding nurses’ work: Exploring the links between changing work, labour relations, workload, stress, retention and recruitment. Econ Ind Democracy. 2015;36(2):305-329. doi: 10.1177/0143831X13505119
24. Malatzky C, Cosgrave, C, Gillespie J. The utility of conceptualisations of place and belonging in workforce retention: A proposal for future rural health research. Health and Place. 2020;62:102279. doi: 10.1016/j.healthplace.2019.102279
25. Bourke L, Dunbar T, Murakami‐Gold L. Discourses within the roles of Remote Area Nurses in Northern Territory (Australia) government‐run health clinics. Health Soc Care Comm. 2021. 29(5), 1401-1408. doi: 10.1111/hsc.13195
26. Onnis L. Clinician-to-manager transitions in remote health work contexts: Lessons from a pilot study. 33rd ANZAM Conference. Cairns, Australia. 2019. https://researchonline.jcu.edu.au/61254/
27. Barclay L, Phillips A, David L. Rural and remote health research: Does the investment match the need? Aust J Rur Health. 2018;26:74–7. doi: 10.1111/ajr.12429
28. Paliadelis P. Nurse managers don’t get the corner office. J Nurs Manage. 2013;21(2):377-386. doi: 10.1111/j.1365-2834.2012.01405.x
29. Chisengantambu C, Robinson GM, Evans N. Nurse managers and the sandwich support model. J Nurs Manage. 2018;26(2):192-199.
doi: 10.1111/jonm.12534
30. Kenny A, Allenby A. Implementing clinical supervision for Australian rural nurses. Nurse Educt in Pract. 2013;13(3):165-169.
doi: 10.1016/j.nepr.2012.08.009
31. Muirhead S, Birks M. Roles of rural and remote registered nurses in Australia: an integrative review. Australian J Adv Nurs. 2020;37(1):21-33. doi: 10.37464/2020.371.5
32. Russell D, McGrail M, Humphreys J. Determinants of rural Australian primary health care worker retention: A synthesis of key evidence and implications for policymaking. Aust J Rural Health. 2017;25(1):5–14. doi: 10.1111/ajr.12294
33. Cox CA. Nurse manager job satisfaction and retention: A home healthcare perspective. Nurs Manage. 2019;50(7):17-23. doi:10.1097/01.NUMA.0000558512.58455.68
34. Govasli L, Solvoll BA. Nurses' experiences of busyness in their daily work. Nurs Inq. 2020;27(3):e12350. doi: 10.1111/nin.12350
35. Smith S, Lapkin S, Halcomb E. Sim J. Job satisfaction among small rural hospital nurses: A cross‐sectional study. J Nurs Scholarship. 2023;55(1):378-387. doi: 10.1111/jnu.12800
36. Smith S, Lapkin S, Sim J, Halcomb E. Nursing care left undone, practice environment and perceived quality of care in small rural hospitals. J Nurs Manage. 2020;28(8):2166-2173. doi: 10.1111/jonm.12975
37. Griffiths P, Recio-Saucedo A, Dall'Ora C, Briggs J, Maruotti A, Meredith P, Smith GB, Ball J. The association between nurse staffing and omissions in nursing care: A systematic review. J Adv Nurs. 2018;74(7):1474–1487. doi: 10.1111/ jan.13564
38. Australian Institute of Health and Welfare (AIHW) Rural and Remote Health. 2019. https://www.aihw.gov.au/getmedia/838d92d0-6d34-4821-b5da-39e4a47a3d80/Rural-remote-health.pdf.aspx?inline=true
39. Parry Y, Button D. Nursing and tensions within the Australian health care system. In NJ Wilson, P Lewis, L Hunt, L Whitehead (eds.) Nursing in Australia: contemporary professional and practice insights. Routledge, Abingdon, Oxon. and New York, pp. 11-20. 2020.
40. Smith T, McNeil K, Mitchell R, Boyle B, Ries N. A study of macro-, meso-and micro-barriers and enablers affecting extended scopes of practice: the case of rural nurse practitioners in Australia. BMC Nursing. 2019;18(1):14. doi: 10.1186/s12912-019-0337-z
41. Lenthall S, Dade Smith J. Remote health practice. In J Dade Smith (ed.) Australia’s rural, remote and indigenous health. Elsevier, Chatswood, NSW., pp. 285–315. 2016.
42. Cheon HS, Yrani T. Multiplicity within and between: Addressing multiple roles through role profiles in couples, Journal of Creativity in Mental Health. 2018;13(1):31-42. doi: 10.1080/15401383.2017.1343165
43. Hanlon N, Kearns R. Health and rural places. In: M Shucksmith, DL Brown (eds.) Routledge International Handbook of Rural Studies. Routledge: Abingdon, Oxon., pp. 92-100. 2016.
44. Mathew S, Fitts MS, Liddle Z, Bourke L, Campbell N, Murakami-Gold L, Russel, DJ, Humphreys J.S, Mullholand E, Zhao Y. and Jones MP. Telehealth in remote Australia: a supplementary tool or an alternative model of care replacing face-to-face consultations? BMC Health Services Research. 2023;23(1):341. doi: 10.1186/s12913-023-09265-2
45. Fast O, Rankin J. Rationing nurses: Realities, practicalities, and nursing leadership theories. Nurs Inq. 2018;25(2):e12227. doi: 10.1111/nin.12227
46. Chisengantambu C. Decision making by rural nurse managers: A study of the decision-making processes by nurse managers working in rural health in situations in South Australia. Unpublished PhD thesis, University of South Australia, Whyalla, South Australia. 2016.
47. Guerrero-Castañeda RF, Menezes TMDO, Ojeda-Vargas MG. Characteristics of the phenomenological interview in nursing research. Revista Gaucha de Enfermagem. 2017;38(2):e67458. doi: 10.1590/1983-1447.2017.02.67458
48. Gunawan J, Aungsuroch Y, Marzilli C, Fisher ML, Sukarna A. A phenomenological study of the lived experience of nurses in the battle of COVID-19. Nurs Outlook. 2021;69(4):652-659.
doi: 10.1016/j.outlook.2021.01.020
49. Nowell LS, Norris JM, White DE, Moules NJ. Thematic analysis: Striving to meet the trustworthiness criteria. Int J Qual Meths. 2017;16(1),1609406917733847.
doi: 10.1177/1609406917733847
50. Jackson J, Nowell L. ‘The office of disaster management’ nurse managers' experiences during COVID‐19: A qualitative interview study using thematic analysis. J Nurs Manage. 2021);29(8):2392-2400. doi: 10.1111/jonm.13422
51. Wakerman J, Humphreys J, Russell D, Guthridge S, Bourke L, Dunbar T, Zhao Y, Ramjan M, Murakami-Gold L, Jones MP. Remote health workforce turnover and retention: What are the policy and practice priorities? Hum Resour Health. 2019);17(1),99. doi: 10.1186/s12960-019-0432-y
52. MacKay SC, Smith A, Kyle RG, Beattie M. What influences nurses’ decisions to work in rural and remote settings? A systematic review and meta-synthesis of qualitative research. Rural Remote Health. 2021;21:6335. doi: 10.22605/RRH6335
53. Udod S, Care WD, Marie Graham J, Henriquez N, Ahmad N. From coping to building nurse manager resilience in rural workplaces in western Canada. J Nurs Manage. 2021:29(7):2115-2122. doi: 10.1111/jonm.13350
54. Udod S, Cummings GG, Care WD, Jenkins M. Role stressors and coping strategies among nurse managers. Leadership in Health Services. 2017);30(1): 29-43. doi: 10.1108/LHS-04-2016-0015
55. Chisengantambu-Winters C, Robinson GM, Evans N. Developing a Decision-Making Dependency (DMD) model for nurse managers. Heliyon. 2020;6:e03128. doi: 10.1016/j.heliyon.2019.e03128
56. Lenthall S, Ivanhoe T, Stothers K. Remote area nursing. In: NJ Wilson, P Lewis (eds.) Nursing in Australia: contemporary professional and practical insights. Routledge, Abingdon, Oxon. and New York. 2021. pp. 191-200.
57. El Haddad M, Wilkinson G, Thompson L, Faithfull‐Byrne A, Moss C. Perceptions of the impact of introducing administrative support for nurse unit managers: A qualitative evaluation. J Nurs Manage. 2019;27(8):1700-1711. doi: 10.1111/jonm.12860
58. Owens K.M, Keller S. Exploring workforce confidence and patient experiences: A quantitative analysis. Patient Experience Journal. 2018;5(1):13. doi: 10.35680/2372-0247.1210
59. Thomas, S, Wakerman J, Humphreys J. What does it cost to provide equity of access to high quality, comprehensive primary health care in rural Australia? A pilot study. Rural Remote Health. 2017;17:4019. doi: 10.22605/RRH4019
60. Cox CA. Nurse manager job satisfaction and retention: A home healthcare perspective.
Nurs Manage. 2019;50(7):16-23.
61. Szumer RTO, Arnold M. The ethics of overlapping relationships in rural and remote healthcare. A narrative review. Journal Bioethic Inq. 2023;20(2):181-190. doi: 10.1007/s11673-023-10243-w
62. McElroy M, Wicking K, Harvey N, Yates K. What challenges and enablers elicit job satisfaction in rural and remote nursing in Australia: An integrative review. Nurse Educ Prac. 2022;103454. doi: 10.1016/j.nepr.2022.103454
63. Alston L, McFayden L, Sen Gupta T, Payne W, Smith J. Creating a sustainable and supportive health research environment across rural and remote Australia: a call to action. Med J Australia. 2023;219:S27-S30. doi: 10.5694/mja2.52027
64. Morell AL, Kiem S, Millsteed MA, Pollice A. Attraction, recruitment and distribution of health professionals in rural and remote Australia: early results of the Rural Health Professionals Program. Hum Resour Health. 2014;12:1-6. doi: 10.1186/1478-4491-12-15
65. Department of Health. National Preventive Health Strategy 2021– 2030. Commonwealth of Australia: Canberra. 2021.
66. Smith JA, Canuto, K, Canuto K, Campbell N, Schmitt D, Bonson J, Smith L, Connolly P, Bonevski B, Rissel C, Aitken R. Advancing health promotion in rural and remote Australia: Strategies for change. Health Promotion Journal of Australia. 2022;33(1):3-6. doi: 10.1002/hpja.569
67. Feather RA, Ebright PR. How staff RNs perceive nurse manager roles. Open Journal of Leadership. 2013;2(03):63-67. doi: 10.4236/ojl.2013.23008
68. Office of the National Rural Health Commissioner. The National Rural and Remote Nursing Generalist Framework 2023-2027. Australian Government, Canberra, 2023.
69. Beks H, Clayden S, Versace VL. Translating aspects of The National Rural and Remote Nursing Generalist Framework 2023–2027 into practice: opportunities and considerations. Australian Health Review. 2023;47(5):626-628. doi: 10.1071/AH23098
70. Rossiter R, Phillips R, Blanchard D, van Wissen K, Robinson T. Exploring nurse practitioner practice in Australian rural primary health care settings: A scoping review. Aust J Rural Health. 2023;31(4):617-630. doi: 10.1111/ajr.13010
71. Robinson T, Govan L, Bradley C, Rossiter R. Transforming health care delivery: The role of primary health care nurses in rural and remote Australia. Aust J Rural Health. 2024:32(3):592-596. doi: 10.1111/ajr.13120
72. Koon AD, Hoover J, Sgonthalia S, Rosser E, Gore A, Rao KD. In-service nurse mentoring in 2020, the year of the nurse and the midwife: learning from Bihar, India. Global Health Action. 2020;13(1):1823101. doi: 10.1080/16549716.2020.1823101.
73. Stewart RA. Building a rural and remote health workforce: an overview of effective interventions. Med J Australia. 2023;219:S3-S4. doi; 10.5694/mja2.52033
74. Hartung SQ, Miller M. Rural nurse managers’ Perspectives into better communication practices. J Commun Health Nurs. 2018;35(1):1-11. doi: 10.1080/07370016.2018.1404829
75. Zheng LX, Walsh EI, Sutarsa IN. Provision of health services for elderly populations in rural and remote areas in Australia: A systematic scoping review. Aust J Rural Health. 2023;31(5):805-825. doi: 10.1111/ajr.13016
76. Anderson J, Malone L. Suitability of the multi-purpose service model for rural and remote communities of Australia. Asia Pacific Journal of Health Management. 2014;9(3):14-18.
77. Beks H, Clayden S, Shee AW, Binder MJ, O’Keeffe S, Versace VL. Evaluated nurse-led models of care implemented in regional, rural, and remote Australia: A scoping review. The Collegian. 2023;30:769-778. doi: 10.1016/j.colegn.2023.05.004
78. Rose H, Skaczkowski G, Gunn KM. Addressing the challenges of early career rural nursing to improve job satisfaction and retention: Strategies new nurses think would help. J Adv Nurs. 2023;79(9):3299-3311. doi: 10.1111/jan.15636
79. Australian College of Nursing (ACN). Healthy ageing in the nursing workforce. 2019. https://www.acn.edu.au/the-hive-2019/healthy-ageing-nursing-workforce