What are the support needs of nurses providing emergency care in rural settings as reported in the literature? A scoping review.

Introduction: Australia is a country with a rich history, and unique geography, with nearly one-third of its population living in rural areas. This presents certain challenges to nurses providing emergency care in these regions, as their support needs are different from their urban counterparts. This systematic scoping review aims to determine the support needs of these nurses providing emergency care in rural settings as reported in the literature. Many other countries have large rural populations, and relevant international literature will be considered to allow discussion of the key issues and recommendations for the future of the rural nursing workforce.
Methods: Databases searched included PubMed, Cochrane database, ERIC and Google Scholar using keywords 'rural', 'nurse', 'emergency', 'support needs', 'challenges' and 'Australia', and research from 2012 onwards was examined for relevance. Earlier seminal texts were also included. Reference lists of retrieved articles were searched and citations explored for further relevant research material. The Joanna Briggs Institute's scoping review framework was used. The primary focus was on peer-reviewed research with supplementary grey literature (eg materials and research produced by organisations outside of the traditional publishing channels). International material was used where relevant.
Results: Analysis of the literature revealed that the four main areas of concern were a lack of effective graduate training programs or the availability of mentors, poor recruitment and retention numbers, a need for better recognition for the extended role of the rural nurse as a 'nurse generalist' or rural 'specialist' and poor access to role-specific ongoing education. These areas of concern were exacerbated by geographic isolation and a perceived lack of funding.
Conclusion: Delivering appropriate evidence-based education to this isolated practice community is vital for safe patient care and improves rural nurse satisfaction and retention. There were gaps in current knowledge, and the body of research to date lacks information on the work of emergency nurse practitioners in the rural context, the effectiveness of graduate mentorship programs and the psychosocial aspect of the rural role. Recommendations are for improved role-specific ongoing education and the availability and development of graduate mentoring programs. Further input into recruitment and retention is required, and further research on the needs of rural emergency nurses is recommended.