Title : Rural nurses in New Zealand pioneered new models of health care during significant times of changing landscapes of health: What can we learn from history, and Will it repeat itself?
Abstract:
Introduction: During the past three decades changing socio-political and economic contexts have affected health care in New Zealand; rural nurses responded with new emerging models of practice in which they have maintained and, in some cases, improved the health care of the residents and visitors to these rural communities. As New Zealand in 2022 progresses into yet another significant change to the delivery of health care 30 years on, will rural nurses reflect on their pioneering spirit while embracing the unique discourse of rural nursing in New Zealand.
Purpose: Traditional discourses aligned with rural nursing practice include personal and professional connections with the rural community; being known in the community; dual relationships; and always being on call; broad scope of practice; jack of all trades, master of none; and a sense of belonging to the geographical location. These discourses are well entrenched within national and international contexts. The focus has changed from associating rural nursing with special needs; the health beliefs of rural populations and the nuances associated with geographical locations to discovering the discourse and practice of rural nurses within their specific context.
Methods:
Narrative inquiry recognises the power story has, to explore meaning. Narrative inquiry was conducted by the authors who collected stories of 26 nurses who had and in some cases were still practising in the rural geographical contexts for more than 15 years. Their practice encountered the past, present and future interacting with the place and people with whom they work. A thematic approach was engaged with to analyse the data. Ethical approval to undertake this research was obtained from Otago Polytechnic Research Ethics Committee in 2016.
Findings: This research presentation shines light on rural nurses’ innovative practice in a changing healthcare landscape and community responses to a shift from national to local governance. Innovative practice has been developed, in close partnership with communities within challenging rural contexts, changing demographics and limited resources. Three emerging models of care have been uncovered in respect to this shifting health care context revealing the Community Trust Model, the Practitioner Lead Model and the Reciprocal Partnership Model. From rural nurses’ innovative practice emerged a unique rural nursing discourse revealing the rural nurse as a pioneer, as an entrepreneurial practitioner supplying the backbone of health care to the community; entrepreneurial with the creative development of tenacious nurses and local communities embracing responsive solutions and new models of healthcare to accommodate the challenging landscapes and changing socio-political tides.
Conclusion: Capturing rural nurses’ stories has helped us learn how communities and nurses have adapted to these changes and in doing so the unique discourse of rural nursing in New Zealand has been revealed. Narrative inquiry has provided a depth of meaning to the rural nurse experience and uncovered the pioneering spirit of rural nursing in the 21st Century. It is now timely to reflect on how they will respond to yet another significant change to the New Zealand health care system in 2022. Will they position themselves once again as pioneers?
