'Thrown in the deep end': Research reveals pressures facing rural registered nurses
Registered nurses entering rural and remote healthcare settings are often expected to provide emergency care in highly complex situations despite limited preparation for the realities of the role, according to new CQUniversity research.
Recent PhD graduate Dr Danielle Rogers explored the experiences of non-emergency-trained registered nurses working in rural and remote health facilities, revealing significant gaps in preparation, support and education while identifying practical solutions to strengthen Australia's regional health workforce.
For Dr Rogers, the research was inspired by her own experiences working in rural Queensland.
When she began her nursing career in the rural community of Monto, she expected to stay for just one year. Instead, she stayed for three, gaining first-hand experience of the unique challenges and rewards of rural healthcare.
"Working in rural healthcare showed me the critical role registered nurses play in providing a wide range of services, including emergency care, often with limited resources and support," Dr Rogers said.
"These experiences sparked a strong interest in rural and remote workforce development and ultimately inspired my research journey."
Her study found many registered nurses (RNs) felt underprepared when transitioning into rural and remote practice, despite often being experienced clinicians.
"Many participants described feeling underprepared when they first entered rural and remote practice, particularly when faced with emergency presentations, autonomous clinical decision-making, limited onsite medical support and delays in patient retrieval," she said.
"Importantly, this was not because they were inexperienced. Rather, they were entering environments that required a unique combination of advanced clinical judgement, adaptability, resourcefulness and confidence in managing uncertainty."
The research identified five key factors influencing readiness for rural and remote emergency care: understanding the complexity of the role, preparation for the specific practice context, access to ongoing education, professional and organisational support, and successful integration into the local community and culture.
In many rural and remote communities, RNs are the frontline providers of emergency care and are often the first healthcare professionals to assess and manage patients experiencing serious illness or injury.
Unlike metropolitan settings, where specialist teams and resources are readily available, rural and remote RNs frequently work with greater autonomy and broader responsibilities.
"Registered nurses must be prepared to manage a diverse range of presentations across the lifespan, often within the same shift," Dr Rogers said.
"They may provide emergency care, primary healthcare, chronic disease management, mental health care, aged care and community health services, depending on the needs of the community."
One of the strongest themes to emerge from the research was the feeling among participants that they had been "thrown in the deep end" when entering rural and remote practice.
Several RNs described receiving minimal orientation before being required to manage complex emergency presentations within days or weeks of arriving in a new community.
One participant recalled the anxiety of caring for a critically unwell patient while waiting for retrieval services, knowing specialist support could be hours away.
"These experiences highlighted that the challenge was not a lack of commitment or willingness to learn, but rather a mismatch between the complexity of the role and the level of preparation and support provided," Dr Rogers said.
The research found inadequate preparation and support can contribute to stress, professional isolation and burnout, while also creating workforce challenges for health services already struggling with staff shortages and turnover.
To address these issues, the study identified several minimum support requirements for nurses entering rural and remote emergency care roles, including structured orientation programs, emergency care education, clinical mentorship, supervision, peer support networks and ongoing professional development opportunities.
Importantly, Dr Rogers said readiness should not be viewed solely as the responsibility of individual nurses.
"The most important message is that rural and remote emergency nursing is a specialist-generalist area of practice that requires its own preparation, capability development and support strategies," she said.
"We cannot assume that because someone is an experienced registered nurse, they are automatically ready to provide emergency care in a rural or remote setting."
As part of the research, Dr Rogers developed the Rural/Remote Onboarding & Guided Evolving Readiness Skills – Context, Capabilities and Supports (ROGERS-CSS) Framework, an evidence-based approach designed to support RNs from pre-deployment through to supported autonomous practice.
She hopes the findings will help inform workforce planning, education and organisational policy, strengthening the rural and remote health workforce while improving healthcare access for communities across Australia.
"Rural and remote registered nurses provide some of the most complex and critical healthcare in Australia," Dr Rogers said.
"My research shows that when we invest in their preparation and support, we're not only strengthening the workforce, but we’re also improving healthcare access and outcomes for the communities that depend on them."
Dr Rogers received her doctorate at CQUniversity's Brisbane graduation ceremony on Friday, 14 August.
