Exploring the impact of an immersive rural nursing placement

In December 2022, seven student nurses about to graduate returned to the University Department of Rural Health in Broken Hill to participate in a writing workshop that was supported by their nursing school, The University of Sydney’s Susan Wakil School of Nursing and Midwifery. The aim of the workshop was to reflectively explore the ongoing impact, if any, of undertaking a 20-week immersive placement in far-west New South Wales and north-west Victoria as part of a pilot project in semester 1 (February to June) 2022.

The immersive placement was named the Extended Nurse Placement Program (ENPP) and is a collaboration between health partners and multiple universities. Its inception came about to encourage a deep engagement with communities that it was hoped would result in students considering rural and remote practice as a career path after qualifying as registered nurses.

Typically, student nurse placements are short in duration, from two to four weeks. Unsurprisingly, this limits their exposure to rural and remote practice and their ability to learn strategies needed to effectively navigate complex inequities. The ENPP comprised two placements: at a primary host site for 14 weeks and at a secondary host site for four weeks. The latter provided students with experience of exiting gracefully from host sites and from the communities that they had become embedded in.   

In preparation for the workshop, which took place six months after their participation in the ENPP, the students were asked to come up with two or three questions to frame their thinking and writing. They produced five. As the questions were explored, and with guidance from three academics, topics became clear and these took over the focus of the workshop. The students explored context in relation to person-centred care, a strengths-based approach, and that lived experience and authenticity went hand in hand. How self and others were developed through advocacy was also discussed. Agency, confidence and empathy rounded off the discussions.

As the students are being supported to write for publication, we don’t want to reveal too much, but in terms of impact, here are a few key reflections from the students’ perspectives:

• The students found that immersion in communities improved their ability to be person-centred and to apply this to their university work and to clinical placements.
• The longer duration of placement provided them with a unique understanding of both individual and community strengths.
• Living and working in rural and remote communities as part of the ENPP enabled students to deeply consider diverse people, communities and cultures and become more comfortable to provide culturally safe care.
• Students were able to solidify and practise clinical skills that were enhanced by the opportunity to be autonomous throughout the extended placement, allowing reflection of the student role and scope.
• On return to clinical placement in metropolitan areas, having cared for people from rural and remote areas allowed students to provide context from their lived experiences to other health professionals about broad considerations affecting that specific population.

Watch this space as we seek to publish a paper that explores how an ENPP can have profound effects on participants. Out of this group, six were eligible for new graduate positions and five chose rural and remote for their new graduate year. We believe that the future is bright for rural and remote nursing to become a career pathway of choice if we give quality long-duration and tailored opportunities to experience rural and remote health care.