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Roles of rural and remote registered nurses in Australia: an integrative review

Objective:The aim of this review is to explore the multifaceted roles of registered nursing practice in rural and remote areas of Australia. 
Background:People in rural and remote Australia have less access to healthcare than their metropolitan counterparts. They are also burdened with higher rates of chronic disease and premature mortality. These areas also have less doctors and allied health professionals than metropolitan areas, with the core workforce being registered nurses. One strategy to address the health workforce disparities, is to promote registered nurses to work to their full scope and in advanced generalist roles. An understanding of the current roles of the registered nurse is therefore required to assist in determining how their scope could be extended, and to inform appropriate educational planning. 
Study design and methods:An integrative review of literature was used to obtain articles from online databases relevant to nursing from 1995 to 2017. Data was quality appraised, extracted, and thematically analysed. 
Results:Registered nurses in rural and remote Australia work in diverse contexts that have a major influence on the roles they undertake. They are already required to be multi-skilled and to practice at an advanced level, including undertaking some aspects of the health professional role traditionally the domain of medical practitioners. These registered nurses often feel unprepared for the breadth and complexity of this role. 
Discussion:To enable registered nurses to be adequately prepared for rural and remote practice, educational programs need to be flexible, accessible and affordable. The registered nurse’s existing experience and expertise should be recognised, and educational pathways structured to enable the nurse to expand their practice according to the context in which they work and the needs of the community. 
Conclusion:Registered nurses in rural and remote areas function as advanced generalists. Greater understanding of these roles is necessary to inform the development of ‘fit for purpose’ educational models. 
Implications for research, policy and practice:Future research is needed to focus on evaluation of existing models of rural and remote nursing practice and in particular the role of the nurse as doctor substitute. The findings of this study highlight the potential expanded contribution of registered nurses in these areas, which is an important factor for consideration by policy makers. In practice, supportive frameworks are required to ensure registered nurses are able to function to their full capacity in their unique context. 
What is already known about the topic?– People living in rural and remote areas are subjected to inequities in respect of health and access to healthcare services.– Registered nurses working in rural and remote areas are essential for addressing healthcare needs that would otherwise be unmet.– Nurses practicing in these areas require an advanced skills-set in order to function effectively in their role. 
What this paper adds.– This paper examines the multifaceted role of the registered nurse working in rural and remote areas of Australia as described in the literature.– Four main themes were identified: roles shaped by context; doctor substitute; multi-skilled and advanced practice; and feeling unprepared.– Understanding the complexity of the registered nurse role in rural and remote areas enables the development of policy, practice and educational approaches to support nurses in functioning to their full capacity. 
https://doi.org/10.37464/2020.371.5