New Zealand’s rural communities are diverse with small populations spread over large geographic areas – think the Marlborough Sounds for example. Meeting the healthcare needs of people living in and visiting these areas is a challenge for all healthcare professionals, including district nurses and nurse practitioners.

Professor Jane Mills, Pro Vice-Chancellor at Massey University’s College of Health and Deputy Chair of the Rural Health Alliance Aotearoa New Zealand, says nurses working in rural areas need to be ‘generalist specialists’ with a broader range of skills and knowledge than their urban counterparts.

“It’s undoubtedly more challenging.”

Complexity of care is a challenge facing rural nurses. The population they’re serving includes a greater number of older adults with chronic or long-term conditions and multiple co-morbidity, including mental health issues.

While they work mostly in primary healthcare, prevention, rehabilitation and chronic disease management, rural nurses also need to be able to manage trauma and unplanned events, often in remote areas away from medical facilities and support staff.

Retention and recruitment of nurses in rural areas is more challenging than in urban centres due, in part, to professional isolation, limited access to professional development opportunities and supervision and inadequate professional recognition, including a career pathway.

Given the depth and breadth of skills and knowledge that rural nursing requires, it needs to be valued as a pinnacle of nursing practice, says Professor Mills. “We have to make it a positive experience, so people aspire to be rural health practitioners.

“Preparing a workforce to serve rural and under-served communities requires us to take a different approach with our curriculum and student learning experience.

“We need to ensure students, ahead of becoming registered healthcare professionals, have the opportunity to participate in a range of positive clinical experiences in a diverse range of settings, allowing them to more fully understand the potential of a rural health career.”

A major challenge facing rural nursing is an ageing workforce. Sixty percent of rural registered nurses are aged over 50; of this group, 24% are older than 60.

“Succession planning is a key issue,” says Professor Mills. “We need to build a pipeline model that enables health practitioners to train and work in their communities.”

Massey is exploring options for a new Master of Clinical Practice (Nursing) and looking at ways to encourage more rural and regional New Zealanders to study nursing via accessible programmes.

As well as school leavers, these could be people in their 30s, 40s or 50s looking for “a second-chance career” working in their local community. But in order for them to live and study at home, nursing institutions will need to provide customised, online and on-demand education and training.

Professor Mills says partnerships between learning institutes and organisations or stakeholders can make a difference, as Massey University’s longstanding partnership with Workforce New Zealand to implement the Te Rau Puawai – Māori Mental Health Workforce Development Programme illustrates.

“Each year the initiative provides bursaries and learning support for students who are seeking to commence or complete a qualification in the field of Māori mental health, with the expectation students will seek employment in a relevant Māori mental health field upon graduation.

“Not only do these students go on to work in the field of Māori mental health, many have gone on to take up roles in rural communities.”


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