The experience of general nurses in rural Australian emergency departments Tracy Kidd * , Amanda Kenny 1 , Terri Meehan-Andrews 2 La Trobe Rural Health School, La Trobe University, Victoria, Australia article info Article history: Accepted 2 May 2011 Keywords: Rural Emergency department Professional development abstract Australia is a geographically unique country with large areas classed as rural. Nurses providing emer- gency care in rural hospitals face a number of challenges, with rural communities expecting multi-skilled nurses, prepared for a wide range of unannounced situations. Using a mixed method approach, involving questionnaires and focus groups, the study was undertaken in two rural health services in Victoria, Australia. The aim was to explore the experiences of general nurses working in rural hospital settings, with regards to their emergency department responsibilities. The findings indicate that nurses lacked confidence, which they attributed to the sporadic nature of working in the area and the diversity of people who presented. A resultant ‘skills rusting’ was described and nurses identified the need to be a diverse ‘specialist’. Some lack of confidence, particularly in the mental health area, was related to feelings of isolation and lack of context specific education and training. While some excellent emergency specific education and training is available for rural nurses, access is limited by a multitude of constraints. This study found there is an urgent need for local emergency education and training; with nurses showing a strong preference for ongoing professional development incorporating scenario based and context specific education. Ó 2011 Elsevier Ltd. All rights reserved. Introduction Large areas of Australia are characterised by rurality, geographic isolation, socioeconomic inequality, inequitable distribution of resources and extreme climatic conditions (Smith et al., 2008, p.159). Rural Australians have poorer health status and outcomes compared to metropolitan dwellers, in part, due to a higher proportion of older people living in rural areas, higher levels of disabilities and chronic conditions, higher likelihood of injury and lack of access to health services (Victorian Government Department of Health, 2009; Gregory, 2010). There is a looming crisis in Australian health services as the population ages and the available workforce contracts. Sustainability of services is threatened by workforce shortages and inequitable funding (Gregory, 2010; McGrail and Humphreys, 2009a; Sullivan et al., 2008). Rural nurses account for 60% of the rural health workforce but their role receives little attention in the broader context of Australian health service delivery (Sullivan et al., 2008). Studies that have examined rural nursing claim that rural nurses should be considered specialists as rural practice is challenging and diverse (Endacott and Westley, 2006; Fitzgerald, 2008). In 2006, Endacott and Westley reported that rural nurses need to be ‘prepared and equipped with the knowledge and skills to deal with a wide range of unannounced clinical situations, such as treating car accident victims, farm accidents, expectant mothers, mental illness, chest pain and acute conditions as well as performing administration roles’ (Endacott and Westley, 2006, p.277). International researchers from Australia, the United Kingdom (UK), Canada, and the United States (US) suggest that rural nurses often work outside of their professional scope of practice, and cite isolation and maintaining professional competency as their great- est difficulty (Manahan and Lavoie, 2008; Montour et al., 2009; O’Meara et al., 2002; Stewart et al., 2005). The rural Victorian context In Victoria, registered nurses provide the core staffing in most rural hospitals and onsite medical practitioners are rare (Australian Bureau of Statistics, 2010; Kenny and Duckett, 2004; Sullivan et al., 2008). Consequently, in most situations registered nurses are required to provide first line management in the absence of medical staff, particularly in hospital emergency departments. * Corresponding author. Tel.: þ61 3 5444 7411; fax: þ61 3 5444 7977. E-mail addresses: t.kidd@latrobe.edu.au (T. Kidd), a.kenny@latrobe.edu.au (A. Kenny), t.meehan-andrews@latrobe.edu.au (T. Meehan-Andrews). 1 Tel.: þ61 3 5444 7545; fax: þ61 3 5444 7977. 2 Tel.: þ61 3 5444 7550; fax: þ61 3 5444 7977. Contents lists available at ScienceDirect Nurse Education in Practice journal homepage: www.elsevier.com/nepr 1471-5953/$ e see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.nepr.2011.05.001 Nurse Education in Practice 12 (2012) 11e15