Editorial


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Editorial 
 

HELLO FROM WESTERN CANADA! 
 

Kathy Crooks 
Editorial Board Member 

 
 

My name is Kathy Crooks and I am a new addition to the editorial board of the 
On-line Journal.  I have been asked to briefly introduce myself and to provide my insights 
into the state of rural nursing in Canada. First, I would like to say how very pleased I was 
to be asked to be on the board.  This provides me with the opportunity to network with 
the "cream of the crop" in this rapidly expanding area of nursing.  

My initial exposure to information in rural nursing occurred when I was 
introduced to literature that came from the United States. Exposure occurred when I was 
asked to develop an undergraduate course in rural nursing. This introduction led me to 
the realization that there were a growing number of other people who recognized the 
unique and specialized nature of nursing in a rural setting. From this beginning I was 
fortunate to be put in touch with Dr. Angeline Bushy who in turn introduced me to some 
of the other leaders in American rural nursing.  My exposure to these dynamic 
individuals resulted in my desire to seek further education in the area of rural nursing. As 
a result I am presently enrolled in a doctoral program at the University of Calgary. 

For the past 12 years I have worked as a nursing instructor in the Division of 
Health Studies at Medicine Hat College, which is located in the province of Alberta in 
Western Canada. Prior to coming to Medicine Hat, I worked as a staff nurse in several 
small acute care facilities in the southern part of the province. Medicine Hat is a city of 
50,000 people and is approximately three hours south east of the city of Calgary and 
about two hours north of Havre, Montana. This area of Alberta shares a lot of similarities 
with the state of Montana although we are not as sparsely populated. Alberta is primarily 
agrarian although there is also a huge oil and gas industry, as well as many recreational 
opportunities. All of these, are of course, high-risk industries. 

Until the very recent past, the idea that rural residents had different health care 
concerns than their urban counterparts was not a consideration in Canada. Unlike the 
United States and Australia, Canada has been slow to realize the distinct nature of the 
rural culture and particularly, rural nursing. In 1998, the Government of Canada finally 
established the Office of Rural Health under the auspices of Health Canada. The mandate 
of the Office of Rural Health is to provide a rural perspective in the development of 
healthy public policy and programs. While this is decidedly worthwhile, it is important to 
note that a physician is charged with heading this office. The appointment of a physician 
to this position represents the traditional organization of health care and publicly 
reinforces the notion of physicians as powerful resources, thus ignoring the contribution 
of the Registered Nurse (Sorrells-Jones & Weaver, 1999). Further, Canadian rural 
physicians have positioned themselves to influence rural health care through the 
establishment of the Society of Rural Physicians of Canada. While there seems to be a 
heightened awareness of rural health issues, as well as of issues pertaining to the role and 
function of the rural physician, there is a lack of Canadian information available 

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regarding the rural nurse. This may be the result of the failure of Canadian rural nurses to 
become organized in the way their Australian and American counterparts have. Or, it 
may be the result of a scarcity of nurses with the appropriate experience, interest, and 
funding to develop an extensive Canadian rural nursing knowledge base. Although much 
of the present information outlining the peculiarities of Canadian rural nursing practice is 
anecdotal, there is presently a study in progress by McLeod and Kulig et al. regarding the 
nature and practice of rural nursing. Research aimed at clarifying the role and 
responsibilities of the rural nurse will increase awareness and result in sensitizing 
politicians, physicians, and the public to the unique nature of rural practice.  

The need for Canadian rural nursing to become organized and place itself in a 
position to influence health sector policy makers is essential. While the idea of a rural 
physician shortage is a concern that has been expressed by the media and governments, 
there is virtually no discussion regarding the acute shortage of rural nurses. Shreffler 
(1998) suggests that recruitment and retention of health care professionals is one of the 
foremost concerns in maintaining access to rural health care. While the average age of 
rural nurses is slightly younger than that of the urban nurse, rural nurses are leaving the 
profession at an earlier age (Canadian Institute of Health Information, 2002). Presently 
the reasons behind the early departures remain unclear. However, if those entering the 
profession are older and rural nurses are known to leave the profession at an earlier age it 
is reasonable to assume that the rural nursing shortage will reach a crisis point sooner 
than expected. While it is imperative that the entire profession of nursing increase the 
public understanding of the role of nurses in health care (Buresh, 2001), it is vital in the 
Canadian rural context. The predicted rural nursing shortage could prove calamitous to a 
population whose health care is already marginalized because of distance and the gravity 
of health concerns. 

The majority of the Canadian population is clustered along Canada's southern 
border (Statistics Canada, 1999) and until recently, rural institutions in the south have not 
been faced with the prospect of recruiting or retaining staff. Presently the incentives 
being offered to attract nurses to rural health care are generally monetary and the 
attraction of the "great out doors".  According to Aiken at al. (2001), recruitment and 
retention strategies that fail to consider more than monetary incentives to improve 
productivity are sure to fail. Consideration must be given to "including opportunities for 
career advancement, lifelong learning, flexible work schedules, and policies that 
promote…loyalty and retention" (Aiken et al. p. 5). Health Canada (2001) has identified 
the interface of home life and work life as an area of concern related to the sustainability 
of the nursing workforce. This is especially true for nurses living and working in the rural 
and remote areas of Canada because there is little, if any, separation between their work 
and home environments. I would suggest that when Canadian policy makers and program 
developers seek to transform rural health care, they expand their knowledge and 
incentives to include the social-life, and home-life concerns of the nurses expected to 
function within that structure as well as providing monetary incentives. Failure to do so 
will affect efforts to recruit and retain a new generation of rural nurses. Consequently, 
there will be a negative impact on quality of nursing care and patient outcomes (Nunn, 
2001). 

Troughton (1999) suggests that health care adds social and economic well being 
as well as traditional health care to a rural community; therefore it is essential to the life 

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of the community. Therefore key to the survival of a distinct Canadian rural culture is the 
presence of available health care for its residents (Canadian Policy Research Networks, 
2001). Consequently, the ability to recruit and retain nurses to provide health care is vital 
for more than the survival of the profession itself. It is imperative that rural nurses 
position themselves to get this message across to governments and policy makers. 

 
REFERENCES 

 
Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J.A., Russe, R., Clarke, H., et al. 

(2001). Nurses' report on hospital care in five countries. Health Affairs, 20(3), 43-
53. [MEDLINE]  

Buresh, B. (2001). The missing voices in the coverage of health. In E.C. Hein (Ed.), 
Nursing Issues in the 21st Century (pp 74-78). Philadelphia: Lippincott.  

Canadian Institute of Health Information. (2002). Supply and distribution of registered 
nurses in rural and small town Canada. Ottawa, ON: Author.  

Canadian Policy Research Networks. (2001). Asking citizens what matters for quality of 
life in Canada: A rural lens. Ottawa, ON: Author.  

Health Canada. (2001). The 2001 national work-life conflict study: Report one. Ottawa, 
ON.: Healthy Communities Division  

Shreffler, M.J. (1998). Professional isolation: A concept analysis.  In H.J. Lee (Ed.), 
Conceptual basis for rural nursing. New York: Springer.  

Sorrells-Jones, J., & Weaver, D. (1999). Knowledge workers and knowledge-intense 
organizations, part 1: A promising framework for nursing and healthcare. Journal 
of Nursing Administration, 29(7/8), 12-18. [MEDLINE]  

Statistics Canada (1999). The 1999 Canada yearbook. Ottawa, ON: Author.  
Troughton, M.J. (1999). Redefining "rural" for the twenty-first century. In W. Ramp, J. 

Kulig, I Townshend, & V. McGowan (Eds.), Health in rural settings: Context 
for action (pp 21-38). Lethbridge, AB: University of Lethbridge Printing Service.  

Online Journal of Rural Nursing and Health Care, vol. 3, no. 1, Spring 2003 
 

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