A double whammy! New baccalaureate registered nurses' transitions into rural acute care

Introduction: Transitioning into the Canadian rural acute care environment can be challenging for new RNs, and as a result, retention is of concern. Currently, few seasoned registered nurses(RNs) are available to support new RNs during transition because (a) the Canadian RN workforce countrywide is aging and significant numbers are retiring, and (b)the number of Canadian RNs working rurally has plummeted in the past 10 years. Investigations into the phenomenon of new RNs' transitions into the workforce have been conducted, but little is known about this phenomenon as it relates to Canadian rural acute care hospitals. Most findings have been based on data from urban or mixed rural-urban samples.
Methods: An interpretive description research approach was used to understand new RNs' transition experiences into the Alberta, Canada, rural acute care environment including supports and challenges specific to recruitment and retention. Face-to-face interviews were conducted with a convenience sample of 12 new RNs who had been employed in one or more Alberta rural acute care hospitals from 1 month to less than 2 years.
Findings: In this study, participants experienced A Double Whammy! consisting of learning I'm A Generalist! and managing the responsibility of I'm It! Participants experienced contradictory emotions of exhilaration and shock that set them on an emotional roller coaster, a finding that differs from previously reported findings, wherein transition was frequently identified as only shocking. The few participants who were well supported by their colleagues and employers reported experiencing minor emotional fluctuations and described transition as exciting, good, and manageable. Those who were not, experienced major fluctuations from exhilaration to shock. They described transition as exhilarating, but overwhelming, and unsafe. Notably, nine of the 12 participants changed jobs within their first 2 years of practice. Other significant findings included problems with the outdated definitions of rural and rural acute care hospitals, which currently do not accurately address rural population growth and the the services provided at rural acute care hospitals. Populations of some communities identified as rural by Alberta Health Services exceeded the upper limit of 10,000, the level long used to distinguish between rural and urban in the Canadian literature. As well, two different types of rural hospitals exist in Alberta: generalist-types and urban-types. The transition experience into these two different types of hospitals varied significantly.
Conclusion: While A Double Whammy! offers only one description of new RNs' transition experiences into rural acute care, it may present readers with recognizable similarities about transition that resonate with their own learning and responsibilities. Transition supports and challenges learned from this study can assist rural health care providers, policymakers, and educators in developing strategies to support and retain new RNs in rural acute care environments. Additionally, researchers must consider a priori whether or not different types of rural acute care hospitals exist in their study locale and if rural population growth is a factor, when conducting future investigations related to rural acute care.