Exploring the Role and Skill Requirements of Registered Nurses Working in Rural and Remote Areas. A Scoping Review

Registered nurses (RN)s account for the majority of the rural and remote health workforce and require different skills, knowledge and working practices compared to their metropolitan counterparts. Given the complexity and diversity of the rural and remote work environment, it is important to investigate the contemporary literature on the role and skill requirements of the RNs in these locations.

A scoping review was undertaken in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. With the permission of the authors, this scoping review extends the work by Muirhead and Birks (2020) who explored the RN role in these locations in 2017. Database searches were conducted in the Cumulative Index for Allied Health and Nursing Literature (CINAHL), Cochrane, JBI, OVID (Emcare), Proquest, PubMed, Scopus and Rural and Remote Health Database. Studies published from November 2017 to June 2024 were included to reflect the current international roles of rural and remote RNs.

A total of 74 articles were included in the study. The overarching categories identified were clinical roles and non-clinical roles. Ongoing analysis established the subcategories of fundamental/foundational, specialist, management roles, support roles and ancillary roles. Four tensions within the rural and remote context were also identified; Generalist and specialist role; Poorly prepared or unprepared; Extended scope of practice; and Role uncertainty.

Registered Nurses in rural and remote locations conduct a wide variety of skills and tasks. Their role is expansive, context-dependant, and dynamic. Analysis of the literature found that globally, similarities exist for the role, including comparable challenges, barriers and opportunities Resource availability in a country impacts RN preparation, emphasising the need for systemic improvements to ensure equitable outcomes, especially in rural and remote areas.

The role of the rural and remote RN is broad and unique and requires different breadth and depth of skills and knowledge. The rural and remote RN role includes all levels of care for all patients across the lifespan, with varying resource and support levels. This scoping review provides valuable insight into the skills required to care for diverse communities. Understanding these requirements is essential, as it can inform the future focus on rural and remote nurse education and training and its subsequent impact on the quality of care for people living in rural and remote communities.