Nurses' Roles, Challenges, and Reported Outcomes in Rural and Remote Healthcare: A JBI-Aligned Scoping Review...

Rural and remote health systems are diverse; while many of these settings face persistent workforce shortages and access gaps, not all are underserved. Nurses play a critical role in improving access, continuity, and quality of care in these contexts. However, evidence on their roles, the challenges they face, and the outcomes associated with their contributions remains fragmented.

To map the roles, challenges, and reported outcomes of nurses working in rural and remote healthcare settings, and to examine the quality and scope of the available evidence.

This study employed JBI scoping review methodology and is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

Eligible studies involved registered nurses (RNs) and nurse practitioners (NPs) providing care in rural or remote settings and reporting at least one outcome related to patients, services, or health systems. Six bibliographic databases (PubMed/MEDLINE, CINAHL, Embase, Scopus, Web of Science, Cochrane Library) plus Google Scholar for supplementary grey literature retrieval and targeted grey literature were searched (from 1 January 2000 to 30 September 2025). The lead author conducted screening and data extraction, supported by a 10% calibration pilot and structured peer debriefing. Design-specific critical appraisal was undertaken descriptively to inform interpretation but did not determine inclusion.

From 22 primary empirical studies (plus 2 contextual-only entries; 24 total, nurses' roles clustered into direct clinical care, care coordination/navigation, telehealth facilitation, and health promotion. Reported outcomes were predominantly in access/utilization (e.g., time-to-care), quality and safety indicators, and patient-reported outcomes/experiences; clinical endpoints were less common.

Nurses in rural and remote settings enact broad, adaptive roles that appear to support healthcare access and service continuity. The evidence base is predominantly descriptive, and causal claims about effectiveness cannot be drawn from the available studies. Standardized outcome frameworks, multi-reviewer methodologies, and effectiveness-focused primary research are needed to advance this field.