Beyond the Lack of Resources: Nurse Managers' Perspectives on Communication in Rural Settings

Background: There is increasing awareness that poor communication is at the root of many chronic problems in healthcare. While poor communication and lack of teamwork of healthcare providers have been demonstrated to be harmful to patients and the healthcare team, nurse managers and administrators are challenged to respond appropriately to these threats to a healthy work environment. Other challenges to the rural setting such as geographic diversity, features of the physical environment, and population density impact how professional staff and nurse managers interact. However, few studies have focused on nurse managers’ view of their impact on communication and, thus, the creation and maintenance of the healthy work environment in rural settings.

Purpose: A qualitative, explorative, and descriptive study using Grounded Theory methods was conducted. The study population comprised 9 nurse managers from rural, regional, and community settings. Participants were recruited through purposive and theoretical sampling. The purpose of this study was to examine how nurse managers in rural settings perceived communication factors that promote a healthy workplace and their role in setting the tone on the unit or program.  

Methods: Data collection consisted of demographic information, audiotaped semi-structured interviews, transcripts of those interviews, and researchers’ field notes and memos. Data analysis was performed using the constant comparative method according to the Strauss and Corbin method and was assisted in the use of qualitative data software (ATLAS.ti) to explicate the processes.

Results: Identified commonalities, patterns, and themes across the interviews indicated a more negative tone of communication in the workplace. Various tools of communication either promoted or hindered effective and healthy communication. The uniqueness of practice in the rural setting challenged nurse managers on a daily basis. Nurse managers’ described their role in setting the tone of communication and factors that helped or hindered the healthy work environment.  

Conclusion: This study provides insights for nurse managers in rural settings who are struggling with creation and maintenance of healthy work environments and strategies to promote effective communication. Accommodation of the rural limitations without sacrificing expanded use of technology is crucial for meeting the needs of health care staff and rural health care settings.