Strengthening the Rural Nursing Workforce Through Stakeholder Engagement

A significant theory-practice gap exists among newly licensed undergraduate nurses (Leach, 2018; Spector & Silvestre, 2012). This inability to integrate academic learning within the clinical practice setting to support critical thinking and clinical reasoning is even more pronounced in rural settings than in urban settings. Nurses in rural practice have been termed “expert generalists” because patient assignments often include individuals across the lifespan and with divergent health conditions. Managing these patient assignments requires that nurses have a broad set of skills and knowledge (Armitage & McMaster, 2000; Hegney, 1996). However, undergraduate nursing programs do not adequately prepare students for the reality of rural nursing practice (Harmon, 2013; Paliadelis, Parmenter Parker, Giles & Higgins, 2017). Lack of preparation contributes to nurse burn-out, high rates of job turn-over among nurses in their first year of practice and nursing shortages (TCN, 2010). To prevent adverse patient outcomes associated with nursing shortages (Aiken, Clarke, Sloane, Sochalski & Silber, 2002) schools of nursing must implement strategies that bridge the theory-practice gap. The purpose of this quality improvement project was to employ a stakeholder engagement process to address the theory-practice gap.

This stakeholder engagement project was a collaborative effort between a school of nursing and a statewide health cooperative. The focus of the project, the theory-practice gap, emerged organically as a shared priority after reviewing salient issues identified by each organization. As the project progressed, existing networks to which the school of nursing and the health cooperative belonged were used to identify additional stakeholders to involve in the process of designing the project. Through consensus, key stakeholders elected to approach the problem of the theory-practice gap by soliciting perceptions about readiness of student nurses and newly licensed nurses for rural nursing practice. To capture specific and relevant information, data were collected using surveys and semi-structured interviews. The sample included senior nursing students, nursing faculty and staff, as well as nursing staff and nursing leaders from the health cooperative member organizations. Descriptive statistics were used to analyze the quantitative survey data whereas thematic analysis was used to analyze the qualitative interview data.

The stakeholder engagement approach was well-received by all stakeholders and participants. Given its collaborative nature, the greatest time investment was in planning. Initial discussions began in April 2018 and the project was approved by all stakeholders and initiated in September 2018. Use of existing networks allowed for rapid recruitment of participants, with data collection completed in November 2018. Scheduling individual on-site interviews reduced the burden of participation which was perceived by participants as a gesture of value and respect. In order to obtain specific and rich findings however, data collection was tailored for all groups, requiring that three versions of the survey and interview question guide be made. This only added time for analyzing the survey data as the interview data were analyzed as a whole.

Stakeholder engagement is a powerful method for identifying and addressing shared priorities, like the theory-practice gap, between schools of nursing and healthcare organizations. With thoughtful planning, stakeholder engagement can provide rich, context-specific findings that allow partners to implement realistic and feasible strategies to tackle complex issues that affect patient health outcomes.