When it is someone you know: lived experiences of rural nurses and midwives

Rural nurses and midwives care for people they know; friends, family, acquaintances, colleagues, their children’s teachers. Often this situation is not by choice but rather by necessity as dictated by staffing numbers or skill mix, or frequently both. Rarely do they bemoan such a situation; rather, they get on with the job regardless of how confronting they might find the situation. This study aimed to examine and develop an understanding of the phenomenon of rural nurses and midwives caring for those they knew. Heideggerian phenomenology was chosen to frame this research. Given that the researcher has considerable experiences with the phenomenon in question, this approach is befitting because Heidegger espoused the researchers pre-conceived experiences and beliefs as integral to interpreting the data. Data were generated with eight participants, who shared the stories of their experiences of caring for someone they knew. The researcher then devised an individually tailored approach to thematically analyze the data. Three substantive themes emerged from the study that provide an empathic interpretation of what it is like to be a rural nurse or midwife caring for someone with whom a dual or multiple relationship is shared. Namely these themes are: Knowing before, knowing more, Doing a bit extra and Holding it together. This study indicates that rural clinicians readily, Do a bit extra for those they know. This finding is attributed largely to the Australian cultural appreciation of ‘mateship’; knowing that they are highly likely to re-encounter their patients rural practitioners want to know they have done their best and additionally that they will be seen in a positive light for having given their best. A particular struggle for rural practitioners is illustrated by the theme, Knowing before, knowing more. Small communities are by definition close knit, with highly functional grapevines as a primary means of communication. Whilst the nurses cherished the privileged position they held, they nevertheless often felt burdened by knowing more about patients, their illnesses or their situations than the person did, or even before the person. Holding it together, describes the requirement to continue to perform clinically despite the personal cost to the rural nurse or midwife. Thus as a coping strategy many employed an alter ego, or a stronger part of themselves called the ‘nurse’ or the ‘midwife’ to absolve their personal self of traumatic events. Despite the many potential difficulties associated with caring for those they knew, rural nurses and midwives unanimously embrace the opportunity, considering the situation a privilege. Overall these findings add to the body of knowledge about rural nursing and midwifery practice and the unique challenges faced by rural practitioners in their daily work. While the findings specifically relate to nurses and midwives, many of the themes may transfer across the many health disciplines of rural health care. These findings therefore, have implications for educationalists and curriculum development to ensure that due credence is paid to the issues common in rural nursing and midwifery and by offering these insights, curricula can better prepare students of nursing and midwifery for their future working lives. Additionally, the outcomes would be a useful inclusion in industry orientation programs, especially those aimed at clinicians unfamiliar with the idiosyncrasies of rural practice.