Labouring to nurse: the work of rural nurses who provide maternity care.

INTRODUCTION This research takes up the standpoint of nurses who provide maternity care to women and families in six different communities of one geographically isolated area of British Columbia, Canada. This first report (phase one of the study) focuses on describing the complexities of rural nursing work and identifies some possibilities for change that would better support nurses in their work. METHODS This study was guided by institutional ethnography and included both observations of nursing work and interviews with expert informants about nurses' work of providing maternity care in rural communities and geographically isolated small towns. Nurses were asked to describe their work in as much detail as possible, and chronological accounts were constructed. Analysis focused on painting a complex picture of the work of rural nurses and identifying traces of social organization for further investigation. RESULTS Overall, the work of nurses who provide maternity care was characterized as broad in scope, as requiring complex knowledge and skills, with a significant amount of professional responsibility in an environment with limited resources. Rural nursing work was also grounded in nurses knowing their community. An adequate number of skilled nurses was consistently identified by all participants as essential for the safe provision of maternity care. Since opportunities to learn the skills needed to provide maternity care were difficult to obtain in small rural settings, nurses also identified affordable and accessible continuing professional education as the most important strategy for recruiting and retaining rural nurses. CONCLUSIONS Phase one of this study has confirmed the complex and contextual nature of rural nursing work. Phase two, which is currently underway, is exploring the institutional discourses, structures and work processes that obscure this complexity and regulate, rather than support, rural nurses' work of providing maternity care.