Varied challenge: that's the spice attracting RNs to rural nursing

Registered nurses Rosemary MacDonald and Jeannie Hare have devoted nearly a quarter century each to nursing in rural Alberta-and every day, they say, brings new challenges. As a signal of the esteem held for their work, both RNs were nominated by colleagues for the 2004 AARN Award of Excellence in Nursing Clinical Practice, one of 10 awards presented at an April 27 gala dinner in Calgary.

"I love rural nursing," says Hare, who was selected to receive the clinical practice award by a selection committee of her peers. A 23-year veteran at Redwater Health Centre, where she was recently named assistant head nurse, she finds the variety at the 13-bed facility particularly fulfilling. "I feel strongly that rural nursing should be recognized as a special area of nursing practice, because you have to be a generalist rather than a specialist," she declares.

A year at Drumheller Medium Institution early in her career fueled Hare's love for both responsibility and variety. Heading out to the units with their doctor bags, institution nurses took and developed X-rays, applied sutures, dispensed medications-in short, coped with varied challenges every day.

MacDonald shares that yen for varied challenge. "I enjoy being a generalist," says the nurse practitioner, who is making a transition to a new Grande Prairie clinic after staffing the Worsley Health Centre for 23 years, at times with one other nurse practitioner plus an assistant. "I never know quite what's going to evolve through the day or what's going to walk through the doors, and I find that exciting. It's never boring, never mundane. Never just routine."

With the nearest doctor more than 100 km away, nurse practitioners in Worsley wear three hats, offering primary health, public health and home care. "The really nice thing is that you are with all ages and doing all aspects of nursing," MacDonald says. "We know our clients so well that we can see beyond the single client to the health and well-being of families and the entire community. For example, if there's a traffic accident, we know which families are involved and we know which students will be there for them."

Having served remote communities as a nurse midwife in England, then as a nurse practitioner in the Maritimes and now in northern Alberta, MacDonald knows both the challenge of practicing solo and the joy of following clients as they grow from infancy to parenthood. "In rural nursing, you're part of their lives. It's a very strong bond with the cornmunity that I think is very special," she says.

Hare's personality and varied interests help forge similar links between health centre and community. Quick to volunteer at school and summer camps while children Rhonda and Matt (now in their 20s) were growing up, she also served teens through such ventures as PARTY (Prevent Alcohol and Risk Related Trauma in Youth) and a high school absentee program. A member of the Redwater Art Club, she recently arranged for a rotation of local work to be hung in the health centre, soon to be joined by an indoor mural. Drawings and essays resulting front school contests and tours also brighten the halls. Waiting outpatients knit squares for lap blankets, helping to prepare for six long-term care beds due to open in 2005. Through such involvement, Hare says, "The families feel a buy-in and the whole community feels this is their hospital."

In Worsley, community buy-in has existed ever since 1931, when residents formed a health council to attract and support a nurse. Visitors caught a taste ofthat involvement in 1987, when the opening of a new health clinic coincided with both a motor vehicle accident and a bee sting reaction. "It really did show everybody exactly how things work in Worsley," MacDonald recalls. Amid an ambulance transfer and the need to respond to anaphylactic shock, "we were asking people attending the clinic opening to sit with one patient while we were working on somebody else." The council's role has changed over the years, yet it remains a potent force, MacDonald says. "It used to make sure there was water and feed for the nurse's horse; now it's lobbying for staff and fundraising for equipment." The council recently raised funds for both a CoaguChek System and a Hemaglobinometer, both particularly useful in monitoring patients at a clinic without an onsite lab.

Being in touch allows these RNs to spot and address emerging community needs, then offer holistic care that respects local norms. For palliative care and cancer patients, Hare obtained a grant to hire a masseuse and educate a licensed practical nurse in makeup techniques that camouflage the effects of chemotherapy. To remember those who died in hospital, Hare began an album and memorial services. When she learned that Edmonton's Northeast Health Centre, where she works occasional shifts, was purchasing rigid I-V tubing to minimixe the threat of accidental strangling by grasping little hands, she imported the idea to Redwater.

Facing an outbreak of strep throat in a close-knit community, MacDonald paid a visit, noted that cups and toothbrushes were being shared, then gave each person a water bottle, a new toothbrush and some hygiene tips. Because she earned trust over the years by getting to know her patients in the context of their environment, pets and traditions included, such advice has brought a notable increase in immunization and deeper understanding of communicable disease.