Challenges to the student nurse on clinical placement in the rural setting: a review of the literature.

CONTEXT: Positive learning experiences for students on clinical placement in rural settings have the potential for supporting the recruitment of qualified nurses to these areas. Recruitment of such nurses is a global concern because current shortages have resulted in decreased healthcare quality for rural residents. By understanding the challenges faced by nursing students unfamiliar with rural settings, educational and organizational strategies can be developed to promote positive learning experiences and so enhance recruitment. ISSUE: A broad literature review was conducted to explore the question: 'What challenges do nursing students from urban communities experience while they are on clinical placements in rural areas, respecting that 'rural' is conceptualized differently by different stakeholders?' The review followed a 5 stage process: (1) identification of the problem and purpose of the review; (2) structured literature search; (3) data evaluation; (4) data analysis; and (5) presentation of findings. Thirteen studies were evaluated independently using tools from the Joanna Briggs Institute. The Ecological Model was the theoretical framework used for consideration of student challenges. LESSONS LEARNED: This literature review revealed a paucity of studies that addressed the research question, with mostly Canadian and Australian studies meeting the inclusion criteria. Findings were organized according to Ecological Model levels and suggested that students face political, environmental, community-based, nursing-related, organizational, relational, and personal challenges on rural placement. Challenges vary according to the placement setting and available student supports. Policy, educational, and nursing practice recommendations include that students should be aware of the impact of limited resources in rural settings; that comprehensive orientation should be provided to clinical and community settings; and that an exploration of financial and distance education supports prior to the placement would be beneficial. Rural practice nurse educators also require support, and it is critical that they and those at the educational institution be receptive to student questions and learning needs.