title: Sustaining the rural workforce: nursing perspectives on worklife challenges.
abstract: BACKGROUND
  Concerns have been raised about the sustainability of health care workforces in rural settings. According to the literature, rural nurses' work satisfaction varies with the resources and supports available to respond to specific challenges. Given the probable effects of stressors on retention, it is essential to understand the unique requirements of nurses in rural practice environments.
  
  
  OBJECTIVE
  To investigate whether nurses receive the resources and supports necessary to meet the challenges of rural practice.
  
  
  METHODS
  Semi-structured interviews were conducted with 21 managers and 44 staff nurses in 19 selected rural hospitals in Ontario, Canada. The interviews were taped and transcripts interpreted through a thematic analysis. Major worklife themes were identified and analyzed within a healthy work environment model based on the work of Kristensen.
  
  
  RESULTS
  Three interrelated dimensions of the model were relevant to workforce sustainability: the balance between demands and the resources of the person, the level of social support, and the degree of influence. The availability of resources and supports affected whether the nurses perceived challenges as stimulating or overwhelming. Deficits interfered with practice and the well-being of the nurses and patients.
  
  
  CONCLUSIONS
  The nurses felt frustrated and powerless when they lacked resources, support, and influence to manage negative situations. Strategies to achieve workforce sustainability include resources to reduce stress in the workplace, education to meet the needs of new and experienced nurses, and offering of employment preferences to the workforce. Addressing resources, support, and influence of rural nurses is essential to alleviate workplace challenges and sustain the rural nursing workforce.
authors.affiliation: Nursing Health Services Research Unit, McMaster University, Hamilton, Ontario, Canada. hunsber@mcmaster.ca
authors.forename: Mabel
authors.initials: M
authors.lastname: Hunsberger
authors.forename: Andrea
authors.initials: A
authors.lastname: Baumann
authors.forename: Jennifer
authors.initials: J
authors.lastname: Blythe
authors.forename: Mary
authors.initials: M
authors.lastname: Crea
mesh_terms: D000383:Agriculture; D002322:Career Mobility; D002391:Catchment Area, Health; D019033:Delivery of Health Care, Integrated; D006272:Health Facility Environment; D006740:Hospital Administrators / Q000523:psychology*; D006780:Hospitals, Rural / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D007588:Job Satisfaction; D024802:Nurse's Role; D009741:Nursing Staff, Hospital / Q000523:psychology*; D009864:Ontario; D015279:Organizational Culture; D010557:Personnel Administration, Hospital; D011365:Professional Practice Location; D012944:Social Support; D000078329:Workforce; D016526:Workload / Q000523:psychology