Experiences of Nursing and Allied Health Students Undertaking a Rural Placement: Barriers and Enablers to Satisfaction and Wellbeing

Abstract

Australia's rural health services commonly face serious and protracted workforce shortages. To help address such shortages in rural and remote areas, a range of programs exist to support university students to undertake placements in a rural setting. In particular, University Departments of Rural Health (UDRHs) are funded to support nursing and allied health students to undertake a rural placement. As UDRHs encourage students to 'go rural' and as they coordinate and facilitate placements in rural settings, a range of enablers and barriers emerge. This study investigates the lived experiences of nursing and allied health students on placement in public health services in rural and regional Victoria. Its purpose was to identify the enablers and barriers most strongly affecting placement satisfaction and personal wellbeing. The intended outcome was to identify modifiable factors that could potentially improve the rural placement experience. Eighteen students were interviewed by a student undertaking her placement. Interviews were 45-60 minutes in length and all face-to-face. The 18 participants were from five universities and were undertaking their placement at one of seven public hospitals operating in northeast Victoria. The researcher recruited participants by attending scheduled debrief meetings at their placement organisation, briefly discussing the research and inviting students to participate. Data were analysed using a thematic analysis approach. The study found that most participants were positive and enthusiastic about their rural placement, both professionally and personally. Three key enablers were identified: 1) enjoyment of the rural environment and community; 2) working in a positive, friendly and supportive workplace; and 3) exposure to broad practice and enhanced learning opportunities. Simultaneously many had also experienced significant barriers before, during or as a consequence of undertaking their placement, and these negatively affected placement satisfaction and personal wellbeing. Identified barriers were: 1) increased financial stress; 2) travel and accommodation challenges and concerns; 3) study-work-life balance and isolation issues; 4) encountering stressful work situations and/or personal events while on placement; and 5) communication issues with universities. The findings are strongly consistent with those identified in the extant literature. The findings add to previous research by deepening understanding about the financial burden and barriers experienced by nursing and allied health students as a result of undertaking rural placements. Disruption to students' lives socially, psychologically, financially and in terms of employment were significant. The study identified some important aspects of the placement experience, suggesting that nursing and allied health students can be dissatisfied with increased financial stress, isolation and inflexibility from universities.

A qualitative exploration of health student perspectives of rural and remote placements during the early stages of the COVID‐19 pandemic

“…This finding is similar to Mak et al 11 who found that virtual placement experiences allow students to achieve clinical learning outcomes, but were not as effective in facilitating their affective and physical learning about the rural location. This reinforces that the physical and relational experiences on rural and remote placements are valued by students and important for their learning and enjoyment of their rural or remote placement 29 . Planning student connection with other students and the rural and remote community throughout placements is therefore important.…”

“…This reinforces that the physical and relational experiences on rural and remote placements are valued by students and important for their learning and enjoyment of their rural or remote placement. 29 Planning student connection with other students and the rural and remote community throughout placements is therefore important. This could be achieved through peer placements and embedding social and interprofessional learning activities into placement planning.…”

An exploration of mental health, stress and well‐being concerns among health students undertaking rural placements in Australia during the early stages of the COVID‐19 pandemic

“…In Australia, the early COVID‐19 public health response included restrictions to reduce social interactions to limit the spread; these public health orders prevented students on rural placements from moving around the local area, restricted duties and social activities during the placement, and meant students were often alone in student accommodation 6 . Even in nonpandemic times, many health students on rural placements are removed from their social supports and likely experience feelings of isolation and loneliness due to this, ensuring students are able engage with the rural community and placement could mitigate some of these concerns 6,13 . However, COVID‐19 likely added multiple barriers to achieving such connectedness.…”

“…Placement demands have been cited as an additional stressor that impacts well‐being, 12 with high levels of anxiety and stress reported by health care students around placements 12 . Rural placements have the potential to further impact mental health by increasing financial stress and isolating students from their social support structures 8,13 . These issues likely intensified during the emergence of the COVID‐19 pandemic.…”

“…12 Rural placements have the potential to further impact mental health by increasing financial stress and isolating students from their social support structures. 8,13 These issues likely intensified during the emergence of the COVID-19 pandemic. In one Australian study surveying 297 medical students, a pandemic-induced deterioration of mental health was identified in 68% of respondents.…”