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Distress and safety: personal reflections on rural and remote nursing research
Oct 25, 2021, By: Crystal McLeod
nurse sitting on a bench
Rural and remote nurses reported excellent peer support to alleviate distress but felt that their institutions lacked resources, services and recognition from leadership.

Takeaway Messages

  • As research on rural and remote nursing in Canada continues to be generated, examining this research for personal insights may be affirming to the nurses working in this field.
  • Jahner, Penz, Stewart, and MacLeod (2020) shed light on the diverse risks, trauma, and loss of safety experienced by nurses in rural and remote settings while also offering interventions for individuals and institutions to reduce distress.
  • Rural and remote leaders and occupational health programs need to address the distress experienced by nurses.

In 2019, I was intrigued by the Canadian Nurse article “Lessons from 20 Years of Research on Nursing Practice in Rural and Remote Canada” (MacLeod, Kulig, and Stewart, 2019). The article shared initial findings from the national data set “Nursing Practice in Rural and Remote Canada II” (RRNII). The RRNII, part of a larger project to define nursing practice in rural and remote Canada, was developed for health planners and policy-makers. However, I found myself examining RRNII data as an individual and seeking correlations with my own rural and remote nursing roles. Over the last five years, I have worked across three rural and remote Ontario communities. Ultimately, I was amazed to read that many of the RRNII nurses (3,822) disclosed the same joys and demands I had felt in these past roles.

Research meets rural and remote nursing experience

Today, studies that feature RRNII data continue to resonate with me, and I recommend this literature to nurses working in small or isolated settings who seek connection with colleagues and the larger nursing profession (University of Northern British Columbia, n.d.). Yet I would like to highlight the most recent study generated by RRNII data, entitled “Exploring the Distressing Events and Perceptions of Support Experienced by Rural and Remote Nurses” (Jahner et al., 2020). This article has had a profound effect on me by validating my own experiences of distress in rural and remote nursing. I recommend that this article be on the reading list of all rural and remote nurses to promote reflection and solidarity in practice.

The opening sentence of Jahner et al.’s (2020) study alone had an impact on me: “Rural and remote nursing is considered a high-risk occupation” (p. 480). In truth, originally reading this statement was emotional for me. I had felt for years that rural and remote nursing was a high-risk occupation, but had repeatedly experienced dismissal of this feeling by leaders and institutions I worked for. The best example of high-risk work I can give was working alone at night in a busy rural emergency department. My mental and physical health was continuously under threat because I had no support, never knew who was coming to the door, and did not know their intentions or acuity of illness. Therefore, this sentence from Jahner et al. gave legitimacy to the vulnerability I had encountered.

Rural and remote occupational health programs are understaffed and rely on leadership to support change.

Building from this acknowledgment of the dangers in rural and remote nursing, the study goes on to examine distressing events and support following these events. I appreciated that Jahner et al. (2020) broadly defined “distressing events” to include those in which the safety of the nurse or the patient was challenged. For example, a distressing event could be a patient threatening a nurse’s safety or the resuscitation of an injured child. The authors’ methodological choice echoes how the well-being of rural and remote nurses is tied to their community. I can further attest to this connection as I once worked in a small-town hospital and long-term care home simultaneously. There was hardly a death or birth in the community that I didn’t witness first-hand. As well, I think the study’s examination of institutional assistance is key to making the results applicable to the experiences of individual nurses. Specifically, I looked at these results based on how fellow nurses managed distress and what could be learned from them. I once ended up leaving a rural nursing position in a state of extreme burnout, and I wish I had learned from research such as this article on how to better cope with distress sooner.

I appreciated the findings from Jahner et al. (2020) as they affirmed my own experiences and built on the 2019 Canadian Nurse article. Notably, a third of nurses described experiencing a recent extremely distressing event, for which the most significant was the traumatic death of a patient. Rural and remote nurses reported excellent peer support to alleviate distress but felt that their institutions lacked resources, services and recognition from leadership. Reading the results of this study was difficult for me because they triggered many memories, especially when reviewing participant quotes. But I also reflected, using this study as a guide, on the insights and resiliency I have developed because of these experiences.

Implications for nursing leadership

In the study’s conclusion, I did note a lack of implications for leaders in rural and remote health. Emphasis was placed instead on occupational health departments resolving issues related to nursing distress. Although these departments have a role to play, rural and remote occupational health programs are understaffed and rely on leadership to support change.

Overall, I believe the study results demonstrate that more should be expected of leadership in promoting rural and remote nurses’ well-being. Drawing on my own experiences of working in rural and urban communities, I think one area for rural and remote leaders to explore is training and building relationships with larger health-care institutions. Just as rural and remote nurses are often sent out of community for specialty training, rural and remote leaders would benefit from learning how different facilities manage risk, create a culture of safety and offer support to nursing staff.


Jahner, S., Penz, K., Stewart, N. J., & MacLeod, M. L. P. (2020). Exploring the distressing events and perceptions of support experienced by rural nurses: A thematic analysis of national survey data. Workplace Health and Safety, 68(10), 480-490. doi:10.1177/2165079920924685

MacLeod, M., Kulig, J., & Stewart, N.. (2019, May 13). Lessons from 20 years of research on nursing practice in rural and remote Canada. Canadian Nurse. Retrieved from

University of Northern British Columbia. (n.d.). Nursing practice in rural and remote Canada II: Publications. Retrieved from

Crystal McLeod is currently a registered nurse at London Health Sciences Centre. She has five years of nursing experience in rural and remote Ontario communities, which she hopes to return to someday.