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Making do and figuring things out: rural nursing as its own specialty

‘Our nurses know how to do just about anything,’ Tracy Mitchell says

By Laura Eggertson
October 31, 2022
Lauren Billey Creative
“We specialize in being generalists,” Tracy Mitchell says. She’s proud of her team, saying “they can deliver a baby, they are the code team, they are the IV team, they are the lift team, after hours they are the pharmacists, they are the maintenance team, and they are the housekeeping team.”

Tracy Mitchell is used to being underestimated.

As a rural nurse for close to 30 years, she’s watched Canada’s health-care-hungry urban centres scoop up nurses drawn to alluring specialties, fully equipped teaching hospitals, and big-city conveniences.

In Canada, as in many other countries, the proportion of nurses caring for people living in rural and remote areas is declining. As of 2015, just under 12 per cent of nurses care for the 17 per cent of Canadians who live in these areas, according to the Canadian Institute for Health Information.

Each year, fewer nursing graduates are drawn to rural positions, where they will have to make do with less.

At the 16-bed community hospital Mitchell manages in Claresholm, AB, about an hour south of Calgary, the only diagnostic tools available are X-rays and basic lab tests. Until recently, the nurses made do with a pen-and-paper system and just three computers at the nursing station.

There are no operating theatres, CT or MRI machines, or  ultrasound services.

What there are, says Mitchell, are skilled and compassionate nurses with a broad scope of practice. They’re ready to handle any illness or emergency that comes through the door.

“We specialize in being generalists,” she says. “Our nurses know how to do just about anything and everything. They can deliver a baby, they are the code team, they are the IV team, they are the lift team, after hours they are the pharmacists, they are the maintenance team, and they are the housekeeping team.”

“We don’t have the luxury of being specialists.”

That broad skill set is a major strength, as far as Mitchell is concerned — one to which too few nursing students are exposed.

That’s why Mitchell, who by nature prefers working in the shadows, is stepping forward to advocate for greater recognition from the health-care community that rural and remote nursing is its own specialty. She’s not willing to be underestimated any longer.

More mentorship programs, mandatory nursing clinical rotations in rural settings, and stronger recruitment/retention strategies across Alberta, and across Canada, would raise the profile of rural nursing, she says.

“We need to increase the amount of rural content in undergraduate nursing (education) too,” Mitchell adds.

“We are still grossly overlooked and under-valued.”

Rural upbringing

Like most rural and remote nurses, Mitchell grew up in rural communities. She arrived in Claresholm at  15, when the RCMP posted her father to the local detachment.

“I hated it,” she says with a laugh. “Look at me now.”

She got hooked on nursing after her first summer job in a long-term care home. She didn’t even know how to work the brakes on a wheelchair when she started, Mitchell says.

She soon learned that getting a resident a glass of water, opening their juice cup or sitting and listening to them “can make such a big difference in someone’s life. It’s very gratifying,” she says.

Today, Mitchell, 49, is not only site manager at the hospital, but she also manages the Nanton Community Health Centre in nearby Nanton, another small town about 40 kilometres away.

Her job involves advocating for patients and staff. She makes sure the 70 nurses she manages, many of them casual, and about 75 other professional staff at both sites offer safe, patient-centred care and abide by the Health Services’ code of ethics.

‘We have a higher level of accountability because we know people.’

She mentors nurses and works with staff, patient families, and the communities to improve and innovate. She hires, manages employees, and follows up on patient concerns.

She coordinates with the University of Lethbridge, Bow Valley, and Medicine Hat to arrange preceptorship or mentorship opportunities for nursing students.

If staff need an extra hand — the emergency department runs with just one RN — she pitches in to help whenever she can.

Community connection

The appeal of nursing in the same community where Mitchell spent her formative teenage years lies in delivering high-quality care for people she may later encounter at the grocery store.

“We have a higher level of accountability because we know people,” she says. “Anybody who comes in — say it’s an overdose — might be our neighbour. It might be our child. As nurses and health-care providers in our community, we’re not anonymous.”

Those connections can also be challenging.

In 2011, a middle-of-the-night emergency call to the hospital had the nurses’ hearts in their throats. Two young adults with gunshot wounds were on their way. Another three people were dead at the scene of a highway shooting.

“When we hear that we’re getting a gunshot wound coming through the door — the first thing we think of is, ‘Is it my friends, my family?’” Mitchell says.

In this case, neither the victims nor the perpetrator were from Claresholm. A jealous boyfriend had run a car containing his ex-girlfriend and three of her friends off the road on their way to the Calgary airport. He then shot them all and killed himself.

Mitchell was called in. Her team was able to stabilize one of the victims, who was transported to Calgary, and survived. The other unfortunately died en route to hospital.

“It was heart-wrenching to our staff, because they were young adults, and we don’t see that kind of violence and injury — ever,” Mitchell says.

She spent the night supporting the staff who were on duty and liaising with Alberta Health Services (AHS). Later, she brought in counsellors to debrief her team.

As traumatic as the incident was, it reinforced Mitchell’s pride in her nurses’ ability to handle whatever comes their way — and their willingness to pitch in.

Because there is only one nurse who normally staffs the emergency department, more than one really ill patient is challenging, Mitchell says. She pulls staff from acute care to help.

“They are very team-oriented and very collaborative. It’s a family environment, which I’m very proud of,” Mitchell adds.

As it did everywhere, the SARS-CoV-2 pandemic taxed the Claresholm hospital’s resources. Initially, there was no COVID testing in the community, and people were forced to travel to Calgary or Lethbridge to learn if they were positive.

So Mitchell’s staff turned over-capacity rooms into four isolation spaces. They also created a drive-through COVID swab service.

“It was a very valued service in our community,” she says. “It wasn’t official — our community just knew to call us, and we put out signs, and word of mouth spread. We even had someone drive up in a lawn tractor,” she says with a laugh.

Despite Mitchell’s pride in her team’s can-do attitude, she wants more resources for them. She’s advocating for a CT scanner and ultrasound, believing this is critical for the hospital’s ability to serve the area’s aging population.

Retaining nurses also means lobbying for more benefits for nurses working casual positions. Like many other rural nurses, most members of Mitchell’s staff have additional responsibilities on ranches and farms, meaning they prefer part-time or casual work.

“If we have the autonomy to be creative, we can recruit or retain in rural areas,” Mitchell says. “We just need to work collaboratively with our partners (in community and primary care, as well as AHS and post-secondary institutions, and employees) to leverage our strengths.”

In addition to enjoying her off-work time with her husband, Matt, paddle-boarding or walking their German Shepherd and Shiba Innu dogs and checking in on her two grown sons, Mitchell plans to be a strong voice to advance rural health priorities, provincially and nationally.

“We need to work on this at a national level,” she says. “There’s no one-size-fits-all in rural nursing.”

Laura Eggertson is a freelance journalist based in Wolfville, N.S.