Objective:The aim of this review is to explore the multifaceted roles of registered nursing practice in rural and remote areas of Australia. Background:People in rural and remote Australia have less access to healthcare than their metropolitan counterparts. They are also burdened with higher rates of chronic disease and premature mortality. These areas also have less doctors and allied health professionals than metropolitan areas, with the core workforce being registered nurses. One strategy to address the health workforce disparities, is to promote registered nurses to work to their full scope and in advanced generalist roles. An understanding of the current roles of the registered nurse is therefore required to assist in determining how their scope could be extended, and to inform appropriate educational planning. Study design and methods:An integrative review of literature was used to obtain articles from online databases relevant to nursing from 1995 to 2017. Data was quality appraised, extracted, and thematically analysed. Results:Registered nurses in rural and remote Australia work in diverse contexts that have a major influence on the roles they undertake. They are already required to be multi-skilled and to practice at an advanced level, including undertaking some aspects of the health professional role traditionally the domain of medical practitioners. These registered nurses often feel unprepared for the breadth and complexity of this role. Discussion:To enable registered nurses to be adequately prepared for rural and remote practice, educational programs need to be flexible, accessible and affordable. The registered nurse’s existing experience and expertise should be recognised, and educational pathways structured to enable the nurse to expand their practice according to the context in which they work and the needs of the community. Conclusion:Registered nurses in rural and remote areas function as advanced generalists. Greater understanding of these roles is necessary to inform the development of ‘fit for purpose’ educational models. Implications for research, policy and practice:Future research is needed to focus on evaluation of existing models of rural and remote nursing practice and in particular the role of the nurse as doctor substitute. The findings of this study highlight the potential expanded contribution of registered nurses in these areas, which is an important factor for consideration by policy makers. In practice, supportive frameworks are required to ensure registered nurses are able to function to their full capacity in their unique context. What is already known about the topic?– People living in rural and remote areas are subjected to inequities in respect of health and access to healthcare services.– Registered nurses working in rural and remote areas are essential for addressing healthcare needs that would otherwise be unmet.– Nurses practicing in these areas require an advanced skills-set in order to function effectively in their role. What this paper adds.– This paper examines the multifaceted role of the registered nurse working in rural and remote areas of Australia as described in the literature.– Four main themes were identified: roles shaped by context; doctor substitute; multi-skilled and advanced practice; and feeling unprepared.– Understanding the complexity of the registered nurse role in rural and remote areas enables the development of policy, practice and educational approaches to support nurses in functioning to their full capacity. https://doi.org/10.37464/2020.371.5

中文翻译：

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澳大利亚农村和偏远地区注册护士的角色：综合评价

目的：本综述的目的是探索注册护理实践在澳大利亚农村和偏远地区的多方面作用。背景：与大城市相比，澳大利亚农村和偏远地区的人们获得医疗保健的机会较少。他们还背负着更高的慢性病和过早死亡率。这些地区的医生和专职卫生专业人员也少于大都市区，核心劳动力是注册护士。解决卫生人力差异的一种策略是促进注册护士充分发挥其作用并担任高级通才角色。因此，需要了解注册护士的当前角色，以帮助确定如何扩展其范围，并为适当的教育计划提供信息。研究设计和方法：综合文献综述用于从 1995 年至 2017 年与护理相关的在线数据库中获取文章。对数据进行质量评估、提取和主题分析。结果：澳大利亚农村和偏远地区的注册护士在不同的环境中工作，这些环境对他们所承担的角色有重大影响。他们已经被要求具备多种技能并在高级水平上进行实践，包括承担传统上属于医生领域的卫生专业角色的某些方面。这些注册护士常常对这个角色的广度和复杂性感到措手不及。讨论：为了使注册护士能够为农村和远程实践做好充分准备，教育计划需要灵活、可及且负担得起。应承认注册护士现有的经验和专业知识，并构建教育途径，使护士能够根据其工作环境和社区需求扩展其实践。结论：农村和偏远地区注册护士具有先进的多面手作用。更好地了解这些角色对于开发“适合目的”的教育模式是必要的。对研究、政策和实践的启示：未来的研究需要重点评估农村和远程护理实践的现有模式，特别是护士作为医生替代者的作用。这项研究的结果突出了注册护士在这些领域的潜在贡献，这是决策者考虑的一个重要因素。在实践中，需要支持性框架以确保注册护士能够在其独特的环境中充分发挥其能力。关于该主题的已知信息是什么？- 农村和偏远地区的人们在健康和获得医疗保健服务方面存在不平等。- 在农村和偏远地区工作的注册护士对于解决原本无法满足的医疗保健需求至关重要.- 在这些领域执业的护士需要具备高级技能才能有效地发挥作用。本文补充的内容。– 本文研究了文献中描述的在澳大利亚农村和偏远地区工作的注册护士的多方面作用。– 确定了四个主要主题：由环境塑造的角色；医生替补；多技能和先进的实践；并感到毫无准备。– 了解农村和偏远地区注册护士角色的复杂性有助于制定政策、实践和教育方法，以支持护士充分发挥其功能。https://doi.org/10.37464/2020.371.5