A crisis in the countryside - Barriers to nurse recruitment and retention in rural areas of high-income countries: A qualitative meta-analysis

A nursing workforce is pivotal for maintaining fundamental healthcare needs. However, recruitment and retention of this integral workforce in rural regions can be fraught with challenges. Whilst global research has identified barriers to working in rurality, these are often focused on the limited infrastructure and isolation of working in low- and middle-income countries. No previous qualitative meta-analysis has considered the factors affecting nurse recruitment in high-income countries. To provide a deeper understanding of the overarching barriers to nurse recruitment and retention in rural areas of high-income countries, a qualitative meta-analysis of primary qualitative research was conducted. Fourteen databases were reviewed systematically for qualitative research exploring barriers to nurse recruitment and retention. Twelve papers from Australia, Canada and the USA met the inclusion criteria. The current meta-analysis identifies themes around ‘health service demands’, ‘challenges of accessing continuous professional development and clinical progression restrictions’ and the ‘rural demography’ as overarching barriers for rural recruitment and retention of nurses in high-income countries. The results of the qualitative meta-analysis have provided new insights into the overarching themes, reflecting the consistent barriers to nurse recruitment and retention in rural areas of high-income countries. Interpretation of these themes highlights the importance of employing the right nurse who possesses a multi-dimensional skillset traversing both the working and community environment. This is discussed in light of current healthcare and education models and the development of innovative recruitment strategies, with the meta-analysis identifying avenues for future research to better address this growing concern. •Recruiting and retaining a skilled rural nursing workforce is now a key concern for all countries, globally.•There is significant disparity and unequal distribution of the existing nursing workforce between urban and rural areas.•Nurses in rural areas require a different generalist skillset which can be challenging for new or urban nurses to achieve.•Rural working is hampered by urban healthcare and educational models.•The potential negative impact on rural healthcare is concerning, unless a quality rural workforce strategy is devised.