'Place' Matters to Rural Nurses: A Study Located in the Rural Otago Region of New Zealand

Rural nursing is recognised internationally as a speciality area of nursing practice, situated within the general field of nursing. This specialist area of practice is an underrepresented aspect of nursing in New Zealand, and its professional identity is challenged, misunderstood and does not fit easily within the national imaginings, wider nursing profession and policies governing nursing practice. This thesis explores the social construction of the evolving professional identity, of rural nurses’ between the 1990 and early 2000s. This period of time was associated with two significant national directives impacting on the professional practice of rural nurses and their contribution for the delivery of health care, from the rural Otago region, of the South Island of New Zealand. The first of these national directives in the 1990s was the restructuring of the health care system, driven by the National government, to improve the social determinants of health that shifted the governance of health care from the state to local community control. Parallel to these changes was the motivation from the profession to reposition nursing, with the aim of advancing nurses’ practice so that their full potential could be harnessed, to improve the delivery of health care and reduce health inequalities. Situating this research within the interpretive paradigm embeds this retrospective study within the discipline of nursing and social geography, and engages with the concepts of place and governmentality. Place is considered a concept, in which meaning is made throughout, with the associated concepts of ‘location’, ‘locale’ and ‘sense of place’ revealing how the professional identity of the rural nurse was constructed. Further, engaging with governmentality creates a deeper understanding of rural nurses and their practice and exposes the different levels of governance, including state, discipline and the self, which govern the nurses’ conduct. National key informant and regional rural nurse interviews generated data and were analysed using thematic analysis. Stemming from the analyses, an analytical diagrammatic matrix has been developed which demonstrates rural nursing as a place–based practice governed both from within and beyond location. This analysis further demonstrates how the nurse aligns the self in the rural community as a meaningful provider of health care. In contrast, understanding the rural nurses’ professional identity is acknowledged from beyond the rural community, as a critical component of engaging within the wider nursing profession and is recognised as different to urban nursing. Difference in this context is considered a valuable and positive concept in which to recognise the unique features aligned with rural nursing, meaning that the rural identity is associated with the rural nurses’ relationship with the physical context, community members and specialist scope of practice. The significance of place in relation to rural nurses’ practice is an imperative and noteworthy factor which cannot be an underestimated aspect driving the evolution of this study