Will future nurses go rural?

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By Prapti Bamaniya

While some Toronto Metropolitan University (TMU) nursing students are considering relocating to rural parts of Ontario because of a new provincial tuition reimbursement program, others expressed that it has little impact on their future employment decisions.

Nursing graduates can receive up to full tuition reimbursement for a two-year commitment to work in an underserved community, as part of a recent expansion of the Community Commitment Program for Nurses (CCPN), according to its website

The expansion, announced in March 2022, will run from 2022 to 2024, with up to 1,500 graduates eligible each year, the website states.

Funding for the expansion is provided by the Ontario government’s “Plan to Stay Open,” a set of initiatives which intends to expand healthcare policies and measures to better equip the province’s response to crisis.

The plan also includes the Ontario Learn and Stay grant—a tuition reimbursement program for up to 2,500 eligible students each year who enrol in a high-priority program in a high-priority community and commit to working in an underserved community for up to two years after graduation, according to the program’s website and press release.  

Applications for the grant will begin in spring 2023 and the consultation process for the eligibility guidelines for programs and communities started this summer.

Tahera Sudha, an international TMU student in her first year of nursing, said she doesn’t mind travelling and would consider the program because of the heavy cost of her tuition.

“As an international student, I am open to travelling because I have already travelled miles to come here, so moving to the rural side is not a big deal,” she said. “We have to pay so much in fees, so if the government is paying the tuition, why not?”

International student tuition at TMU can range from $31,749 to $38,472, according to TMU’s website. Domestic tuition fees for students range from $7,050 to $11,986. 

Fourth-year nursing student Millisent Olanrewaju said she is willing to take a job anywhere post-graduation.

“My ideal situation after graduation would be finding a job; it doesn’t have to be in Toronto.” 

However, the tuition program and the potential impact of working in a rural community gives her additional reasons to relocate.  

“The money would help me,” she said. “I think [the program] will help the individuals who live in those communities, making healthcare more accessible. That’s also very appealing.”

Based on Ontario’s Rural, Remote and Northern Nursing Report in 2015, rural communities are those with smaller population sizes. The report defines a rural community as one that has “a population of less than 30,000 that [is] greater than 30 minutes away in travel time from a community with a population of more than 30,000.” 

Jasmine Zhang, a 2021 TMU nursing graduate, said she would not consider working in a rural community despite the incentive.

“It’s not worth it, even if I get reimbursed,” she said. “Of course, tuition is on my mind but it’s a high cost to put your whole life on pause just to go up there, even for two years.”

Samin Barakati, a fourth-year nursing student at TMU, said working in a rural community for two years would have a big impact on her life. She also said she has significant help with paying tuition from the Ontario Student Assistance Program (OSAP).

“Personally, it’s still a big decision to live in a rural area for that amount of time, so I would not apply,” she said. 

Other nursing students said they aren’t willing to give up their attachments and relationships in Toronto and the Greater Toronto Area.

“My life is here. I can’t imagine myself living in a smaller [city] no matter the incentive,” said Cheryl Kahandavitagamage, a third-year nursing student.

Nenna Abdella, another third-year nursing student, agreed. “I’m so used to my social network in the city that it would be hard to communicate [with] them if I were to move to a rural area for work.” 

The recruitment and retention of nurses in rural, remote and northern areas of Ontario is difficult and if left unresolved, these areas could face a human resource crisis, according to a 2015 workplace report from the Registered Nurses’ Association of Ontario.

“Access to quality health care [is] a long-standing issue in these areas,” read the report. It added that mortality rates increase with the remoteness of a community.

Corinne Hart, an associate professor of nursing at TMU, said healthcare quality in rural communities needs help. “There is such an underservice of nurses in rural areas. There’s a real lack,” Hart added.

“I think probably in some of the rural areas, nurses take on more and more responsibility.”

Hart said the tuition reimbursement program offers a chance to benefit rural areas and makes nursing school more accessible to those with financial constraints. 

“It may open nursing school and the profession to people who might not otherwise be able to afford it,” she said.

There are also disadvantages to the program, she added. “In rural areas, the work is often much more complex and challenging. It may force people who could not otherwise afford [tuition] into working environments where they might not have otherwise chosen to go.”

Matthew Shepherd, a fourth-year nursing student at TMU, said he would not apply to the program because he hopes to become a travel nurse post-graduation. 

“Why stay here, where we’re not getting paid enough, where we’re starting to get treated like shit, and the government isn’t helping us in any way, shape or form when we can actually just leave and get paid 10 times more.”

Travel nurses are registered nurses contracted through a healthcare staffing agency who work in short-term roles at hospitals, clinics, and other healthcare facilities worldwide to fill critical staffing needs, according to an article from The Journal of Nursing Administration.

Travel nursing compensation is higher than a permanent staff position. Its higher salary is commonly assumed to be the main attractor for the profession, according to a February 2022 article in Nurse Leader, the official journal of the American Organization for Nursing Leadership. 

Shepherd said the government should do more to encourage nurses to work throughout the province, not just rural communities.

“We’re desperate for nurses in all of Ontario,” he said. “They should probably reimburse if not all, [then] half of the nursing tuition for all the students that have been going to nursing school,” said Shepherd.

Shepherd also hopes to see the elimination of Bill 124, which imposes a hard cap of one per cent per year to wages and benefits for nurses and other health care professionals, according to the Ontario Nurses Association. 

If housing was reimbursed as part of the government’s new program, Abdella said she would consider the move.

“It would be a lot better if they were covering it; maybe I would go.”

Barakati said she thinks rural work experience should be a mandatory component of Canadian nursing education to help underserved communities. 

“Especially since it’s getting worse and worse, it might be worth it to make it compulsory.”

She added, however, that a short work term in an underserved community doesn’t solve issues with medical care in those areas.

“Solving the problem is not necessarily just having someone there on a monthly basis,” she said. 

“It’s a matter of continuity of care. For example, you need a family doctor to take care of you for a number of years, not just months.”

Although some students don’t wish to work in rural communities long-term, they said they might still want a temporary experience.

“It would be great as a short-term experience,” Zhang said. “What attracts me is basically just the idea of increasing your scope of practice, as well as gaining a lot of experience working with different populations and just taking on more autonomy and responsibility on your own.”

Barakati said she would consider working in a rural community in Ontario for her 12-week winter placement, even without an incentive.

“I just want to experience different environments, improve working conditions and my own understanding of working in these situations,” she said. 

At the end of the day, Barakati just hopes rural communities get the support they need.

“At the back of everyone’s mind we know about the health disparity in remote communities and rural communities and they just need help.”

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