I have also examined rural nurses work of providing maternity care which is considered to be an important part of primary health care services (and often many client's first contact with the health care system). I have learned from rural nurses that the fewer births there are in their local community the more concerned RNs become that they will not have the skills needed to work with physicians and midwives to provide this essential service. A vicious cycle is then created where fewer women and families are encouraged to have their babies in a rural or smaller community hospital.

And yes, when a rural nurse needs a broader spectrum of skills it seem unfair to shift the burden of responsibility onto the individual nurse for paying for all these requirements. I have noticed that communities and employers vary significantly in their willingness to support ongoing professional development for nurses working with rural, remote and indigenous communities.