Extreme nursing: Qualities and attributes of long-term retained nurses in Bristol Bay Alaska

Background: The profession of nursing is grounded in principles of social justice and service to vulnerable populations yet there is a longstanding extreme shortage of nurses in remote settings, particularly in Alaska. Recruitment is difficult and expensive. Living conditions are primitive, social amenities few, and turnover rates very high. The common wisdom holds that nurses who come are “either running away from, or searching for something.” And yet there are nurses who come, practice, and stay to become influential community members. This study explores the qualities and attributes of nurses who settled and stayed in this very remote, underserved region. Methods: The study entailed use of a semi-structured interview of 10 of 14 nurses living in Bristol Bay, Alaska, for at least 15 years, in 2012. Nurses were selected from a small population known to the principle investigator and “snowball” selection thereafter. Transcribed interviews were analyzed for content and themes. Results: Analysis revealed this sample of nurses to have a strong sense of adventure, an independent attitude associated with family growth and development, and positive views, although often negative experiences, of Native Alaskan culture and institutions. Motivations for moving to or staying in bush Alaska did not specifically include the practice of nursing in this setting. Conclusions: This study will inform recruitment and retention practices in remote settings among vulnerable populations, as well as ensure these unique nurses' stories are preserved and told.