Predictors of work engagement among rural and remote nurses who provide hospice, palliative, and end of life care: Results from a national study
4 affiliations
- 1College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- 2School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
- 3Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- 4University of Akureyri, Norðurslóð, Akureyri, Iceland
Abstract
Background: The availability of palliative health care professionals is considered a global concern, especially within rural/remote practice settings. Nurses across all domains of practice are expected to advocate for high-quality hospice, palliative, and end of life (H/P/EOL) care. However, within many rural/remote geographical areas, formal palliative care services are non-existent, leaving generalist nurses to take on this complex responsibility. Methods: Examining results from a Pan-Canadian cross-sectional survey of rural and remote nurses (N = 3,822), this paper explores a subset (n = 295) of nurses who provided hospice, palliative and/or end of life care as part of their practice. Analyses examined job demands and job resources, predictors of work engagement, and a summary of open-ended responses. Results: The rural and remote nurses who worked in hospice, palliative, and/or end of life care had significantly higher satisfaction with practice demands related to their safety, lower practice resources related to staffing and time, and higher levels of work engagement compared to nurses in other areas. Multiple regression analyses demonstrated that seven variables accounted for 40% of the variance in their work engagement, including: perceived mental health, job satisfaction, interprofessional collaboration, affective organizational commitment, continuance organizational commitment, normative organizational commitment, and lower job demands related to working conditions. Open-ended data revealed that rural nurses felt privileged to provide H/P/EOL care, however, faced barriers related to blurred personal/professional boundaries when dealing with death/dying and lack of access to palliative resources. Conclusions: This is the first Canadian national profile of rural and remote nurses who provide hospice, palliative and end of life care and highlights key areas related to their professional quality of life (e.g., work engagement, organizational commitment, job resources/demands). The results of this analysis may inform practice and policy development for health human resource planning and recruitment/retention in hospice, palliative and/or end of life care across rural and remote settings.
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BibTeX
@article{penz2026predictors,
title = {{Predictors of work engagement among rural and remote nurses who provide hospice, palliative, and end of life care: Results from a national study}},
author = {Kelly L. Penz and Erin Barker and Julie G. Kosteniuk and Norma J. Stewart and Steinunn Jónatansdóttir and Martha L. P. MacLeod},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0358592},
url = {https://doi.org/10.1371/journal.pone.0358592},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Predictors of work engagement among rural and remote nurses who provide hospice, palliative, and end of life care: Results from a national study
AU - Kelly L. Penz
AU - Erin Barker
AU - Julie G. Kosteniuk
AU - Norma J. Stewart
AU - Steinunn Jónatansdóttir
AU - Martha L. P. MacLeod
PY - 2026
DA - 2026/09/16
JO - PLOS One
DO - 10.1371/journal.pone.0358592
UR - https://doi.org/10.1371/journal.pone.0358592
AB - Background: The availability of palliative health care professionals is considered a global concern, especially within rural/remote practice settings. Nurses across all domains of practice are expected to advocate for high-quality hospice, palliative, and end of life (H/P/EOL) care. However, within many rural/remote geographical areas, formal palliative care services are non-existent, leaving generalist nurses to take on this complex responsibility. Methods: Examining results from a Pan-Canadian cross-sectional survey of rural and remote nurses (N = 3,822), this paper explores a subset (n = 295) of nurses who provided hospice, palliative and/or end of life care as part of their practice. Analyses examined job demands and job resources, predictors of work engagement, and a summary of open-ended responses. Results: The rural and remote nurses who worked in hospice, palliative, and/or end of life care had significantly higher satisfaction with practice demands related to their safety, lower practice resources related to staffing and time, and higher levels of work engagement compared to nurses in other areas. Multiple regression analyses demonstrated that seven variables accounted for 40% of the variance in their work engagement, including: perceived mental health, job satisfaction, interprofessional collaboration, affective organizational commitment, continuance organizational commitment, normative organizational commitment, and lower job demands related to working conditions. Open-ended data revealed that rural nurses felt privileged to provide H/P/EOL care, however, faced barriers related to blurred personal/professional boundaries when dealing with death/dying and lack of access to palliative resources. Conclusions: This is the first Canadian national profile of rural and remote nurses who provide hospice, palliative and end of life care and highlights key areas related to their professional quality of life (e.g., work engagement, organizational commitment, job resources/demands). The results of this analysis may inform practice and policy development for health human resource planning and recruitment/retention in hospice, palliative and/or end of life care across rural and remote settings.
SN - 1932-6203
ER -