If not us, then who?

Ethnographic insights into the changing role of nurses in rural health care

This paper presents an ethnographic study of the changing roles of nurses in rural healthcare in Norway, particularly in the context of the Coordination Reform of 2012 which aimed to decentralize healthcare. We examine the challenges faced by rural municipalities in providing equal access to primary care due to factors like climate, demographics, geography, and the recruitment and retention of qualified healthcare personnel. We also explore how rural nurses navigate these challenges and how their roles have evolved in response to political and demographic developments. Drawing on the theory of the social organization of healthcare work, we highlight the often unacknowledged complexity of nurses' professional skills and knowledge, and their crucial role in service development. Furthermore, we use the ‘local’ and ‘cosmopolitan’ concepts to explore how the lack of consistent access to doctors in rural healthcare settings impacts the work of nurses and the social dynamics within the emergency clinic. We conclude by emphasizing the need to recognize and value the unique contributions of rural nurses in reshaping and reorganizing health services to meet future demands and expectations.