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Call to boost rural staff incentives

Nurses will play a leading role in ensuring all Australians get equal access to healthcare – if they get support. By Amie Larter
By the year 2020, the National Rural Health Alliance (NRHA) hopes all Australians will have equal access to healthcare.

In general, people living in rural Australia do not have the same opportunities for good health as those living in our cities, but Gordon Gregory, NRHA executive director, says that nurses arguably play the greatest role in changing this imbalance.

Compared with other medical professionals, nurses have the largest footprint in the rural areas, and although there are still widespread shortages of staff, Gregory says that the figures are less than for other medical specialists.

“You have remote area nurses who do a wonderful job and who are frequently the most highly trained health professional in the area,” he says. “The doctor comes in and does a clinic on Wednesday afternoon or once a month, but the resident, on-the-spot health professional with the highest skills is often the remote area nurse.”

To date, a population-needs approach to workforce planning is not apparent in Australia. The undersupply of health professionals to remote areas has meant that local residents have poorer health outcomes than those in metropolitan areas, having higher levels of disease and risk factors and shorter lives.

“Less than a third of the total number of doctors, nurses and allied health workers work in rural and remote areas,” Gregory says. “In general, the more remote you go, the worse the shortages are.”

According to the Health Workforce 2025: Doctors, Nurses and Midwives report, by 2025 the need for registered nurses could exceed supply by 115,800.

The report suggests the shortfall can be reduced only with more training capacity combined with workforce reforms and skilled migration options.

Gregory believes that we need to focus on persuading trained nurses to stay in the industry in order to continue improving the supply to remote areas.

“We have got to get a greater proportion of nurses to be willing, able, equipped, encouraged and incentivised to work in rural areas,” he said.

The report also reveals that while a suite of programs exist for doctors, there is less encouragement for nurses and midwives to work in remote areas.

NRHA is working to standardise incentives across the board.

Gregory also says cultural exposure needs to be addressed in order to encourage nursing in rural areas.

“Very subtle things, like the way teachers both in high schools and particularly universities describe, model or connote rural practice, have to be set right,” he says.

“This needs to be followed through to well-supported – and that means happy – rural placements when [students] are training at university.

“At the moment, nurses have much less support from their preceptors, mentors and universities, as well as less travel and accommodation support; all things are worse for nurses than they are for medical students.”

Case study: Alice Springs Hospital

Servicing a region of over a million square kilometres, Alice Springs Hospital’s (ASH) emergency department is not a stranger to workforce shortages. With over 43,000 presentations a year, this hospital plays a vital role in the area’s medical services.

Denise Brewster-Webb, executive director of nursing, says that the hospital’s location poses many challenges when recruiting, with many people having preconceptions about living and working in a desert area.

“To get to the nearest capital is a two-day drive,” she says. “At present there is one airline operating out of Alice Springs with daily flights to most mainland capitals and some regional airports.

“Staff who wish to experience remote nursing/midwifery or are on a travelling work holiday will often come for shorter periods like three to six months.”

Presentations have increased by seven to eight per cent on average per annum over the past six years, with 60 per cent of patients being Indigenous, and paediatric patients accounting for 20 per cent.

The Indigenous population has a complex range of chronic diseases requiring more frequent hospitalisations; they are also resource-intensive.

“Like all major secondary hospitals we look for staff with many and various skills to suit individual areas such as renal, ICU, ED and perioperative services,” Brewster-Webb says. “Staff with a generalist medical/surgical background come with the clinical skills to work within the hospital.

“An understanding of the cultural aspect and [experience] in working with an Indigenous population are helpful to have prior to coming, but not essential as we offer cultural training.

“Our skilled educators assist staff in making a successful transition to their clinical area. We also offer professional development opportunities.”

This last point is one of the advantages of working in a rural area. Nurses can more easily gain experience in different departments, as well as access dedicated programs for career advancement.

“Giving people the opportunity to enter a supported program enables practitioners to learn the basics before undertaking postgraduate qualifications, and this is an opportunity to develop a career pathway,” says Brewster-Webb.

“We are currently at the front end of developing advanced practice/nurse practitioner roles, with the aim of having our first nurse practitioner role in the ED.”

The current ED, which provides support to the community, remote clinics and Tennant Creek Hospital via consultant advice in pre-hospital management, has served the community well, but construction is now underway of a new, purpose-built department. Staff from the ED have been involved with its design.

“Our new ED, which is due to open in March 2013, is significantly larger, with an additional 18 treatment spaces – in the form of an eight-bay primary care unit to fast-track patients, and an eight-bed short-stay unit,” Brewster-Webb says.

“In all, the facility will comprise 31 treatment spaces including a paediatric treatment room, two secure assessment rooms and three resuscitation areas, as well as triage, procedure and consultation areas, a training and education room, a reception area and staff office space.”

Despite the challenges of space and the current age of the ED, Denise says that there is great team spirit, which is important for dealing with the many and varied presentations.

“The ED is education-focused and offers a supportive place for experienced and beginning practitioners to advance their knowledge and skills, and experience the difference of working with a largely Indigenous population.”
A nurse’s perspective

Shannan Ryan, nurse resource co-ordinator at Alice Springs Hospital (ASH) gave Nursing Review an insight into his experience in the rural health sector.

NR: What prompted your decision to work in a rural hospital?
Ryan: I grew up in a rural area of Victoria and decided to travel with my partner before we had kids. We thought we would go around Australia and do short contracts. So for two-and-a-half years we worked in the Northern Territory and Western Australia – but we kept coming back to Alice Springs. I did four contracts before signing on permanently in 2009, and I stayed. Having a small town with a big hospital appealed to me.

NR: What are the differences working at ASH in comparison to other hospitals?
Ryan: The clientele is completely different; many Indigenous. It’s a lot different from the work I was used to in the eastern states. There is lower length of life, increased health problems and [worse] living conditions. Adapting to realising [the Indigenous people’s] situation is one of the biggest changes, as well as being able to assist them from their point of view rather than trying to force a Western medicine ideal on them.

NR: What additional skills have you learnt from working in a remote environment?
Ryan: Advocacy and looking more at the patients’ benefits. We are trained to fix the problems, but there is not necessarily an easy problem to fix. That’s one of the challenges in Alice Springs – actually finding the causes and why the causes are. Also realising that sometimes your beliefs aren’t what other people’s are, and that’s where the advocacy is important.

NR: What is the appeal of working at ASH?
Ryan: Due to our staffing problems, you have the opportunity to experience areas that you may not in other hospitals. If you want to try renal studies, intensive care or emergency, the opportunities are more readily available. There is also a lot of opportunity for study as well. The clinical work here is not that much different; however, because we are 1600km from the nearest metropolitan centre we are able to look after a lot sicker and more complex patients.

NR: What is the lifestyle like outside of work?
Ryan: We have got two senior staff members from Sydney originally working here at the moment, and they have just signed on permanently. You are coming into a small country town that is very community driven and has strong community relationships. It is very outdoorsy, with a good climate; sport is a big factor as well as other social activities outside. I think the town can be a bit of a culture shock for some big-city nurses, just because you are in a rural centre and you don’t have the services or lifestyle that you have in a big city.

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