Remote incentives for nurses

There is a desperate need for nurses in rural areas, but there’s also a great sense of potential for the nurses who do relocate. By Flynn Murphy

I was at Royal Hobart, and I’d been there for 15 months,” recalls specialist ED nurse Jerildene Smith. “I got a phone call the day my contract expired which said ‘you can finish up the roster, but after that, there’s no more work for you’.”

Smith’s was just one of hundreds of nursing positions slashed during a particularly savage round of cuts in the 20161-12 financial year.

After failing to find work locally, Smith signed up with a nursing agency. There was a spot available up in Leonora, around 2.5 hours’ drive north of Kalgoorlie in WA. An immediate start.

“So four or five weeks after I’d been told there was no work in Hobart, I left to take up a three month position [in Leonora].”

Smith admits she was forced to make the leap. But she’s glad she was.

“I had no idea of what I was diving into, or what to expect. It was $700 one-way [for the flight to Kalgoorlie], and I had to pay that up front – though I got it back at tax time. You can go overseas and back again for that amount of money.”

Having qualified as a registered nurse in 2008, Smith says it was frightening to find herself in charge on a night shift at Leonora District Hospital, which is classified as “very remote”.

But while noting it was difficult to get time off for professional development, Smith calls her decision “the best I’ve made … I learnt bucket-loads about the things you just don’t see, like rheumatic heart fever … and I saw more bad ear infections than I’ve ever seen in my life.”

Smith was always made to feel welcome at Leonora and at ‘neighbouring’ Laverton Hospital (one hour north), where she took occasional shifts. “Even though they had a high staff turnover, they were incredibly supportive.”

Her critical care skills diminished due to lack of practice, but she gained valuable competency in triage and suturing, she says.

“My health assessment skills went off the chart. You’ve got to decide whether you can manage something yourself … and that improved my professional confidence. You ask yourself, do I need to ring the doctor, or do I need to get the director of nursing involved? Is it going to blow up in my face? And you’re making these decisions at 2.30am. You can’t afford to drag somebody out of bed at that time for a cut finger.”

Smith made $6000 more than the EBA rate at Royal Hobart Hospital just by virtue of being in Western Australia. In addition, she was paid $170 dollars a fortnight by the government.

Rural or remote?

There is nowhere ‘rural’ left in Australia. At least, not according to the Federal Health Department’s classification system.

Since 20016, it has used the Australian Bureau of Statistics classification model, which splits Australia into ‘Remoteness Areas’ (RAs) based on population size and distance from urban centres.
There are five zones, ranging from major cities (RA1) to “very remote” (RA5). Each zone sees government pay different incentives to contracted health professionals.

The Rural Health Professionals Program, developed by Health Workforce Australia, offers incentives to those who move to a location with a higher RA than the one they currently work in.

The program has placed a total of 100 nurses since it began in January 20162 – just over half of which came from outside Australia. Seventy-nine of these nurses have been placed in the RA2 and RA3 category zones, which traditionally lack the drawing power of higher category areas.

Carole Taylor, CEO of remote health professional advocacy group CRANAplus, says pay is not an issue for remote nurses, and that most are very well-paid. But she says many don’t receive the support they need.

“They need to be properly oriented. When people are going into a remote community, whether it’s a mine, or an aboriginal community … you can’t just dump people into places.”

Taylor says while the differences between metropolitan and RA2-3 are huge, the differences between RA2-3 and RA4-5 are even bigger – particularly when it comes GP support.

“Most [RA2-3] hospitals have a strong GP base, whereas GPs often don’t exist in remote areas.”

She adds that when it comes to aboriginal health, “no such thing as generic cultural awareness” – but that cultural awareness is community-specific and needs to be treated as such.

Placement and agency contracts

For nurses seeking to take up an RA2-5 placement, there are two types of contract available – ‘placement contracts’, and ‘agency contracts’. Circumstances differ state to state, but the type of contract a nurse is on affects their rate of pay, entitlements and incentives.

A health facility such as a public hospital can choose which contract to hire nurses on, and both placement and agency contracts can be administered through nursing agencies.

The key difference is that the rate of pay on an agency contract is generally higher than that on a placement contract (which is the same as that of the local permanent staff).

The pay is traded for entitlements – an agency contract typically won’t offer sick leave, annual leave, long service leave or professional development leave entitlements. So placement contracts can be ideal for medium to long term stays. Typically, nurses on placement contracts can carry these bonuses over to other sites.

While private facilities have discretion about which contracts they hire nurses on, all contracts offered in public facilities in the NT, NSW and SA are placement contracts.

In West Australia, the casual and agency nurse pool for public facilities is governed by the state government through NurseWest, but only agency contracts are available in the West Australian public system.

There is great demand for RA2-5 nurses, and many agencies offer financial incentives to encourage take-up, such as a weekly stipend, travel assistance and accommodation (though many facilities provide this for free).

Nursing Review spoke with Alison Allardyce, nurse enquiries manager with CQ Nurse nursing agency.

“On the whole, agency work in Australia is in a downturn … [but] nurse applications have skyrocketed.”

By offering access to education programs for contract nurses, CQ Nurse has been able to capitalise on the fact that Australian Health Practitioner Regulation Agency (APHRA) will be auditing nurses to ensure they are completing their required 20 points of Continuing Professional Development per qualification – education being something contract nurses can find difficult to access.

So where are the most popular places to go? Allardyce gave Nursing Review the low down. On her list of hotspots right now are WA, NT and NSW for nurses, though she said midwives and emergency department nurses were in demand pretty much everywhere. In Queensland, however, a public health recruitment ban has cooled the market.

Dry communities in WA and NT continue to be very popular places for remote work, and Alice Springs Hospital produces consistently positive feedback. Alice Springs is also a popular destination for nurses looking to transition into aboriginal health.

When it comes to aged care nursing, NSW is a popular site for rural nurses seeking the more lucrative agency rates offered by private facilities there.

Tully Hospital, a rural hospital in far north QLD, stands out as a consistently popular place due to its proximity to Cairns.

Wherever the placement, Smith says she can’t recommend working nursing in rural and remote areas more highly.

“It’s enhanced my practice, my skills, my ability to problem solve and deal with unexpected situations – and it’s probably made me better as a person as well.”

ANF: Incentivise remote nursing

With graduates finding it increasingly difficult to obtain jobs, many have weighed in on the issue pointing out that grads could be further encouraged to take up remote area placements.

ANF federal secretary Lee Thomas says incentives such as reimbursing the course fees would be a “win win” for nursing and midwifery graduates and “high need” workforce areas, such as Australia’s rural and remote communities.

“Highly trained nurses and midwives play a crucial role in delivering safe patient care in in remote and rural communities across Australian,” Thomas said.

“As we’ve highlighted, the federal government offers a range of incentives to attract medical students into working in rural and regional communities, yet the same doesn’t apply to nurses and midwives.

“Reimbursing course fees would help in attracting nurses and midwives to relocate to rural practice and at the same time, be providing them with clinical placement or in some cases a graduate year.

“As we know, these communities are all too often short-staffed and there would be great benefit to both the community and the nurse or midwife in offering these incentives.”

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