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Rural health: It’s time to address the issues

Now is the time for the government to direct incentives to the rural workforce. 

Health Workforce Australia (HWA) has released an online consultation paper, Nursing Workforce Retention and Productivity, to encourage further feedback and discussion in regards to strategies to improve nurse retention and productivity, as well as inform HWA of existing programs that are already successfully addressing these issues (HWA 20173b).

This paper was prepared after preliminary consultation with key stakeholders. In my capacity as Australian College of Nursing CEO, I have been involved in a number of these preliminary discussions.

One issue from the paper I would like to pay particular attention to in this editorial is that of rural health. The paper highlights the fact that the most significant workforce issue facing rural communities is the ageing nurse workforce, and that strategies need to be developed and implemented to ensure a sustainable rural nurse workforce.

The paper provides examples of innovations in the rural nurse workforce, noting HWA’s own Rural Health Professionals Program designed to provide support services to international and local nurses and other health professionals practicing in rural and remote Australia, and in Aboriginal and Torres Strait Islander health services. Also mentioned is the government’s Nursing and Allied Health Scholarship and Support Scheme which encourages the pursuit of a career in rural health and facilitates educational opportunities for nurses, midwives and allied health professionals (HWA 20173b, p. 29).

If HWA is to properly address the issues affecting rural communities it’s important that messages from last year’s Senate Standing Committee on Community Affairs senate inquiry are carefully considered. The committee’s inquiry report, The factors affecting the supply of health services and medical professionals in rural areas, was released in August 20172 (SCACS 20172). The findings were noted by HWA; however, it is important to note that stakeholder feedback indicated that the inquiry’s recommendations could have gone further; a belief shared by ACN.
The report included eighteen recommendations to address issues faced by rural and remote health services. Amongst these recommendations were:

• The development of an accommodation strategy
• The extension of the HECS Reimbursement Scheme to nurses and allied health professionals
• The improvement of data collection
• That ‘generalist’ medical skill-sets be encouraged.

Notably, Royal College of Nursing, Australia (RCNA), now ACN, was cited substantially within the report as representatives from RCNA presented their perspectives at the initial inquiry hearing. While the report largely focused on the medical profession, it had clear advice for the government that it’s time to direct incentives to the rural nurse workforce.

Accommodation and education

It is widely acknowledged that professional life in rural and remote areas can be challenging for health practitioners, particularly those who relocate for work purposes.

The senate inquiry’s report recognises many of these personal and professional challenges for practitioners. Importantly, the inquiry recommended the development of an accommodation strategy for rural health workers as part of the federal government’s planned review of rural health programs. ACN was pleased to see the committee make this long overdue recommendation, as one of the major impediments met by nurses considering a rural nursing role is the lack of access to appropriate and affordable accommodation.

Another significant challenge facing rural nurses is access to ongoing education; if nurses working in rural communities are not able to maintain and, indeed, enhance their practice skills this can only have a detrimental impact on both the nurse and the community they work for. While there are many issues to be considered when looking at reform of the rural nursing workforce, if the problems of adequate accommodation and access to education are not addressed as priorities for reform, tangible progress in the rural nursing workforce will not be fully reached.

HECS reimbursements

Compared with the medical workforce there are very few policy incentives in place, either financial or career – to attract and develop the rural nurse workforce. This has direct implications for the quality of health services available to rural communities, as in many rural areas the bulk of services are provided by nurses. That’s why the committee’s clear recommendation that the HECS Reimbursement Scheme, currently available for doctors, be extended to nurses and allied health professionals; another positive development in the right direction.

Data collection

The report also acknowledged that data collection must be improved to provide a foundation for future strategies that will address gaps in service delivery. We know the nurse workforce in rural and remote areas is ageing, and in the past there has been a lack of ‘robust and meaningful’ data to inform a cohesive strategy to address the capacity and capability of the current and emerging rural nurse workforce.

Pleasingly, the advent of the national registration scheme and the release of HWA’s Australia’s Health Workforce Series – Nurses in focus (HWA 20173a) are examples of positive advances to address this shortfall of data.

Generalist medical skill sets

In remote and very remote areas, there are small populations across large geographical distances, the implication being that there often is not enough demand for specialist medical services. The committee noted this and recommended a move towards a more ‘generalist’ skill-set in medical professionals working in remote areas, encouraging a higher education course which promotes the generalist skill set.

Equally, nurses working in rural and remote areas need to possess a high level of generalist skills.

This raises some issues: how to develop and maintain such a broad skill-set when some of these skills may only be called upon occasionally; and recognition and career pathways for nurses are more commonly recognised through specialist areas of practice, rather than good generalist skills.

These can be difficult to address but are very relevant in the rural and remote settings.

While noting these recommendations, ACN does believe the committee missed an important opportunity to argue for incentives to expand the nurse practitioner model within rural health services. The committee made specific mention of the need to broaden the scope of skills and competencies of the existing workforce, noting nurse practitioners, but fell short of making a definitive recommendation.

ACN is encouraged by the report’s findings as well as the additional work taking place through the HWA consultation process. However, it is crucial that these recommendations gain momentum and is followed up by both current and successive governments, for the issues affecting rural health services to be addressed in a meaningful way.

In partnership and collaboration with ACN rural nurse leaders we will carry on representing the nursing profession at future HWA forums, and will continue to ensure the needs of rural nurses are not overlooked.

Adjunct professor Debra Thoms is chief executive of the Australian College of Nursing.

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