The challenges for nurses in remote and rural areas of Australia are myriad, but so are the opportunities to improve health outcomes for some of the country’s more-vulnerable populations.
Nurses are often the primary carers in such communities, working either in small teams or in isolation. They care for patients in areas with reduced or minimal clinical support — and often with much higher rates of disease and lower life expectancies than in metropolitan centres.
Even though all nurses train as generalists, the geographic setting of rural and remote nursing dictates the need for advanced skills in generalist practice. Nursing responsibilities in rural and remote areas run the gamut of healthcare — from aged care to emergency response to mental health support — and they include responsibilities in the areas of health promotion and education. Empowering nurses with the knowledge, skills, competence, and confidence to make clinical decisions and ultimately deliver total patient care is key to driving good patient outcomes.
The National Rural and Remote Nursing Generalist Framework 2023-2027 has been developed as a tool for registered nurses who currently work or want to work in this space — to help them apply the full scope of practice. The nursing generalist framework is also a guide for those tasked with ensuring professional growth and support, including educators and government agencies.
Facing the challenges
The framework acknowledges difficulties for rural and remote nurses. As socioeconomic disadvantage increases with remoteness, so does the level of complexity of healthcare issues in those communities.
Rural and remote nurses typically work in regions that have higher rates of hospitalisation, injury, and death as well as reduced access to healthcare services. In even more-remote areas, they are often the only continuous source of healthcare, working without support from allied health or other medical professionals. It means they need skills for leading the clinical assessment of patients and even for developing public health initiatives to improve their communities.
The framework emphasises the need for advanced generalist nurses with a thorough understanding of common and significant conditions across the care life span and the skills to manage them, as well as the clinical confidence to push beyond their comfort zone.
The framework examines the context of practice and core capabilities, dividing them into four domains:
- Culturally safe practice
- Critical analysis
- Relationships, partnerships, and collaboration
- Capability for practice
The domains outline what’s required for a nursing cohort to become better equipped to care for the 7 million Australians who live in regional, rural, and remote areas and to drive positive change in overall health outcomes.
Culturally safe practice
At the heart of the framework is the crucial concept of culturally safe practice. Nurses must be aware of how their own culture, values, and beliefs can affect their perception and care of others and take the lead to ensure person-centred care.
Rural and remote nurses are engaged in communities with much higher percentages of First Nations Australians, who represent the country’s most-disadvantaged group in all social indicators, including employment, education, and housing, all of which affect health outcomes. They also serve a wide range of people with diverse needs, including culturally and linguistically diverse groups.
Upholding culturally safe practice demands capabilities that:
- Actively support individuals’ rights to determine their own cultural safety
- Take the time for critical reflection, seeking cultural guidance and applying those learnings
- Advocate for fairness and equity in rural and remote communities and actively contribute to challenging beliefs based on assumptions.
Critical analysis
Registered nurses must use critical analysis at every step of the health continuum — including assessment, planning, delivery, and evaluation — in the delivery of person-centred care and public health programs. That critical analysis consists of:
- Recognising the effect of colonisation on health outcomes, operating with cultural humility and respect, and actively incorporating professional and cultural knowledge in caregiving
- Critically evaluating information so as to deliver evidence-based practice and working with individuals, families, and communities to codesign health interventions and programs
- Making best use of available technology — including digital health platforms — to assist in access to healthcare remotely and continue professional development.
Relationships, partnerships, and collaboration
Rural and remote nurses’ isolation is not only physical but also professional, with reduced, if any, supportive health resources on the ground. Therefore, they must facilitate and maintain open engagement with all care partners by:
- Communicating effectively with families, community support networks, and multidisciplinary team members to provide wraparound person-centred care
- Drawing on collective expertise from those relationships to deliver collaborative holistic care that is evidence based and supports individuals’ needs and independence
- Creating and nurturing a supportive learning environment that generously shares skills in low-resource settings and champions the profession.
Capability for practice
The challenges of remote and rural work make it imperative that nurses not only hold themselves to account but also constructively support their colleagues’ capabilities for practice. Nurses who work remotely must focus on:
- Maintaining care of self and others through peer support, mentorship, and clinical supervision and by using resources innovatively to provide the full scope of practice
- Demonstrating commitment to ongoing learning and development through remote and rural health professional organisations to enhance quality and culturally safe care
- Identifying gaps in learning and then upskilling and working to improve rural and remote nursing by being accountable for their own practice and supporting the development of colleagues.
Nurses have a critical and diverse role in the healthcare of rural and remote communities. Healthcare leaders must ensure appropriate mentorship, must offer nurses educational opportunities, and must establish ongoing support to help recruit, develop, and retain nurses with the advanced generalist skills required in these geographic areas.
Interested in learning more about how Lippincott® can help support care in remote or rural care settings?
