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Interview with Rural & Remote Nurses

outback nursing

We recently interviewed Nicole. H and Rachel. F, both Emergency Department Rural & Remote (R&R) Nurses at Healthcare Australia (HCA) to find out about their transition into remote nursing with HCA’s New to Remote Pathway (NTRP).

As R&R roles can be physically and emotionally demanding, the NTRP helps Nurses ease into their new remote placements. Keep on reading to find out more about what Nicole and Rachel had to say about their travel adventures and the firsthand advice they give to others looking to work in a rural & remote setting.

HCA: When, where and what was it like when you first started doing R&R contact work?

Nicole: I’m an Emergency Department (ED) nurse, with four years experience at Royal Darwin Hospital.  My first remote contract was one month in Lajamanu over Christmas last year. The clinic was run by agency staff at the time. We all had different clinical strengths which made for a great team. It was both really exciting and exhausting. Exciting because no two days were the same and it was my first experience of using CARPA (Central Australian Rural Practitioners Association), the standard treatment manual that is used in remote clinics in the NT. Exhausting because it was a very busy clinic and I had so much to learn. I learned a huge amount in that first month, particularly about primary health, and made some good friends along the way.  I left the contract feeling like I had definitely made the right choice in taking the leap in going remote.

Rachel: I’m a hospital trained nurse and was working as a Sole Practitioner when I began remote nursing in the late 1970s at Goodooga, North West of NSW. During that time, I was a Registered Midwife which made ante and post-natal checks easier, so I could deliver a premature baby with one other nurse, luckily both mum and the baby made it through.

HCA: What made you choose R&R Nursing as a career?

Nicole: One of the reasons I became a nurse was because I was keen to go remote. I’ve always had a strong interest in social justice and the social determinants of health.  I’m also currently completing a Masters in Public Health and Tropical Medicine which is very relevant to remote nursing. I feel very lucky.  I get to live and work in stunning remote locations that very few people get to see and learn about indigenous culture, all whilst supporting these communities.  I also love how flexible I can be when taking leave in between contracts, which makes for an amazing work-life-study balance.

Rachel: I was always drawn to the bush when I was young and I had an interest in working with the aboriginal people. I grew up in a regional area going horse riding and bushwalking, so it was a natural transition for me. My kids and beautiful grandchildren are very supportive of my career, so it makes it that much sweeter when I see them and tell them stories about remote nursing.

HCA: How did the New to Remote Pathway (NTRP) help you transition to remote work in Australia?

Nicole: Working in the Royal Darwin ED for four years before going remote really set me up for the job as we received patients from the very communities I am now working in. In addition to all the usual ED nursing skills, I learned a huge amount about tropical medicine and indigenous health.

I had some experienced Remote Area Nurse (RAN) friends who recommend HCA to me. I had been planning on going remote for a few years before I made the call to HCA. I had pretty much done all the pre-requisite courses and competencies. From the first contact with HCA I felt like I was in safe hands. They have relationships with clinics that are willing to take on and support new to remote nurses. Hollie and Danni really listen to me and have never pushed me to do something that I wasn’t comfortable with. I feel like the R&R team are helping me to develop my career and that they hold my safety as paramount.

Rachel: The NTRP set me up for courses that I was required to do, these included Pharmacotherapeutics and Immunisation Certificate. I felt very well-equipped when I did my first placement with R&R HCA. At first, they sent me to places I felt comfortable with and then slowly progressed me into more challenging roles. Some roles included Wilcannia (Western NSW) in February which was a wonderful experience. Working with the R&R HCA team has been fantastic and they were very supportive when I had to leave a contract one week earlier than expected.

HCA: What has been your most challenging remote role so far?

Nicole:  The contract in Yarralin.  It was rewarding to be able to support a small community of only approximately 200. I really felt like I got to know a large number of people in the community. However, it’s a two-nurse post so I was first on-call for half of the week after long days at work. I became quite exhausted after six weeks. The R&R HCA Team supported me through this.

My first ever on-call shift was memorable in Lajamanu on Christmas day. I was second on-call and received a phone call in the middle of the night from tired and stressed first on-call nurse stating that we had a patient in labour. I rushed over to the clinic whilst running over in my head what I had learned in CRANAs Maternity Emergency Care (MEC) course. Very few communities have midwives so you must be prepared for it all. Anyways, with the help of the District Medical Officer (DMO) on the telephone, we managed to stop the contractions and evacuate the patient out of the community safely.

More recently, I received a call that a patient on an outstation 45 mins 4WD away had been fitting for 30 or more minutes. It was a two nurse post, so I called my colleague and we quickly headed out to the outstation in the troopy ambulance.  There is no telephone reception out there either, just one landline phone in the middle of town, which adds to the challenge.  We managed to stabilise the patient at his home and get him back to the clinic and contact the DMO to have him evacuated. In my experience, the DMOs are wonderful to work with and it’s always a relief when Care Flight arrive.

Rachel: When I worked in Lajamanu, it was quite overwhelming and the work was quite complex, with sexual health screening and treatment. I required more knowledge of sexual health and diseases, infant and maternal welfare.

In more recent times, my most challenging situation was when a 2-year-old fell off a slippery dip at night and became unconscious. I had to stabilise the baby and wait for Care Flight to arrive. When the doctors arrived they were so kind, patient and supportive and it made for a very surreal experience. Another hair-raising experience was a pregnant mum who was being physically abused by her husband and wanted to escape with her 4-year-old child. These types of situations are very emotional and stick with you for life.

HCA: What’s a typical day like for you?

Nicole: Unless you’ve been on call the night before, the start time is 8 am for a meeting. As a team, we look at the recall lists and the people who need to be seen. The types of patients we see varies from things like common colds, antenatal checks, and immunisations, to full-on emergency presentations. If there is a GP in the clinic, they will help during the day. If there is an emergency in the middle of the night, the District Medical Officer (DMO) assists via the telephone and Care Flight is on call to evacuate patients.

Rachel: My day starts with an 8 am meeting for 30 minutes to discuss re-calls and at 8.30am the clinical day starts. The types of patients we treat are children with sores, people who require penicillin injections for rheumatic heart disease, monthly injections, STI screening, taking of blood, immunisations, chest infections, post-natal care, stab wounds, station accidents, broken limbs, roll overs and much more.

HCA: Where has been your favourite part in Australia to work remotely?

Nicole: Millingimbi, the location I’m currently based at, and Kalkarindji have been two of my favourites. Milingimbi has a big team for a remote area with a lot of Yolngu staff. I am usually on-call two times a week, and we have a Yolngu security officer who looks after us when we have to work late which is extremely comforting. I have really enjoyed getting to know the community here. Gattjirrk Cultural Festival has been on whilst I was here which was wonderful. I joined one of the choirs. Being a tropical island it’s lovely being so close to the ocean.

Kalkarindji is also an interesting place, four hours south west of Katherine. There’s quite a bit to explore in the area, a nice creek to swim in, bush walking and fossicking for amethyst and smokey quartz. It’s also very close to the site of the famous Wave Hill walk-off commemorated in the song ‘From little things big things grow’.

Rachel: I loved the desert country in Kalkarindji because of its history of the Walk-Off in the 60’s and 70’s. It also has a 15-km Walk-Off track, lots of hills and a beautiful river which is nice when it’s very, hot! I’m currently at Aurukun up in the Cape where I’m always hunting down delicious mangoes… but trying to limit myself to two per day!

HCA: What’s the most eye-opening thing you have experienced or seen since working remotely?

Nicole: The overcrowding and the burden of chronic disease in indigenous communities. I was aware of it before I went remote but I wasn’t fully prepared for the extent of it.

Rachel: Seeing the range of chronic diseases and acute diseases. It’s nice having a supportive team who look out for each other during challenging times.

HCA: Where do you see your career now going?

Nicole: I feel that I will probably go back to Rural & Remote at a few different points in my career. There’s a lot that I am interested in, we are very lucky to have so many opportunities as nurses. I’m currently studying a Masters of Public Health and Tropical Medicine which is fascinating. I love working with student nurses and student indigenous health workers. I plan to go back and work for Medecins Sans Frontieres/Doctors Without Borders again as a nurse.

Rachel: I want to continue working in the Rural & Remote community. I think I will focus on chronic disease and mental health in the future.

HCA: Do you have any advice for ED Nurses looking to enter the NTRP program?

Nicole: If it’s something you want to do, start by talking to people who have hands-on experience and get the competencies you require (each state is different). I started organising myself as soon as I graduated because I knew it was something I wanted to do once I got the experience. The CRANA courses are great and it’s a good opportunity to meet and speak with other RANs.

It’s important to always stand up for what you feel is a safe practice for your patients and for you. You may feel nervous at first, but I find if you are polite about it no one minds. I don’t do first on-call for the first few nights so I can safely and smoothly transition. The HCA R&R Team will always support you through it.

Always go into a new location with an open mind until people get to know you. People are usually super helpful but may feel uncomfortable at first dealing with a new person. Be sure to ask for help, as no one is ever 100% ready for anything and you will learn something new every day.

Rachel: It’s important to read up on sexual health, as well as infant and maternal health as you will most likely use these skills and try to be as flexible as possible.

Another important tip is to try and buy the right food and pre-plan your meals if you have time. The local fruit and veggies are reasonably priced, however treats are quite expensive, so try to bring some from home. A lot of people become temporary vegetarians as meat is also quite expensive. Good time to detox!

When it comes to packing, my motto is less best. Try and pack lightly, 2-3 casual outfits, as you’ll be wearing a uniform at work most of the time.

If you think this NTRP program is something you would like to consider, please reach out to the HCA Rural & Remote Team email rural.remote@healthcareaustralia.com.au, visit https://www.healthcareaustralia.com.au/jobseekers/rural-remote/ or call 1300 885 728.

Please note that there are certain requirements to enter the NTRP Program, so it’s best to contact us first to discuss.

Promo: If you’re looking to up-skill with CRANA, we are currently offering an education bonus when you work a 6-week contract with us! Find out more https://www.healthcareaustralia.com.au/jobseekers/rural-remote/nurse-rural-remote/