Nursing in remote or isolated areas of Queensland: Roles, resources and readiness for practice

Introduction: Examining the role of nurses working in remote and isolated areas of Queensland and identifying the necessary competencies, training and resources required by registered nurses to work in these practice contexts was the aim of this commissioned research study. Preparing nurses for practice in these environments and providing professional development support has historically been ad hoc as the nature of this type of nursing practice has not been well understood.Methods: A multiple case study research design was utilised to investigate nursing in remote and isolated areas of Queensland. The data generation methods included an integrative review of the published and grey literature, an analysis of workforce data, and a mini environmental scan to determine the parameters and characteristics of the three cases. These data provided background for interpreting additional data generated from semi-structured interviews and focus groups with nurses employed in each case. Results: 13.11% of the nursing workforce in Queensland work in non-metropolitan areas as classified using the ARIA classification index with 4.34% of this number employed in remote or very remote areas. For most of these nurses their role is generalist and acute care interventionist focussed, although there was an acceptance that health outcomes would improve if primary prevention activities were prioritised. For most nurses being clinically competent to manage first line emergencies and myocardial infarctions was deemed important. The nurses indicated that they were quite autonomous in their practice, although there was a level of concern highlighted that not all nurses were able to dialogue professionally with medical colleagues about patient clinical status. Nurses reported that accessing professional development opportunities on topics such as mental health, maternity education, wound management, leadership, finance, budgeting, and trauma management was essential to augment their knowledge and practice. The nurses agreed that there was a plethora of staff development, training and education offered by Queensland Health and other providers on these and many other clinically relevant issues. A number of barriers were cited however, that limited their ability to engage in professional development such as a lack of locum support, large geographic distances to venues offering programs, associated costs that for some were not affordable, and time away from family and other local commitments. Understanding local communities and being culturally aware and clinically competent were seen as necessary skills for working in these contexts of practice. For some, these skills developed over time, for others past experience and preparation for practice enhanced their understanding. Working in these environments was challenging but most agreed the practice was rewarding. Undertaking a comprehensive orientation program prior to assignment assisted nurses in preparing for and adapting to their role in these contexts.Conclusion: The role of nurses working in remote and isolated practice settings in Queensland is complex. A new model of service delivery and care that is primary health care focussed is recommended. To accommodate the adoption of this model nurses require explicit job descriptions, clarity of organisational structure and reporting lines, access to pre-deployment training, and ongoing professional development that enhances capacity to engage with communities and promote wellbeing.