Why do nurses stay in Australia’s small rural hospitals? Why do they leave?

Miss Sarah Smith1, Professor  Elizabeth  Halcomb1, Dr  Jenny Sim1, Dr Sam Lapkin1

1University of Wollongong, Wollongong , Australia


Access to healthcare for rural populations depends on an adequate, skilled workforce, however recruiting to rural areas can be difficult. Rural areas depend on nurses to provide much of the healthcare from small rural hospitals, however it can be a stressful occupation with its own unique issues and work environments. These issues can make rural nursing  particularly susceptible to increased turnover and shortages which is an ongoing concern worldwide. Australia is not immune to this phenomenon with ongoing difficulties in recruiting and retaining nurses to rural areas and significant shortfalls of nurses predicted in the future .

The presentation will provide an insight into the factors that impact on nurses’ intention to leave rural hospitals. Both quantitative and qualitative data will be presented which was collected as part of a large national study of the experiences of nurses working in rural hospitals throughout Australia. Besides investigating nurses’ intention to leave their workplace the national online survey also explored what factors impact job satisfaction, missed care in rural hospitals and examined the professional practice environment within small rural hospitals.

Participants were registered and enrolled nurses and dual registered nurse/midwives working in Australian small rural public hospitals. 543 nurses responded to the online survey however 160 responses were removed due to less than 50% of the survey being completed leaving 383 total responses for analysis.

The findings of this study will provide an understanding as to why nurses choose to leave rural hospitals and may be used to inform future initiatives to increase successful recruitment and retention of skilled clinicians. The findings may also assist in developing future nursing curricula and campaigns to attract nurses to rural hospitals and better prepare them to work in these unique and rewarding environments.


Sarah is a PhD candidate with the University of Wollongong.  She is an early career nurse researcher who completed nursing honours with UOW in 2015 and was awarded runner up of the Australian Primary Health Nurses Association’s new graduate Nurse of the year award in 2016. Sarah has experience in general practice nursing and rural hospital nursing and she currently works as a registered nurse in a NSW rural hospital where she was nominated for a NSW Health Rising Star Award. Her current research is investigating the nursing workforce in Australian rural hospitals.

Indigenous eye health – diversity and connection will close the gap for vision

Ms Rosamond Gilden1, Mr Mitchell  Anjou1, Mr Nick  Schubert1, Mrs Carol Wynne1, Mrs Tessa Saunders1, Professor Hugh  Taylor1

1Indigenous Eye Health, The University of Melbourne, Carlton, Australia



Initiatives and activities to close the gap for vision by 2020 are currently being implemented across Australia. Aboriginal and Torres Strait Islander people still (2015) have three times more blindness and vision loss compared than other Australians but this has been significantly reduced since 2008 when there was six time more blindness. The Roadmap to Close the Gap for Vision (Roadmap, 2012) proposed 42 sector-endorsed and evidence-based recommendations necessary to close the vision gap. The Roadmap identified that the eye care pathway was like a leaky pipe. To successfully navigate the patient pathway and tackle the ‘leaks’, the whole-of-system, collaborative approach proposed by the Roadmap connects diverse organisations within geographic regions who work together to close the gap for vision.

What is happening in your project/ health service/or what has been your experience:

Roadmap recommendations have been progressively implemented at national, jurisdictional and regional levels since 2012. Regional eye health stakeholder groups have been established, comprising members from various organisations involved in the patient journey. The diverse nature of these groups has been critical in identifying local barriers and determining solutions to address inequities and reform approaches.

Over 50 regions across Australia are now engaged in this way, representing urban, regional and remote areas. To 2018, 19 of the 42 Roadmap recommendations are completed and over 75% of intermediate activities commenced. Through regional collaborative processes, we have seen improved eye health outcomes for Indigenous Australians. This is reflected in national surveys (2015) and measures (2018) which show improved screening, examination and surgery rates and reduced blindness


This paper will consider the impact of embracing diversity through regional eye health stakeholder networks and how this has built stronger connections between patients, providers and services resulting in better eye health outcomes for Aboriginal and Torres Strait Islander people.


Rosamond Gilden started in the role of Research Assistant with Indigenous Eye Health (IEH), University of Melbourne in June 2016. Upon completion of her masters in Orthoptics, Rosamond worked as an Orthoptist in both the public and private sector. Rosamond joined the Centre for Eye Research Australia in 2014 as Clinical Coordinator for the National Eye Health Survey. In her role with IEH, Rosamond is part of the Roadmap team that helps to support implementation of the Roadmap to Close the Gap for Vision.

Expanding Indigenous Cardiovascular Education & Healthcare In Rural & Remote Australia

Dr Sarah Edwards1, Mr Nicholas Dutton1

1NSW Ambulance



Cardiovascular health outcomes for the indigenous population, especially in rural and remote areas, continues to lag behind the rest of the population in Australia. This remains a significant challenge for the health system. NSW Ambulance has committed to a program that delivers culturally safe healthcare advice and education in rural & remote NSW.

Aim of the project:

NSW Ambulance established the Aboriginal Cardiac Education Program in 2010.

The program aims to deliver a targeted health promotion program to raise awareness of acute cardiac events and Acute Coronary Syndrome, specifically:

  • To increase knowledge of the signs and symptoms of heart attacks
  • To raise awareness of the importance of calling Triple Zero (000)

A gap analysis involving engagement with local elders and Aboriginal Medical Services at the time was conducted. Expansion of the scope of the program to raise awareness of cardiovascular disease in a broader context was identified as an area of improvement as well as strengthening the core message of cardiovascular health.

The educational content of the program has been expanded to include:

  • Rheumatic Heart Disease
  • Stroke
  • Diabetes

The program has been supported by the introduction of new protocols for clinical staff e.g. Acute Rheumatic Fever released in 2018.


Analysis of the program shows an increase in participants accessing the program and an increased demand for sessions in 2017 and 2018. Event numbers have increased from 9 in 2014 to over 40 in 2018 (and is on track to grow even more in 2019).


Significant health disparities still exist for Aboriginal and Torres Strait Islander peoples.  It is essential that healthcare providers undertake continuous quality and service improvement to close the gap between Aboriginal and non-Aboriginal peoples.


Nick Dutton is the Paramedic Cardiovascular Advisor with NSW Ambulance in charge of the operational education and clinical support for NSW Ambulance clinicians, including Acute Coronary Syndromes. Other cardiovascular emergencies focused on including out of hospital cardiac arrest (OHCA) and CVA.

He is an operational Paramedic qualified as both an Intensive Care Paramedic (ICP) & Extended Care Paramedic (ECP) with 14 years’ experience.

Prior to joining NSW Ambulance Nick worked as an ICP (MICA Paramedic) with Ambulance Victoria (AV) for 7 years.

He has previously held roles as an Educator at the NSW Ambulance Education Centre and a Paramedic Clinical Instructor with AV.

His interests involved Paramedic management of ACS (including systems of care in ACS, 12 lead ECG & Paramedic initiated thrombolysis) and Paramedic management of OHCA.

Nick has a Bachelor of Education from Wollongong University, a Graduate Diploma of Emergency Health (MICA Paramedic) and a Masters of Paramedic Practice (Critical Care Paramedic) from Edith Cowan University

Embracing Nursing’s Diversity to build Stronger Pathways for the Rural Generalist Registered Nurse

Ms Deborah Grant1, Mrs Michelle Gunn2, Mrs Michelle Garner1

1Queensland Health – North West Hospital and Health Service, Mount Isa, Australia,

2Queensland Health – Clinical Excellence Division Office of the Chief Nurse and Midwifery Officer, Brisbane, Australia



In rural and remote communities, the effective and safe delivery of comprehensive Primary Heath Care services is dependent on the strength, capacity and capability of the health workforce. The International College of Nursing (ICN) (2010) recognises that Nurses are effective practitioners, health coaches, spokespersons, and knowledge suppliers for patients and families throughout the life course. Rural Generalist Registered Nurses (RGRN) are valued as essential members of the multidisciplinary healthcare team and recognised as crucial at maintaining links between individuals, families, communities and other areas of the healthcare system.

The Queensland Health RGRN Program is being established as a professional pathway for post graduate registered nurses (from novice to expert). It articulates multiple entry points, acknowledges the capability requirements, and provides a mechanism to enable registered nurses to work in Rural Generalist Nurse positions across a diverse range of rural, remote and isolated locations and communities within Queensland Health. It is envisaged that this will lead to the development of a Nationally Recognised Rural General Registered Nurse Pathway.

What is happening in your project/ health service/or what has been your experience:

The RGRN Pathway builds on National and International information as well as the experience of Registered Nurses working in diverse Rural, Remote and Isolated environments. The development has incorporated environmental scanning, exploration of curriculum frameworks and generation of combined workforce and educational pathway options.


This presentation walks the reader through the development of the Queensland Health RGRN Program and proposed implementation as an opportunity to embrace Nursing’s Diversity to build Stronger Pathways for the Rural Generalist Registered Nurse.



Astana Declaration on Primary Health Care: From Alma-Ata towards Universal Health Coverage and the Sustainable Development Goals. International College of Nursing (ICN) (October 2018) downloaded on 22 April 2019 from https://www.nursingnow.org/wp-content/uploads/2018/01/PHC-statement-ICN-NN.pdf


Deborah Grant

Certificate in Nursing, Bachelor Applied Science (Nursing Science) , Masters  of Health Practitioner, Grad Diploma  Diabetes, Grad Cert Management(QH). RN, RM, RIPRN, NP, ADEA DE,

Nursing Director Rural Pathways Project

North West Hospital and Health Service

Queensland Health deborah.Grant@health.qld.gov.au

Deborah is a Nurse Practitioner and Midwife with extensive experience across a range of health service contexts. Currently Nursing Director Rural Pathways Project North West Hospital and Health Service she has lead the development of a multi-level rural generalist registered nurse pathway for Queensland Health.

Driving Change Through Diversity: How new staff can make a difference

Miss Laura Wright1, Mr John Wright1

1Tennant Creek Hospital, Tennant Creek, Australia


Being a new staff member can be challenging and confronting, but can also provide an avenue to initiate and drive change. Good communication is crucial and recognition of shared responsibility is key to sustainable change.

We will share our experiences from the perspectives of a new nurse and a manager and mentor of new staff. We all know generally that diversity is important. Diversity of experience is vital in developing innovative healthcare teams, and it provides an avenue for newly qualified staff to enter and thrive in those teams.

New staff bring fresh perspectives for identifying areas for improvement and suggesting alternative approaches to ‘the way it has always been done’. However, fantastic ideas don’t work alone, as effective change requires the whole team. Unilateral decisions are unsustainable, whether made by anyone from the student to the manager. Success depends on balancing eagerness for change with respect for history and experience. Managers and leaders must unequivocally support the exploration of new ideas. Whether or not they turn out to be workable is not the point, a culture of continuous improvement is the goal.

Finally, we offer practice tips for both new staff and managers, to help them navigate the communication minefield of change.


Laura Wright RN, BN, MACN, Emergency Nurse, Tennant Creek Hospital. Laura is in her third year as an RN, graduating from CDU in early 2017. Having grown up in the bush, she is passionate about remote health and making a difference wherever she can.


John Wright RN, BN, MRHP (NP), MRHM, GCCE, MACN, Fellow CRANAplus, Fellow CENA, Nursing Education and Research Coordinator, Tennant Creek Hospital. John has 25 years of experience in emergency nursing, remote area nursing, management, and education. He has a strong focus on supporting change and building effective teams.


United We Stand

Mrs Kathy Arthurs1

1Royal Flying Doctor Service, Central Operations, Alice Springs, Australia


Different stakeholders at times connect to provide services that enable people to live and work in remote Australia. The Royal Flying Doctor Service (RFDS) and the Alice Springs Hospital (ASH) based Medical Retrieval and Consultation Centre (MRaCC) have partnered together to provide a 24 hours aeromedical service across Central Australia, an area the size of Western Europe. This model provides support and assistance to the Remote Area Nurses (RANS) in Remote Clinics, removing the concept they are working totally alone.

Prior to February 2018, requests for medical advice and evacuation were directed to an on-call Remote Medical Practitioner, a primary care specialist who consulted as required with the duty Emergency Consultant managing the ASH Emergency Department. On occasions, RANS would make multiple telephone calls for clinical advice and support and it became evident the pre-retrieval management of critically unwell patients in particular was suboptimal and not timely, escalating the response for a deteriorating patient.

Post February 2018, MRaCC alone lead the co-ordination and management of retrievals in the Central Australian region. Serviced by dedicated critical care trained retrieval consultants, who are not otherwise engaged with ongoing primary health care consults or the overseeing of a busy ED, these expert clinicians are familiar with the relevant patient populations, the professional aeromedical platform and personnel of the RFDS, and are ready to assess, treat, manage and retrieve patients to definitive care in a timely manner thereby reducing the course of deterioration.

The diversity displayed in Central Australia, through the co-operation of MRaCC, RANS and the RFDS has resulted in a safer, more effective and efficient retrieval service for the patients resulting in the referring RANS and the RFDS Flight Nurses, even though working remote, to feel far less alone.


Registered Nurse, Registered Midwife, Graduate Diploma Emergency, Bachelor Health Management (Operational), Certificate IV Training & Assessment.

Worked 28 years in a rural hospital in NSW and 14 years as a Flight Nurse.

Currently Senior Flight Nurse, Royal Flying Doctor Service, Central Operations, Alice Springs Base NT.


Cultural Safety and the Nursing Profession

Ms Sammy Petric1, Associate Professor Bethne Hart1

1University of Notre Dame


Cultural safety has its challenges; it requires a shift in each person, in relationships and in nursing practice and education. Remote Area Nurses are in the unique position to promote cultural safety as the workforce that directly engages with Aboriginal and Torres Strait Islander communities. A review of current literature exploring racism in nursing, decolonising nursing and cultural safety within the nursing profession will be presented. Critical reflections will be discussed within the remote nursing context as a process for Remote Area Nurses and organisations to review their cultural safety within their professional practice. This presentation promotes cultural safety partnerships with Aboriginal and Torres Strait Islander people and communities. It also reminds us that a strong commitment towards cultural safety from managers of healthcare organisations must be in place for the nursing profession to shift its ways of thinking, doing and being


Samantha is a Registered Nurse with over six years’ experience working within the domains of rural/remote nursing within Australia and metropolitan hospitals in Sydney. She has worked in four different Aboriginal and Torres Strait Islander health services and research settings. Samantha is a currently completing her Master of Philosophy (Nursing) degree and is the 2018 recipient of the Joan Hardy Scholarship for postgraduate nursing research. Samantha continues to undertake a decolonising approach to her professional and research practice including completion of Cultural Safety Training with CATSINaM.


Connecting and supporting health professionals who work in Aboriginal and Torres Strait Islander health

Mrs Jane Burns1

1Australian Indigenous HealthInfoNet, Mt Lawley, Australia


The Australian Indigenous HealthInfoNet (HealthInfoNet) is recognised as an innovative and vital part of the Aboriginal and Torres Strait Islander health infrastructure. It collects, develops and shares up-to-date evidence about a variety of health conditions through its web-based resources (https://healthinfonet.ecu.edu.au). For those working in remote or isolated areas, it is particularly useful as it provides readily available, up-to-date, relevant information.

The HealthInfoNet contributes to improving the health of Aboriginal and Torres Strait Islander people by making knowledge readily accessible to inform the health workforce and support them in their decision-making.

This presentation will outline the collaborative knowledge exchange process that informs practice among health professionals who care for Aboriginal and Torres Strait Islander people. It will also demonstrate how the HealthInfoNet can help busy health professionals keep up-to-date with the latest information; this is particularly useful for those working in remote and isolated areas.

The HealthInfoNet’s undertaking of knowledge exchange involves the synthesis of knowledge from a wide variety of sources and disseminating information mainly via the Internet. This is supplemented by print publications, for example, The overview of Aboriginal and Torres Strait Islander health; knowledge exchange resources and by facilitating the exchange of information through yarning places, newsletters, Twitter accounts and webinars.

The HealthInfoNet website includes a variety of health topic sections, for example: chronic diseases and sections on alcohol and other drugs and nutrition. The resource includes information and links to: policies; programs; health promotion and practice resources; publications; organisations; jobs; courses; funding and events. By providing the information in one location, it can save health professionals time and inspire learning.

The HealthInfoNet has made a valuable, sustained and enduring contribution to support health professionals who work in Aboriginal and Torres Strait Islander health. This presentation will demonstrate the extent of the HealthInfoNet’s content.


Jane Burns is a Research Team Leader with the Australian Indigenous HealthInfoNet, based at Edith Cowan University in Western Australia. Jane currently leads the chronic disease team at the HealthInfoNet. She is the Production Editor for the annual publication of The overview of Aboriginal and Torres Strait Islander health and also the Production Editor of the Australian Indigenous HealthBulletin.

Qualifications: Bachelor of Health Science, Graduate Diploma of Project Management


caring@home resources: Supporting home-based end-of-life care in communities

Dr Karen Cooper1, Prof Liz Reymond1, Mrs Sue Healy2, Mrs Louise Goodwin1

1Brisbane South Palliative Care Collaborative, Eight Mile Plains, Australia,

2Metro South Palliative Care Service, Eight Mile Plains, Australia


For the over seven million people who live outside of major cities in Australia, access to appropriate end-of-life and palliative care can be challenging. And while most Australian palliative care patients say they prefer to be cared for at home, and to die at home if possible, most do not achieve that wish.

Many people, in the terminal stage, are admitted to in-patient facilities because their symptoms cannot be adequately controlled at home. Often, towards the end of life, breakthrough symptoms need to be managed using subcutaneous medicines. Medicine for breakthrough symptoms needs to be given quickly and in rural and remote areas healthcare professionals may not be able to do that given resourcing and distances.

Carers, when appropriately educated, are competent, can safely manage breakthrough symptoms using subcutaneous medicines and that in bereavement they reflect that they are pleased they assumed the role of quasi-professional carer.

caring@home, an Australian Government-funded project, has produced free resources for organisations, healthcare professionals and carers to support carers to help manage breakthrough palliative symptoms safely using subcutaneous medicines.

caring@home resources, applicable to all jurisdictions in Australia, include:

For organisations

  • Guidelines for the handling of palliative care medicines in community services developed by NPS MedicineWise
  • A template example policy and procedure for organisations to tailor and guide the operational implementation of the resources

Healthcare professionals

  • The palliMEDS app for prescribers
  • Online education modules for nurses concerning training of carers


  • A comprehensive caring@home package for carers that contains step-by-step guides, a diary, training videos, a practice demonstration kit and a colour-coded labelling system.

caring@home resources are evidence-based and enable service providers in rural and remote areas to implement best-practice care that is person-centred and enables quality end-of-life outcomes for individuals at home and their carers.


Prof Liz Reymond MBBS(Hons), PhD, FRACGP, FAChPM

Prof Reymond is Deputy Director, Metro South Palliative Care Service and Director, Brisbane South Palliative Care Collaborative. Her research interests include palliative care symptom management, advance care planning (ACP), and service delivery and development. Liz is currently directing the Queensland-wide Office of ACP, the Improving End-of-Life Care for Residential Aged Care Facility Residents Initiative (in collaboration with Brisbane South PHN), and the national caring@home project to improve the quality of palliative care service delivery across Australia to support people to be cared for and to die at home, if that is their choice.

Agricultural Health and Medicine education-engaging rural professionals to make a difference to farmers’ lives

Ms Jessie Adams1,2, Dr Jacquie Cotton1,3, Professor Susan Brumby1,2,3

1National Centre For Farmer Health, Hamilton, Australia,

2Western District Health Service, Hamilton, Australia,

3Deakin University, Hamilton, Australia


Populations in agricultural communities experience poorer health outcomes than their metropolitan counterparts. Despite continued higher rates of workplace injuries, earlier morbidity and mortality in farming populations globally; few formal programs focus on agricultural health, wellbeing and safety. Agricultural Health and Medicine (HMF701) was developed in 2010 by Deakin University and the National Centre for Farmer Health, aiming to increase cultural competencies and empower rural professionals to improve the health outcomes of rural and remote Australians.

This research used a mixed method approach to identify the extent to which past students (2010 to 2018) utilise the Agricultural Health and Medicine unit content in their current occupations, and identify barriers faced in implementing their learnings. Students were invited via email to complete an online survey. Following the survey, consenting students participated in a one-on-one phone interview.

Forty-one students completed the survey; a response rate of 31%. Additionally, interviews were conducted (n=11). Results were analysed using descriptive statistics, frequencies, chi-square tests and open-ended questions were themed. Nursing and farming were the most represented occupations. Of responders, 81% felt confident discussing agricultural health and medicine topics with their peers and community. Upon completion, over 75% agreed their ability to diagnose, treat or prevent agricultural occupational illnesses or injuries had improved, with 42% reporting that they use the course content professionally at least weekly. However, minimal evidence suggested career development resulting from course completion.

This research informs the continuous curriculum development and innovation within Agricultural Health and Medicine, and highlights the importance of an integrated and collaborative approach to at risk populations. Despite engaged graduates and the continued high mortality and morbidity rates within the agricultural industry, the importance placed in farmer health within organisations is inadequate and under recognised, with structural barriers a factor restricting career development post completion of this highly valued course.


Jessie Adams completed her Bachelor of Public Health and Health Promotion (Hons)/Bachelor of Commerce at Deakin University in 2017.  Currently, Jessie is working as a Research Assistant at the National Centre for Farmer Health in Hamilton working on a variety of projects focused on improving the health, wellbeing and safety of farmers in Australia. This opportunity has allowed Jessie to combine her interests of health and agriculture.

BCom, BPubHealth & HealthProm (Hons)

Email address: jessie.adams@wdhs.net