Caring for the carers, are we there yet? Reaffirming resilience, redesigning and revealing the 4P’s remote workforce safety training road trip

Mrs Brenda Birch1

1CRANAplus, Wonga, VIC


If you’ve ever spent any time with the remote Australian health workforce, you will very quickly conclude that they are some of the most resilient, inspiring and committed people you’ve ever met. But how resilient are the system in which they work? Are they adaptable to such complex and dynamic environments? The purpose of this presentation is to challenge the need for a safety maturity model designed specifically for remote and isolated health sector.

This presentation will inform participants of the current journey to transition workforce safety and security legislation, research and guidelines into practice within the remote and isolated health workforce in Australia with a specific focus on aggression and violence. The 4P’s approach is an inclusive and innovative risk assessment methodology to create a shared understanding of preventative, recovers and supportive controls.

How will remote or isolated clinicians, managers, educators, researchers and decision makers know if we are doing enough to protect the health and safety of remote and isolated workers? Are we measuring what matters?

Imagine having certainty of a resilient safety culture supported by a maturity assessment tool that alignments patient, workforce, systems and community safety. It’s time to transition global knowledge and work with communities to develop, deploying and be proud of safety strengths and a shared safety the vision for the future.

1. Foster, P., & Hoult, S., (2013) The Safety Journey: Using a Safety Maturity Model for Safety Planning and Assurance in the UK Coal Mining Industry. Minerals, 3(1), 5972.
2. Law, MP et al (2010) Assessment of safety culture maturity in hospital setting. Healthcare Q Spec No: 110-5.
3. Reason, J. (1998). Achieving a safe culture: theory and practice. Work and Stress, Volume 12(3), 293-306.
4. Hollnaguel, E., et al (2006) Resilience Engineering, Concepts and Precepts. Aldershot, UK: Ashgate.


Brenda Birch (National Remote Safety and Security Educator) is passionate about safe, high quality and inclusive healthcare for both patients and the people who provide the care. Brenda has held several key quality, safety and risk leadership roles in VIC, NT and QLD health sector. Brenda has implemented risk management across a large and diverse health service which has been externally recognised as having areas of advanced maturity.
Qualifications include: RN, non-practising RM, Certificate IV Training and Assessment, Green Belt Six Sigma, Lead Auditor in Quality Management System, Certificate IV WHS, Graduate Certificate Health Service Management and Graduate Diploma Engineering.

Safety and quality in maternity care – developing a National Strategic Approach to Maternity Services

In Australia, the planning and delivery of maternity services is a State and Territory responsibility, with the Commonwealth playing an important role in providing national direction and coordinating efforts to improve care and outcomes.

Significant progress in improving Australian maternity care services was made under the National Maternity Services Plan 2010–2015 which concluded on 30 June 2016. Successes included Australian Health Ministers’ Advisory Committee (AHMAC) endorsement of national core maternity indicators and evidence-based antenatal care guidelines, expanding the range of maternity models of care, establishing the Pregnancy, Birth and Baby Helpline, identifying characteristics of culturally competent maternity care for Aboriginal and Torres Strait Islander peoples and developing a framework for birthing on country programs.

In 2017 AHMAC tasked the Australian Government to work with the jurisdictions on development of a National Strategic Approach to Maternity Services (NSAMS). Extensive consultations have been conducted and the resulting draft NSAMS is now the subject of further consultation. The NSAMS is intended to provide an overarching national approach to maintaining Australia’s high-quality maternity care and working towards further improvements.

Australian Student Nurse Clinical Experience in a Developing World

Jacklyn Favretti


The unique experiences and stories held by rural and remote nurses and midwives provide invaluable insight into the challenges of primary health care in the environments they live and work. Through a dialectical sharing of personal nursing experience, it is observed that rural and remote nurses are faced with minimal access to resources, and increased workplace responsibility. This is a topic of global concern, and can be applied to nursing within the Kingdom of Tonga.

The Kingdom of Tonga, otherwise known as ‘the Friendly Islands’, has been identified by the World Health Organisation as the most obese country in the world with an epidemic on non-communicable diseases including cardiovascular disease and respiratory illness. Completing my clinical placement in Tonga has provided me with the unique opportunity to develop my nursing skills in the international arena of health and illness. My experiences within Tonga have incited an appreciation for the nature of nursing within this developing nation. Themes of nurse resourcefulness in an environment with limited resources shaped my Tongan nursing experience. Here, it is observed that the challenges faced by all Tongan nurses remain inherently similar to the challenges faced by rural and remote nurses practicing within Australian Borders.

Discussions regarding the experience of an Australian student nurse engaged in clinical practice within a developing nation will be centred on the Kingdom of Tonga. Upon sharing my experiences and stories, I will engage case studies to demonstrate how services operate within the main Vaiola hospital, discuss the challenges and barriers to nursing in a developing nation, and make recommendations based on my experiences.


Jacklyn Favretti

Schwarz Family Practice Clinical Assistant

3rd Year Bachelor of Nursing Advanced Studies Student – University of Sydney

Connecting the conceptual and practical dots – preparation of health professionals to work effectively and safely in Indigenous primary health care settings

Robyn Williams


The author’s PhD research into the above question led to the development of a conceptual framework outlining the key components of preparedness and mediating factors. These components include:

1. Core Attributes (background, upbringing, personality, making sense of the landscape, being comfortable with discomfort and difference);

2. Education and Training (formal, informal, placements, professional development);

3. Orientation to the Practice Context (Indigenous communities, formal, informal, self-directed, ‘knowing what you don’t know’);

4. Key Requirements of a ‘Good’ Health Professional (skill sets, currency and competency, cultural safety, working cross-culturally and across disciplines).

So what does all this mean in terms of future practice locally, nationally and globally?

There aren’t many surprises in the findings, but they do provide data to support much of what we know anecdotally and a cohesive frame work; both of which can contribute to policy and strategies for curriculum development, recruitment and retention, orientation in the short term and improved health outcomes in the long term.

Recommendations include reorientating the education and training of health professionals to comprehensive primary health care and cultural safety and specific practice contexts; ensuring transparent and well-resourced career pathways for all health professionals; and embedding flexible and comprehensive orientation programs that meet local community needs, organisation and system requirements, and national policy and strategic responses to government priorities.

The focus is on remote health practice but there are wider implications for all health professionals and the context where they work.


Robyn Williams BA, RN, Grad DipEd, MPET

Robyn has nursing and education qualifications and has nearly forty years of experience of working with Indigenous peoples, primarily in the NT but also all over Australia. Her experience and interests include cultural safety, effective communication; curriculum development and program implementation; evaluation of community based programs; and qualitative research in Indigenous and rural and remote health issues.

Robyn is currently coordinating the Bachelor of Health Science at CDU where she also teaches into the Bachelors of Nursing and Midwifery (Indigenous health, working cross-culturally and rural and remote health). Recently she has been part of a CATSINaM working group for the adaptation of the National Aboriginal and Torres Strait Islander Health Curriculum; and is working with IAHA on a Career Pathways project and a Cultural Responsiveness workshop package. She has also worked closely with the Chronic Conditions and Remote Health programs, NT Department of Health, and has facilitated effective communication and health literacy workshops for an NT DoH project.

Robyn has worked collaboratively with the NRHA, AMSANT, CATSINaM, IAHA, Lowitja Institute of Indigenous Health Research, and CRANAplus.

Robyn writing up her PhD thesis on exploring preparation for health professionals to be culturally safe and effective practitioners in Indigenous primary health care settings.

Security measures for RANS in a challenging Environment

Robby Chibawe



Puntukurnu Aboriginal Medical Services (PAMS) provides primary health care to the Martu people of the Western Australian Desert communities of Jigalong, Cotton Creek, Punmu and Kunawarritji. These are very remote communities accessible by dirt roads. Jigalong is 3 hours drive east of Newman, Cotton Creek 6 hours drive, Punmu 10 hours drive and Kunawarritji 14 hours drive from Newman.

Due to community sizes, only Jigalong health service has 3 nurses at any given time. Punmu, Cotton Creek and Kunawarritji are all single nurse posts. PAMS has put in place some mechanisms to provide a safe working environment for staff.

Our strategy is a multi- pillar approach of:

  • Strong community engagement
  • Security measures which include installation of cameras and intercom systems on all nursing houses and clinics.
  • Communities with Aboriginal health Workers are the first line contact.
  • For other communities community members encouraged to go to Community Engagement Officers employed by PAMS as first point of contact after hours
  • Improving the employment conditions for Community CEO’s for the hours they spend supporting community

The above measures are working, so far we have had no cases of violence on our staff. At this stage the communities do not support concept of erecting high fences.

Question is how far do you go with implementing security measures that can potentially create greater barriers between staff and community rather than protection

We are still lobbying the Government for more funds to abolish single nurse posts


Robby Chibawe, has about 20 years’ experience in health.. Initial nursing training was undertaken in n Zambia, Africa and worked extensively in HIV/AIDS programs from training to Prevention of Mother to Child Transmission of HIV, Counselling and Testing. Bachelor of Nursing completed at Latrobe University in Melbourne and has worked in Victoria, Queensland (Bidgerdii Aboriginal Health Service in Rockhampton) and now with PAMS… I started working as a RAN in Jigalong, Punmu, and Kunawarritji. Then back to Jigalong as Clinical Coordinator, then promoted to Clinical Manager. I was appointed Acting CEO late last year, then confirmed CEO in February 2018. Currently studying Masters of Public Health at UQ.

The Kowanyama Narrative; the adventure of developing a relevant nursing workforce

Anne-Marie Scully


Kowanyama PHCC had to rethink its nurse workforce; pose the question “what is in the best interest of the communities?” So in Kowanyama we identified the need for a transformative nursing workforce because we were not meeting the community needs and not impacting their health status. We acknowledged that “nurses are a linchpin for health reform and will be vital to implementing systemic changes in the delivery of care.”

This is the narrative about our experiences in developing a nursing workforce for Kowanyama, a community of approximately 1,200 in Far North Queensland (FNQ). We needed a nursing workforce that reflected the identified needs of the community and so we changed the nursing mix and, for example, now have registered nurses and a new renal role.

We posed many questions and we know, for example, that the Kowanyama community benefits from a longer stay by nurses but, like many isolated places it can be hard to stay. Many nurses only come for short periods. We wanted to change that; so we asked what a resilient nurse can manage. What does a capability framework look like for Kowanyama isolated practice? Can we grow registered nurses in community? What other knowledge/s do we need?

The nursing profession also need to take a lead in supporting the transformation of the isolated workforce because they are the preeminent workforce and will remain so.  What is the role of CRANAplus, ANMU and ACN as national representatives of the profession? What role can they play in supporting a transformative workforce in isolated practice?

Has the profession been innovative and creative enough….because there is a significant need in isolated primary healthcare centres for a transformative nursing workforce model; and, we are not closing the gap in a significant way, not achieving the targets agreed at COAG.

This Kowanyama narrative is about a journey, an exploration, of our trial and error, successes and challenges but results in the beginning of a strategy that works for community and we can describe the workforce which will go some way to addressing the identified health needs of the community. It has been quite a journey, and is ongoing…..we want to share it with you, hear feedback and most of all let’s truly debate the isolated community’s workforce.


Anne-Marie SCULLY

RN,  RM,  Ba App Sci, Cert 4 Grief and Bereavement,  Masters

A long time nurse with an interest in health policy, workforce planning and safe practice. I am undertaking a PhD in policy analysis and remain curious about contemporary practice and how it meets the community’s needs. I enjoy debate and discussion, translation of evidence into practice,  have been the Chair of the National Nursing Organisation, a member of the Australian Pharmaceutical Advisory Council (APAC) and have an enduring interest  in health economics and impact on the ability of the nursing profession to practice safely.

The Nursing and Midwifery Exchange Program

Andrew Hughes



The Nursing and Midwifery Exchange Program is an innovative workforce program. NMEP inspires candidates to try different areas and arms aspiring leaders with the skills required to lead. NMEP journeys our workforce to different places; both professionally and geographically.


This state-wide program is aimed toward;

– Professional development for Queensland Health Nurses and Midwives

– Enabling networking between Queensland Health rural and metropolitan facilities and HHS’s

– Exposure to different clinical areas/locations and environments

– Fostering leadership and Mentoring

NMEP is available to staff from our EN’s to our DON’s. Leadership: Voice at all levels.


Running four cohorts per year, we facilitate the matching and exchanging of nurses and midwives across the state in order to allow them to try each-others jobs.  Candidates engage in a 12 week program and engage in a mentoring relationship.

Ultimately, we are growing a Queensland Health nursing and midwifery workforce with a wide variety of skills and experiences. We strongly believe that the cross pollination of skills across our state will have better outcomes for our rural/remote communities.  NMEP takes nurses and midwives on the journey of leadership; through experiencing different and diverse areas, nurses/midwives refine and retain their skills.

Results Outcomes:

The date, NMEP has received 52 applications from nurses/midwives all over the state. NMEP has measured candidates self-assessed ability in areas such as leadership, mentoring, clinical skills and how likely an applicant is to seek employment in a rural/remote area. Preliminary results have shown favourable outcomes for rural/remote work with a growth in professional confidence and skill.


The program has shown benefits to the individual, the facilities hosting exchange candidates and to health services engaging in exchange.  The sharing of knowledge and skill across our diverse state ensures that our staff are inspired and grow within their leadership journey.

Enabling successful transition of dental graduates to regional and remote practice through curriculum design and clinical practice

Dr Felicity Croker1

1James Cook University, Cairns, Australia


The Bachelor of Dental Surgery (BDS) at James Cook University (JCU) was established in 2009 as a socially accountable program with the mission to address the population health needs and workforce shortages of rural, remote and tropical Australia. This presentation will focus on how aligning curriculum design and clinical experiences enables and encourages transition to graduate careers in rural, remote and regional areas.

An ongoing process of evaluation involving data gathered from participatory action research, student feedback surveys, clinical partners, and graduates has informed development of the innovative curriculum design of the JCU program.  The rural and remote focus is embedded into the dental curriculum across the pre-clinical and clinical years. In addition to clinical and cultural competency, the course prepares dental graduates for interdisciplinary teamwork in rural and remote practice.  This pioneering dental program also embeds education on domestic violence (DV-RRR) and authentic medical emergency simulations. Final year students complete extended clinical placements in rural and remote communities; this is essential if graduates are to feel comfortable and competent to join the remote health workforce.

Ongoing feedback is informing program design and delivery to optimise engagement and preparedness for practice. With student input, learning opportunities and clinical experiences can prepare ‘fit for purpose’ graduates whose distinctive profile and capabilities enable them for transition to the rural and remote workforce.  Destination data and GIS mapping of graduate destinations reveals the significant contribution JCU dental graduates have made to the rural and remote oral health workforce since 2013.  However, given the given the challenge of funding rural and remote student placements, further research is required to evaluate the impact of the current policy and budgetary environment  on the viability of the current curriculum.  This may reduce the capacity to continue contributing work-ready graduates to the future rural health workforce.


Felicity Croker (PhD; B.Ed (Hons1), RN, RM.

Felicity is a Senior Lecturer in Dentistry at JCU who is passionate about growing socially accountable health professionals who are ‘fit for purpose’ for regional and remote practice. She is actively involved in applied research on rural oral health, domestic violence, and graduate preparedness for rural practice.  Felicity has initiated and established work integrated placements for students. With the first dental cohort graduating in 2013, Felicity has evaluated four years of final year students’ intentions and the impact of rural and remote experiences on graduate destinations.

“Facilitating remote student nurse placements in Central Australia – a wealth of experiences.”

Ms Emma Bugden1,2, Ms Jessie Anderson3

1Flinders University, Alice Springs, Australia,

2Menzies School of Health Research, Alice Springs, Australia

3Centre for Remote Health, ALICE SPRINGS


In response to the challenge of recruiting a nursing workforce to provide care in remote areas, more nursing students are being given the opportunity to experience this unique working environment through their Professional Experience Placements. Research into the decision making processes of new graduate health students regarding returning to practice in remote locations indicates that student perception of the placement experience is significant. This experience is shown to be impacted by the quality of supervision and support.

With large investments by the Commonwealth government, universities and other organisations such as CRANAplus aimed at encouraging students to undertake remote placements to increase the possibility they will choose to work in remote locations on graduation, it is essential that the quality of supervision is such that the experience for students is both positive and supported.

Barriers to this include a lack of qualified or available staff to facilitate student placements in person.  Many universities adopt a preceptor-led model of facilitation where the health facility staff are responsible for both the learning and assessment of the student. Flinders University aims where possible to provide a dedicated facilitator that is employed by the university.  With placement settings across the Northern Territory it is often necessary for facilitation to be provided using technology including telephone and video conferencing.

To outline the issues involved, this presentation will discuss the challenges and triumphs of providing meaningful and accurate facilitation to students in remote areas of the NT.  Approach and techniques utilised, challenges to communication and interaction encountered and the valuable and educational experiences some of these students have achieved will be included.


In 2017 Emma Bugden was awarded the Gayle Woodford scholarship and graduated with a High Achievement award from stage 3 of the Emerging Nurse Leader(ENL) program. She is the Chair of the ACN NT South region leadership group and a candidate for stage 4 of the ENL program in 2018.  Emma has worked in Central Australia for Flinders Uni, Menzies School of Health Research and the Alice Springs Hospital. Having raised two children, with has a background in nursing and ethics, she is committed to inspired leadership, effective and supportive management, building strong communities and rural and remote nursing practice.

Jessie Anderson, RN, BN (Hons), MNurs (Emerg)
Nursing Lecturer at the Centre for Remote Health, Flinders NT, Alice Springs.
Coordinator of RHMT supported Nursing placements in the Northern Territory.

Rheumatic Heart Disease Australia – 2018

Ms Diana Mosca1

1Rheumatic Heart Disease Australia, Darwin, Australia


Rheumatic Heart Disease Australia (RHDAustralia) is funded under the Australian Government’s Rheumatic Fever Strategy to support the control of rheumatic heart disease (RHD) in Australia. The aim of this hotspot is to highlight the current activities of RHDAustralia. Australia has among the highest prevalence of RHD in the world, largely in rural/remote communities. Resources are available to support people with RHD, and those who work with them.

What we are doing:

⦁              The Australian ARF/RHD Guideline is being updated and expanded. The new edition will be based on the latest evidence-based research, with a focus on culturally-appropriate practice.

⦁              The current Guideline, a rheumatic fever diagnosis app, and an injection treatment tracker app are freely available online.

⦁              We work in partnership with RHD control programs across Australia to deliver workshops for the health workforce to increase capacity around RHD prevention and management.

⦁              Free e-learning modules, short movies, and many other resources are available on our website.

⦁              RHDAustralia works closely with its partners, stakeholders, patients, families and communities to develop culturally-appropriate information for disease prevention and support. The current focus is on peer support initiatives, self-management tools and health promotional material for people living with RHD and their communities.

Visit the RHDA booth in the trade displays and let us know how we can support you and your community.


Diana Mosca currently works as a nurse advisor for Rheumatic Heart Disease Australia. She qualified at Princess Margaret Hospital for Children in 1985, and in 30 years her career has taken her from paediatrics, to public health, and back again via perioperative nursing, projects and nursing education. She has worked most of her career in the NT and regional Queensland. She has a Masters in Public Health and Tropical Medicine, Graduate Certificates in Perioperative Nursing and Clinical Leadership, and a Cert IV Training and Assessment.