Dr McCul­lough is a lec­tur­er based at Edith Cow­an Uni­ver­si­ty in Perth, who has pub­lished sev­en aca­d­e­m­ic arti­cles and count­ing on remote health. In 2018, she com­plet­ed her PhD the­sis, which estab­lished a frame­work of remote area nurs­ing practice.

For McCul­lough, it all start­ed when she grad­u­at­ed as a Reg­is­tered Nurse in 1995, lived in New Zealand for a few years, and then arrived in Kakadu Nation­al Park look­ing for a nurs­ing position.

“I lit­er­al­ly just turned up, not know­ing any­thing, went to the clin­ic and said, ​‘Can I have a job?’” she explains. 

“The answer was, ​‘Well, no, you don’t know what you’re doing here. But you can work as med­ical recep­tion­ist for a few months.’

“Dur­ing that time, I read the CARPA man­u­al con­tin­u­ous­ly at my desk, attend­ed every train­ing oppor­tu­ni­ty, and spent more time in the clin­ic rooms and hang­ing round with oth­er staff than answer­ing the phone.

“I was for­tu­nate because I end­ed up in a clin­ic where there was a real­ly sta­ble, expe­ri­enced team of nurs­es and mid­wives and even a cou­ple of GPs. When a vacan­cy did come up, they agreed as a team they’d be pre­pared to men­tor me and put in what­ev­er sup­port they need­ed to get me up to speed. I feel eter­nal­ly grateful.”

Dr McCul­lough went on to spend three and a half years work­ing in the clin­ic, attain­ing the posi­tion of clin­i­cal man­ag­er. She says she learned so much and ​“not just clin­i­cal stuff, but about myself, my own capac­i­ty to deal with the unknown – because that is a char­ac­ter­is­tic of remote area nursing.”

Inspired by first­hand experience

After mov­ing to Perth and becom­ing a moth­er, Dr McCul­lough began look­ing for a research project.

“My men­tor at the time asked: ​‘What was your biggest con­cern when you were out bush?’” she says. ​“I said per­son­al safe­ty. In the com­mu­ni­ty there had been a num­ber of vio­lent inci­dents and I felt unsafe and some­what trau­ma­tised, know­ing it was hap­pen­ing out in the com­mu­ni­ty, even if not hap­pen­ing direct­ly to me.”

That was the inspi­ra­tion for her first pub­li­ca­tions and since then, she has tran­si­tioned onto oth­er top­ics informed by her own expe­ri­ences and the expe­ri­ences of the RANs she reg­u­lar­ly talks with.

“I felt that when I was work­ing out bush that most peo­ple didn’t have any idea what RANs actu­al­ly do,” she says. ​“They couldn’t com­pre­hend the lev­el of respon­si­bil­i­ty, the com­plex­i­ty of the deci­sion mak­ing, the impor­tance of build­ing rela­tion­ship with com­mu­ni­ties, and the whole idea of liv­ing in a com­mu­ni­ty that you’re actu­al­ly work­ing with as well.”

“Com­mu­ni­ties, employ­ers, oth­er nurs­es and Aus­tralians at large real­ly need to under stand, val­ue and recog­nise the con­tri­bu­tion nurs­es are mak­ing to the health and well­be­ing of com­mu­ni­ties, and the advanced prac­tice nature of what they’re doing.”

​“If we knew that, we would sup­port peo­ple more and pro­vide bet­ter incen­tives for going out bush. Our com­mu­ni­ties would val­ue nurs­es a bit more – and that’d make a dif­fer­ence to remote health.”

Research find­ings bear­ing out sub­jec­tive experience

Dr McCul­lough says that if remote area nurs­es read her 2018 the­sis, titled The deliv­ery of Pri­ma­ry Health Care in remote com­mu­ni­ties: A Ground­ed The­o­ry study of the per­spec­tive of nurs­es, they would hope­ful­ly feel a sense of recognition.

“What I was try­ing to do was present a mod­el or frame­work for oth­er peo­ple to under­stand what it is that RANs do,” Dr McCul­lough says.
​“Hope­ful­ly RANs would read that work and say, ​‘oh, yeah, that’s what I do’. And peo­ple who are not RANs will hope­ful­ly say, ​‘oh, wow, there’s actu­al­ly a lot to what they do.’”

“If you pub­lish some­thing that’s evi­dence based then it can be dis­sem­i­nat­ed and used in a much more con­struc­tive way than a sto­ry, because there’s this rigour around the way it’s col­lect­ed and presented.”

Dr McCul­lough says, build­ing upon the frame­work estab­lished through her PhD, she now has six oth­er research projects going, and five PHD stu­dents mak­ing con­tri­bu­tions to the rur­al and remote research body of knowledge.

McCullough’s research pro­gram is now most­ly explor­ing the idea of how we can mea­sure the qual­i­ty and safe­ty of nurs­ing prac­tice in rur­al and remote areas, she says.

The impor­tance of par­tic­i­pat­ing in research

Dr McCul­lough appre­ci­ates the obsta­cles to RANs par­tic­i­pat­ing in research, but says that when they do par­tic­i­pate, they make a huge difference.

“They’re under a lot of pres­sure, with a lot of work and things to do,” she says. ​“But when they par­tic­i­pate in research, answer sur­veys, or agree to be inter­viewed for research pur­pos­es, they’re actu­al­ly con­tribut­ing to change. 

“We need the evi­dence that’s com­ing from the peo­ple who are out there at the coal­face doing the work.

“Yes, they’re just one per­son com­plet­ing that sur­vey, but when every­one does it, then we have some strong evi­dence and that makes it eas­i­er to argue the case for RANs. Peo­ple pay atten­tion to jour­nal arti­cles and research find­ings; peo­ple all over the world. In Cana­da in par­tic­u­lar, they ref­er­ence our work on what RANs are doing in Aus­tralia – so it has a glob­al impact.”