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Why we stay and why we leave
As part of her Flinders University Master’s of Remote and Indigenous Health, RN Jacki Argent interviewed seven experienced RANs for her study ‘Why we stay or leave and what we value: a qualitative study of retention strategies for remote area nurses’. We run through a Q&A with Ms Argent about key findings and recommendations to improve RAN retention.
Firstly, tell us a bit about your own background as a remote area nurse.
I finished my Bachelor of Nursing in 1997.
I have worked as a RAN in Queensland, WA, New South Wales, SA, and the NT. Of that, I’ve spent the last 15 years mainly working in Central Australia. I’ve been a RAN, a clinical manager, and a remote educator.
What is the level of turnover around the country and how does it impact remote health?
On average, there was 148 per cent turnover annually in the Northern Territory between 2013 – 2015, as found by John Wakerman. That’s compared to a hospital nursing turnover in Australia of 15.1 per cent.
Another paper by John Wakerman, released in that same period, identified that the NT Government spent 29 per cent of the operating budget on recruitment and retention of staff.
Money not spent on retention and recruitment can be spent on other priorities that directly improve remote health. An unstable workforce also negatively impacts the health outcomes in remote areas, because of the lack of continuity of staff.
Why do RANs stay?
RANs identified an interest in Indigenous health and culture. They also noted the variety and the scope of work. Especially in the smaller communities, a functioning team was identified as a main reason to stay – similarly, if the team is dysfunctional, people just leave.
Another reason is a sense of adventure. It becomes a lifestyle.
Why do RANs leave?
The number one reason was a dysfunctional team and management. Other reasons include the inability to maintain one’s own social and cultural connections, and fatigue of the job, of the hours, of the call.
Also, the lack of boundaries and the lack of being able to be anonymous. You’re always the nurse – you’re never not the nurse – because you’re living in the community.
At the shop, at home, or at work, you’re always in that role. The only time people are not is when they can go out.
I’ll note that people might leave that remote area, but they may go onto a different remote area. They don’t necessarily pack up and head off: “That’s it, I’m never going remote again.”
For RAN retention to improve, what needs to be done and by who?
Employers, be they government or non-government, need to have a commitment to change. Also, policy makers and health service providers need to have a better understanding of retention issues.
There’s a growing body of literature that discusses these issues, but nothing happens… It’s like we’re on a roundabout.
If you’re living in an isolated area away from your own social and cultural belief and perceptions, long term it’s not sustainable. If you’re working a year and only getting six to eight weeks out of community, that’s not very long.
There are organisations that have already made significant change to employment models, such as nurses doing six weeks on and two weeks off, or eight weeks on and three weeks off, but during my research there was no documented evidence if that works or not. We need evaluation into what works and what doesn’t.
Is there a particular employment model that is best?
I don’t think there’s one model of employment that’s a quick fix for remote areas, because it’s a unique sort of working environment.
Geographically, the isolation is different. There are some places where you’re close to other bigger centres and then there’s places that are hard to get out of.
No two communities are the same. While there may be similar issues, they’re not the same – so employers need to have a flexible and adaptive approach.
What is one less obvious risk we face if change isn’t made?
The remote workforce has changed because there’s agency nurses now. People will leave the government jobs and go and do that agency, because they can find that better work-life balance, so if the government continues with a non-flexible model, people just leave that and then go and do agency work.
Are there any flawed ideas holding back progress on RAN retention?
I think it’s easy to say RAN retention is an ongoing issue and will always be, because it’s the nature of the work. Historically, it’s the pattern of recruitment and retention. RAN retention issues are just normalised.
If they evaluated and implemented change, they could have a better go at it.
What happens next with your research?
I hope to get it published, then it’s a published personal perspective. My research came from RANs and it was their personal insights into these issues, so I hope by documenting them, I’ve put some anecdotal experiences into something more formal.
Doing this research project was a steep learning curve. It gave me insight into the process of research. I don’t have any plans to do future research at the moment, but never say never.
Are you conducting or have you completed research on remote area nursing? We’d love to hear about your work for inclusion in the CRANAplus magazine. Contact us.