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.