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Why we stay and why we leave

3 Dec 2021

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.