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Improving safety in remote clinics: a Q&A with Laura Wright

4 Apr 2022

RN and research student Laura Wright discusses the findings of The Remote Area Safety Project, her mixed methods study involving a literature review, survey, interviews, and policy analysis. What are we doing well, how can we keep nurses safer, and is safety legislation fit for purpose?

Gosse River

Lau­ra Wright.

What inspired you to inves­ti­gate remote safety?

The mur­der of Gayle Wood­ford back in 2016 and the rec­om­men­da­tions that were released from that via the CRANAplus Report, NT Health, and Gayle’s Law. We want­ed to know: what’s actu­al­ly been put in place years later?

What is one rec­om­men­da­tion that clin­ics have fol­lowed quite well?

Many clin­ics now have nev­er alone poli­cies, even though it isn’t wide­ly leg­is­lat­ed yet. It’s a rel­a­tive­ly new rec­om­men­da­tion, so I thought that was pret­ty good. I think it strength­ens the safe­ty net pro­vid­ed by actions like check­ing up on each oth­er and pre­vent­ing patients from seek­ing help at RANs’ houses. 

What is a safe­ty rec­om­men­da­tion the sec­tor is fail­ing to follow?

One gap is around safe accom­mo­da­tion. One in four par­tic­i­pants didn’t even have work­ing fire alarms or work­ing locks on their accommodation. 

This point relates to basic require­ments required by law through the Nation­al Uni­form Leg­is­la­tion for Work Health Safe­ty… The WHS leg­is­la­tion requires that in remote or iso­lat­ed areas where the employ­er pro­vides the accom­mo­da­tion, they have to main­tain it to a stan­dard that doesn’t place the work­er at health and safe­ty risks.

But even when [a safe­ty require­ment] was specif­i­cal­ly leg­is­lat­ed it wasn’t nec­es­sar­i­ly in place.

Do you think some of these facil­i­ties were made before safe­ty was a talk­ing point, and now that safe­ty is increas­ing­ly dis­cussed, their inad­e­qua­cies are becom­ing obvious?

That’s what I’ve heard, espe­cial­ly for the clin­ic build­ings. Quite a few RANs have com­ment­ed that as the old build­ings are being rebuilt or ren­o­vat­ed, safe­ty con­sid­er­a­tions are com­ing more into it.

But accom­mo­da­tion… A few RANs have said their employ­ers are real­ly on the ball with get­ting issues fixed, but many more spoke of a lack of response to main­te­nance requests.

Do the RANs you talked with feel safe­ty edu­ca­tion is good enough?

The access to ori­en­ta­tion and train­ing needs improve­ment, but those who did access the train­ing found it help­ful. One of my par­tic­i­pants did a tran­si­tion to remote pro­gram, and said it was real­ly good with­in that pro­gram. Anoth­er par­tic­i­pant didn’t even get an ori­en­ta­tion and was on call on their first night.

What states and ter­ri­to­ries are safest?

Some regions are bet­ter than oth­ers, but it real­ly dif­fered com­mu­ni­ty by com­mu­ni­ty as to how well [safe­ty rec­om­men­da­tions] had been imple­ment­ed. Inter­est­ing­ly, how safe peo­ple felt didn’t nec­es­sar­i­ly relate to how safe their clin­ic or accom­mo­da­tion was. The vibe of the com­mu­ni­ty also had a big part of it, whether it was seen to be a peace­ful com­mu­ni­ty or not.

There were some health ser­vices where their poli­cies looked good, but where staff said it’s more of a she’ll be right’ approach. Where­as in oth­er health ser­vices, the staff said [man­age­ment] are com­plete­ly onto it.

It was also about resourc­ing; putting their mon­ey where their mouth is.

Due to under-resourc­ing, is there some­times a con­flict in a nurse’s mind between main­tain­ing safe­ty and get­ting the job done? Does that put nurs­es in an awk­ward spot?

Def­i­nite­ly. For exam­ple, there were the down­sides of try­ing to run around find­ing your sec­ond respon­der, if they’re not pick­ing up the phone and you’ve got a sick patient you’ve got to see.

The pos­i­tive was that when the sec­ond respon­der was pro­vid­ed, when the prop­er resourc­ing was there, peo­ple were enabled to pro­vide real­ly good care.

How did the nurs­es you talked with feel about a nev­er alone pol­i­cy being imple­ment­ed nationally?

Most feel that the basic rec­om­men­da­tions, like nev­er alone [poli­cies], should be across the board, but that there need­ed to be some vari­abil­i­ty based on indi­vid­ual clin­ics and com­mu­ni­ties. Most seemed amenable to the idea there couldbe a basic set of expec­ta­tions. For exam­ple, every­one should be able to expect to not go on call outs alone, a safe clin­ic and accom­mo­da­tion, and safe com­mu­ni­ca­tions equip­ment. Most of which is already in leg­is­la­tion anyway.

How can the exist­ing leg­is­la­tion become more effec­tive at improv­ing safety?

It would be rea­son­able to have a set of safe­ty stan­dards that clin­ics or health ser­vices can be held to and assessed against. 

Clin­ics that were doing well at meet­ing the safe­ty needs of their staff would be able to attract more staff because they’d have a good safe­ty score. Then RANs would be able to make an informed deci­sion when going to work in an unsafe com­mu­ni­ty or clinic.

It would almost improve that path­way so we’re not turn­ing off new staff who are just start­ing remote and then end up acci­den­tal­ly in an unsafe clin­ic, going I can­not deal with this”.

More expe­ri­enced staff felt bet­ter pre­pared to work in unsafe set­tings because they’ve built up the strate­gies to address that and stay safe.

Would a safe­ty score’ exac­er­bate staffing short­ages in some areas?

That’s the prob­lem, it prob­a­bly would. I guess that could be a strong dri­ver to improve though, because most of these are leg­is­lat­ed any­way, so it’s some­thing that does need fix­ing… It’s such a com­plex top­ic. These nuanced dis­cus­sions are hard to get down into a short article!

You said before that some par­tic­i­pants felt nev­er alone poli­cies need­ed to be flex­i­ble. Could you share an exam­ple of this?

Not all com­mu­ni­ties could obtain local dri­vers as sec­ond respon­ders, so in some if they want­ed a sec­ond per­son it had to be a nurse.

There was dis­cus­sion about how to have anoth­er per­son there to improve safe­ty, with­out cre­at­ing more safe­ty prob­lems by increas­ing fatigue.

How impor­tant is the inclu­sion of local dri­vers as sec­ond responders?

You’ve got the safe­ty from the local knowl­edge they provide.

They can also help nurs­es to show respect and cul­tur­al safe­ty, for exam­ple by respect­ing the bound­aries of a men’s busi­ness area.

For ages RANs had been say­ing going out alone on call­outs isn’t great, but the response was we can’t afford to have more nurs­es” – until Gayle’s mur­der, when there was a real­i­sa­tion that it doesn’t nec­es­sar­i­ly have to be anoth­er nurse (unless it’s a clin­i­cal emergency).

That’s such a good idea – yet this answer nev­er real­ly came up until the cri­sis. It was a bit like, yes, we’ve final­ly found a solu­tion. Which gives me hope that for all these oth­er safe­ty issues – which seem so huge – that there is an answer out there. We’ve just got to find it.

How can our read­ers access your research?

My the­sis lays out the find­ings of all four stages of the project, and they’ll also be pub­lished as aca­d­e­m­ic jour­nal arti­cles. I’m sure CRANAplus will be hap­py to share the link with every­one, and I’ll post them to my LinkedIn account as they become available.

View our safe­ty resources, or browse oppor­tu­ni­ties to par­tic­i­pate in research.