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Kellie Kerin: Upfront about Trauma, Turnover & Culture Shock

17 Mar 2022

Short-lived attention to workplace safety for nurses and midwives in remote settings is nothing new. If RN Kellie Kerin, the NT Indigenous representative on the CRANAplus Nursing and Midwifery Roundtable, has anything to do with it, State and Federal authorities, health services and nursing agencies will finally make meaningful, lasting changes.

Kel­lie and her big sis­ter (Yapa) Djan­di Ganam­barr, a com­mu­ni­ty leader and Elder in the Dar­ti­wuy Clan from Galiwin’ku who adopt­ed Kel­lie into her fam­i­ly in Octo­ber 2020.

Even before the pan­dem­ic, safe­ty issues were recog­nised as a most press­ing and urgent pri­or­i­ty fac­ing remote health,” says Kellie. 

Health work­ers face unac­cept­able work­loads, chron­ic lack of resources and inad­e­quate prepa­ra­tion for all things remote’, includ­ing cul­ture shock.

Now, more than ever, agen­cies and health ser­vices are so des­per­ate, they are send­ing out peo­ple who are, at times, total­ly out­side their com­fort zone.

[That] can set staff up to fail, and so the staff don’t hang around. High turnover is not good for the Health Ser­vice, com­mu­ni­ties; not good for the nurs­es who can’t stay, not good for those who do stay, and not good for the agen­cies,” says Kellie.

Kel­lie, a nurse for 26 years, has seen this pat­tern repeat itself. She came full cir­cle over an eight-year peri­od by mov­ing from metro to region­al to rur­al quite quick­ly, and then onto remote. In the same speedy fash­ion, she then reversed those steps to move to Bris­bane to under­take fur­ther study.

I was young, enthu­si­as­tic and full of adven­ture, seek­ing that buzz [of] adren­a­line when I start­ed prepar­ing to go remote in 1997,” she says.

The day before I left for my R&R expe­ri­ence, my Mum dis­cov­ered the fam­i­ly she nev­er knew of and I dis­cov­ered my own Indige­nous heritage.

I hadn’t been raised in the cul­ture, and in those first five years work­ing remote, I learned how mis­in­formed, une­d­u­cat­ed and naïve I was. I wasn’t aware just how much until I embraced my own identity.”

Kel­lie went on to gain a Diplo­ma in Health Sci­ence (Holis­tic Coun­selling) to improve her com­mu­ni­ca­tion skills, worked through her own lived expe­ri­ence of PTSD, became a Facil­i­ta­tor in the Applied Sui­cide Inter­ven­tion Skills Train­ing (ASIST) and obtained a Cer­tifi­cate IV in Train­ing and Assess­ment. She worked in men­tal health for eight years, in areas includ­ing sui­cide pre­ven­tion, clin­i­cal super­vi­sion, patient safe­ty and the prison system.

Kel­lie and an AHP in the school library cross-check­ing new enrol­ments onto the clin­i­cal database.

Kellie’s cur­rent job with the Abo­rig­i­nal Med­ical Ser­vice Alliance NT is in the role of clin­i­cal COVID-19 advi­sor, and it cov­ers the Top End includ­ing the Big Rivers and East Arn­hem regions.

I put my hand up to invest time on the CRANAplus Round­table because of my pas­sion to share my knowl­edge on psy­cho-social aspects, emo­tion­al well­be­ing and the trau­ma peo­ple are exposed to – whether it’s vic­ar­i­ous or pri­ma­ry – when they go into remote loca­tions,” she says.

My pas­sion is to raise aware­ness, to high­light that going remote is going to be a life-chang­ing deci­sion,” says Kel­lie. There are going to be extreme highs and extreme lows.

A lot of con­ver­sa­tion around safe­ty issues and the fact that remote health ser­vices are gross­ly under-resourced con­tin­u­al­ly falls on deaf ears,” says Kel­lie. It’s time it was made a priority.

There is a high burnout rate, a high attri­tion rate, for many well-known fac­tors, his­tor­i­cal and on-going.

The trou­ble is remote health tends to be reac­tive. There are so many com­plex and over­lap­ping demands. But aim­ing to keep staff hap­py, healthy and con­tent, that should be a priority.”

The Round­table in Feb­ru­ary explored rea­sons and pos­si­ble actions to address safe­ty issues, includ­ing direct advo­ca­cy in the polit­i­cal are­na in the lead-up to expect­ed elec­tions this year.

We need to pre­pare peo­ple bet­ter, be frank and upfront about what they will be deal­ing with,” Kel­lie says. It’s about being aware of the skills that will be need­ed, and the day-to-day sit­u­a­tions that arise.

A lot of peo­ple don’t realise… how com­pre­hen­sive the pri­ma­ry health care mod­el is in remote, the advanced clin­i­cal skills required, the extra qual­i­fi­ca­tions and expe­ri­ence you need. You can have the best inten­sive care or emer­gency nurse, but when you’re out there, you face less equip­ment, less resources, maybe two peo­ple to assist if you’re lucky – not 10 peo­ple who respond at the push of a but­ton on the ward wall.”

The sit­u­a­tion forces some peo­ple to leave because they feel unsup­port­ed, as does the liv­ing stan­dards and sub­stan­dard accom­mo­da­tion for which they may not have been prepared.

An out­door class run by Shep­herd­son Col­lege (a school on Galiwin’ku) with a focus on healthy eat­ing options and cook­ing up local tra­di­tion­al foods.

The solu­tion requires pre­pared­ness for cul­ture shock and Kel­lie wants to see a New to Remote pro­gram focus on resources and assis­tance for nurs­es and mid­wives, with new’ apply­ing regard­less of age or expe­ri­ence elsewhere.

Health work­ers go out there because they want to work in cul­ture and with the mob and that’s great, but they need to be giv­en as much cul­tur­al infor­ma­tion as pos­si­ble,” she says.

When they put their feet on Coun­try, they are in anoth­er world… Each com­mu­ni­ty, each lan­guage group, and sub groups have their own cul­ture. It’s much more than the dif­fer­ence between trop­i­cal coun­try in the North and the desert coun­try in the Centre.

They hit the ground run­ning. If they’re lucky, they might get the keys to their accom­mo­da­tion before they get thrown into a clin­i­cal situation.

Every health ser­vice should have a loca­tion-spe­cif­ic cul­tur­al man­u­al pro­vid­ed imme­di­ate­ly to new staff, infor­ma­tion that is con­stant­ly updat­ed. There is not one size fits all.”

Kel­lie sug­gests one of the best ways to pre­pare peo­ple for remote work is through sto­ry­telling and pho­tos where appro­pri­ate, using real-life expe­ri­ences to show this is real­i­ty and this is what happens.”

She high­lights that sup­port needs to con­tin­ue even after nurs­es and mid­wives return home.

When nurs­es return home, the ten­den­cy is to share the won­der­ment, the unique­ness, the fresh sto­ries full of adven­ture which are grip­ping to lis­ten to,” she says.

Peo­ple may not be ful­ly aware they have been trau­ma­tised. They have inte­grat­ed into the set­ting. It has become the norm. They for­get basic bound­aries and decide we just have to get on with it.’ They might say, I would not nor­mal­ly do this, but I am on call, I bet­ter do it.’ They make mal­adap­tive deci­sions, psy­cho­log­i­cal­ly sac­ri­fic­ing them­selves, mov­ing into the local groove.

Often, the real trau­ma is pushed aside. It’s still pro­cess­ing and the full impact is yet to come.”

Work­ing for Miwatj Health Abo­rig­i­nal Corporation.

If you would like to share your own sto­ries of work­ing in remote health and your ideas about how to resolve chal­lenges faced by the work­force, email marketing@​crana.​org.​au