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The case for place-based care as a remote area nurse
Unique personal and professional rewards await those who live and work in remote communities, says RN and CRANAplus Nursing and Midwifery Roundtable member, Katie Pennington. These include opportunities to improve your practice through external feedback, therapeutic primary health care relationships, and the opportunity to advocate for change.
“When you’re place-based, or in a long-term FIFO role, you are providing care for people who are also your community,” Katie says.
“They may be the local barista at your favourite coffee shop, kids at the local school or grandparents of someone you know.
“In an urban setting, you often only have brief interactions with people who you don’t see in your daily world.
“In a rural and remote setting, you see the outcomes of the care you provide in the lives of the people around you.
“The personal benefit [of this] is the emotional satisfaction and joy when you witness positive outcomes,” Katie says, going on to provide an example from her own career. In a remote Western Australian community where Katie used to work, she had the opportunity to support community members – some of whom first interacted with non-Indigenous people in the late 1970s and 1980s when they were already in their 20s or 30s – to remain on their Country for their end-of-life journey.
“I now work in remote Tasmania in a primary health care role, that at times also involves enabling families to provide end-of-life care for loved ones at home, in the places they are connected to,” Katie says.
“It’s sad because they’re people you know, members of your community, but joyful in that you are helping them achieve something they really desire.”
While witnessing a successful outcome can confirm you in your approach, seeing the impact of health care that didn’t have the desired result provides strong external feedback that indicates where you may need to improve or extend your practice.
Deep community connections also maximise your ability to deliver healthcare and inspire you to advocate – which is one reason why Katie prefers place-based models of care to short-term placement models.
“It takes time to develop the trust required for therapeutic relationships,” she says.
As a resident in a remote community, Katie says: “When I think about myself as a health care consumer, I’m really picky and choosy about who I share my health stories to, so I have empathy for people living in areas with a high turnover of healthcare staff… It’s that thing of having to tell the same health story to different people.
“The work you can do with people, particularly around the challenging changes to lifestyle that are required to prevent chronic conditions, or understanding complex support and advocacy needs – that only really occurs when you’ve established a long-term therapeutic relationship.”
As she has learnt about healthcare needs and barriers in the communities she has served, Katie has felt driven to improve the status quo. She has helped to improve funding arrangements for health service delivery in numerous communities and settings through the use of relevant data, political advocacy, and working with funding bodies.
Katie has recently completed research examining the impact of medicines and poisons legislation on health service delivery in remote Australia, which contributed to legislative reform enabling RNs working in remote areas of WA to legally supply medicines for chronic conditions.
She is currently advocating for sustainable models of primary health care provision on the East Coast of Tasmania, while also sitting on the CRANAplus Nursing and Midwifery Roundtable to ensure CRANAplus is aware of local healthcare challenges.
“Initially as a healthcare advocate I probably bumbled my way along, until I learnt strategies that can successfully be used to advocate for change,” Katie says.
“It was being brave, saying that… even though I might not know exactly the right way to start speaking up, I’m going to have a go.
“The opportunity may not have arisen in urban settings, because there are so many other people around – the systems are bigger, the professional white noise louder – that your voice may not be heard, or the need for you to be an advocate may not even exist.
“In remote areas, where you may be the only health professional who is consistently present, who has that deep understanding of local barriers and challenges, the drive to be brave and use your voice is very strong.
“I would put the challenge out to [short-term workers] to consider the difference they could make if they chose to return to the same place, continually,” Katie says in closing.
“We can only fix the things that are wrong with the systems in which we work if we stay in a place and tackle the challenges ourselves… If we say okay, I can see these things are broken – how am I going to be part of the solution?
“If you stick with it and see one positive outcome, then another, and then realise you are part of positive change in the system that’s resulting in improved health care delivery – how rewarding is that?!”
Access CRANAplus’ step-by-step guide to getting remote and isolated health on the agenda in your electorate.