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The case for place-based care as a remote area nurse

9 Dec 2022

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.

Katie pre­sent­ing at the 2022 CRANAplus Conference.

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.

Hawk­er, SA. Greg Brave – stock​.adobe​.com

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.