“I have to speak up when I see a sit­u­a­tion I’m not will­ing to accept,” says remote area nurse Katie Pen­ning­ton. ​“Chang­ing sys­tems can be slow, but it doesn’t mean we shouldn’t give it a try, shouldn’t make a start.”

“‘I believe we have a duty to nego­ti­ate and advo­cate on behalf of our clients. We might be the only peo­ple they have who are health work­ers and who have a broad­er knowl­edge of the health system. 

“We have the knowl­edge to explain the inequities to the decision-makers.”

In receiv­ing the Auro­ra Award, Katie was acknowl­edged for her ​‘qui­et ded­i­ca­tion to and advo­ca­cy for the health of remote com­mu­ni­ties’, and for her phi­los­o­phy and nurs­ing prac­tice revolv­ing around evi­dence-based care.

“Through my prac­tice in remote com­mu­ni­ties over the years, I have found sig­nif­i­cant bar­ri­ers, sys­temic bar­ri­ers in the main, that pre­vent us giv­ing that care,” says Katie.

“For exam­ple, the abil­i­ty to facil­i­tate preg­nant women attend­ing appoint­ments with a fam­i­ly mem­ber. A sim­ple but impor­tant task. Iden­ti­fied and well-acknowl­edged. If that ser­vice is not sup­port­ed in real life by health­care sys­tems, then we know we are not pro­vid­ing the best care.”

Katie says that research is one part of her nurs­ing career where she has been able to look at influ­enc­ing a change in sys­tems that aren’t work­ing well.

“The research I under­took as part of my Mas­ters involved a small project exam­in­ing leg­is­la­tion, [and it] has seen some changes in leg­is­la­tion in WA,” she says

“The project find­ings are now being con­sid­ered in terms of cur­rent broad­er nation­al projects such as RN-des­ig­nat­ed pre­scrib­ing, scope of prac­tice review and nation­al nurs­ing strat­e­gy. I am hope­ful that the research will con­tribute to pos­i­tive change for nurs­es and com­mu­ni­ties in remote Australia

“This shows that one small ques­tion, one every­day nurse doing one small thing, can indeed have a rip­ple effect.

Katie, orig­i­nal­ly from Ade­laide, lives with her fam­i­ly on a rur­al bush prop­er­ty on the east coast of Tas­ma­nia, in the Chain of Lagoons area – which, she says, is as pic­turesque as it sounds.

Until mov­ing there in 2018, the fam­i­ly spent sev­er­al years in remote com­mu­ni­ties in the Pil­bara and cen­tral desert regions of West­ern Australia.

“The chil­dren were com­ing of school age and they had spent most of their lives away from fam­i­ly,” says Katie.
​“We want­ed them to devel­op their iden­ti­ty with a sense of place, so we came back to Tas­ma­nia, where my hus­band comes from, and we are now embed­ded in this local community.”

Katie works at the Bicheno Med­ical Cen­tre, where she’s cur­rent­ly involved in help­ing tran­si­tion the prac­tice to a com­mu­ni­ty health mod­el of care, sim­i­lar to the mod­el used by Abo­rig­i­nal Com­mu­ni­ty Con­trolled Health Organ­i­sa­tions (ACCHO).

“Com­mu­ni­ty health mod­els of care are cost-effec­tive mod­els for vul­ner­a­ble pop­u­la­tions,” says Katie, ​“with the flow-on effect of reduc­ing the cost on the acute care sys­tem down the track.

“In Tas­ma­nia, we have sev­er­al vul­ner­a­ble com­mu­ni­ties. Apart from being in a remote area with extreme­ly lim­it­ed health ser­vices, we have, here where I work, a hyper-age­ing pop­u­la­tion, lots of peo­ple over the age of 75. In addi­tion, across the demo­graph­ic, we have quite a lot of clients with com­plex comor­bidi­ties – over­lap­ping on occa­sion with men­tal health or alco­hol and oth­er drug concerns.”

Katie says it is excit­ing to be a part of the project, fund­ed through the Pri­ma­ry Care Rur­al Inno­v­a­tive Mul­ti­dis­ci­pli­nary Mod­els (PRIMM) program.

“The fund­ing is exact­ly what’s need­ed to help us bet­ter under­stand the needs of this region and, work­ing with the com­mu­ni­ty, to co-design health ser­vices that are more fit for pur­pose than what is cur­rent­ly available.”

The inequitable lev­el of health care avail­able in remote Aus­tralia was first brought home to Katie while she was serv­ing as a medic with the Aus­tralian Army from 1998 – 2002.

“I did a bit of work in a remote com­mu­ni­ty in Aus­tralia on a devel­op­ment project and, short­ly after that, I was deployed to East Tim­or,” she explains.

“What was a real eye-open­er were the sim­i­lar­i­ties I saw between the health care avail­able in remote areas of Aus­tralia and those in East Tim­or, in the ear­ly days after conflict.”

When Katie left the army, she start­ed a law degree but soon realised she missed work­ing in health­care and swapped her stud­ies to start train­ing as a nurse in Tas­ma­nia. An oppor­tu­ni­ty to attend a CRANAplus Con­fer­ence in Dar­win set the course of her career, she says.

“I knew I want­ed to work in remote Aus­tralia. I also knew I didn’t want to go remote with­out the right knowl­edge and skills and was deter­mined to get into the Grad­u­ate Diplo­ma in Remote Health Prac­tice at Flinders Uni­ver­si­ty, con­sid­ered one of the best cours­es of its kind.

“I think my time in the Army and in East Tim­or helped me get a place even though I was new to nurs­ing.”
Katie lat­er under­took a Grad­u­ate Cer­tifi­cate in Child and Fam­i­ly Health Nurs­ing to fill in her knowl­edge gap at the time in child health nurs­ing, a crit­i­cal com­po­nent of health prac­tice in remote communities.

A CRANAplus Mem­ber since 2006, Katie has rep­re­sent­ed her home state of Tas­ma­nia as a mem­ber of the CRANAplus Mem­ber Nurs­ing and Mid­wifery Round­table; advo­cat­ed for rur­al health care at the Tas­man­ian Par­lia­ment Leg­isla­tive Coun­cil Inquiry into Rur­al Health Ser­vices in Tas­ma­nia in 2020 as a CRANAplus rep­re­sen­ta­tive; and sits on the Aus­tralian Com­mis­sion on Safe­ty and Qual­i­ty in Health Care, Pri­ma­ry Care Com­mit­tee, as a nom­i­nee of CRANAplus.

The Auro­ra Award will mean Katie has quite a full man­tel­piece, hav­ing ear­li­er tak­en out the CRANAplus Pri­ma­ry Health Care Cham­pi­on Award win­ner in 2011 and the CRANAplus Excel­lence in Research in Remote Health Award in 2019.

“I would like to urge all remote nurs­es to take the time to realise the pow­er of their voice, and what that voice can mean for cre­at­ing pos­i­tive change for indi­vid­u­als and com­mu­ni­ties that they work with,” Katie says in closing.

“Politi­cians, leg­is­la­tors and bureau­crats may think they are meet­ing the needs of peo­ple in remote com­mu­ni­ties, but they are so far removed from [that] real­i­ty, that they don’t know the extent of the needs of peo­ple in these remote loca­tions, the com­plex­i­ty of the sit­u­a­tions or the front­line impact of our frag­ment­ed sys­tems of care. As remote area health work­ers we can use our unique exper­tise and voice to break it down for them, to help make sure that the sys­tems we work in are fit-for-purpose.”