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The History of CRANAplus (Part 4): From cottage industry to corporate entity

12 Dec 2023

CRANA's history is defined by two major growth spurts — the funding of the late 1990s and the diversification of the late 2000s. But when its ambitions have exceeded its budget, passionate volunteers have always been at the ready to bring the dream to life.

The Board in 1996, with the organ­i­sa­tion on the cusp of sud­den expansion.

It is safe to say of the ear­ly days that CRANA’s aspi­ra­tions exceed­ed its bud­get. Before 1991, CRANA was run by vol­un­teers work­ing in their lounge rooms and using fax and phone to communicate.¹ It had received spo­radic fund­ing for con­fer­ences and projects but rather than restrict itself to its fund­ing streams, it built itself into a com­mit­ted com­mu­ni­ty organ­i­sa­tion around them.

In 1987, CRANA pub­lished its first newslet­ter, the 8‑page Out­back Fly­er². In 1988, the organ­i­sa­tion became incor­po­rat­ed under the Asso­ci­a­tions Act, Vic­to­ria. The mod­est Mem­ber­ship rev­enues of the day built up a small work­ing fund that allowed CRANA to pur­sue these goals. In 1991, Mem­ber­ship cost $50, or $25 for stu­dents, and the organ­i­sa­tion had 287 Members.

The organisation’s hori­zons expand­ed in 1991, when CRANA received $50,000 in fund­ing towards its Nation­al Sec­re­tari­at from the Fed­er­al Depart­ment of Health, Hous­ing and Com­mu­ni­ty Ser­vice. Sud­den­ly, it could appoint an Exec­u­tive Offi­cer and open its first office. The first EO was Bernie Ibell who was based in Tas­ma­nia but the organ­i­sa­tion soon shift­ed to Cairns, where it set up shop in a mod­est two-room office.

Board Mem­bers in 1998, dur­ing the boom years of major expansion.

CRANA’s first major fund­ed project

Sal­ly John­son speaks out in the Cairns Post in 1993.

CRANA was right on cue. Still hang­ing the wall­pa­per in the new office so to speak, it found itself respond­ing to an evolv­ing sit­u­a­tion on Cape York.

Sal­ly John­son was CRANA pres­i­dent in the ear­ly 1990s. She explains that at one stage there was an aver­age of one assault of nurs­es per month on the Cape and that in some remote com­mu­ni­ties the turnover rate exceed­ed 200 per cent.

I was par­tic­u­lar­ly con­cerned that it was dif­fi­cult for nurs­es to stay in remote areas, because I knew that our best work was done after the first few years in a com­mu­ni­ty, when trust had been earned on both sides,” Sal­ly says.

At that time Indige­nous groups and com­mu­ni­ties were deal­ing heav­i­ly with results of dis­pos­ses­sion of their land, forced relo­ca­tion, sep­a­ra­tion from fam­i­ly, exter­nal con­trol, rapid social change and many oth­er trau­mat­ic events asso­ci­at­ed with colonisation.”

Sal­ly spoke exten­sive­ly with the media at this time and in the back­ground, CRANA set about being a part of the solu­tion. By March 1993, it could announce its two-year Locum Sup­port and Relief Pilot Project’, which it would deliv­er in part­ner­ship with the Penin­su­la and Tor­res Strait Region­al Health Authority.

Draw­ing on Gov­ern­ment fund­ing and coor­di­nat­ed by CRANA’s Mar­garet Daw­son (who had been CRANA’s first sec­re­tary), the project involved four expe­ri­enced RANs work­ing as locums, reliev­ing RANs in the field and seek­ing to embed a pri­ma­ry health care philosophy.

The RANs who had been relieved would head to Cairns, where they could then attend pro­fes­sion­al devel­op­ment and cross-cul­tur­al aware­ness work­shops, or sim­ply take some time out, util­is­ing fur­nished rooms in town.

The project had many facets, among them the pro­vi­sion of a 24-hour, tele­phone-based coun­selling ser­vice for RANs. This detail, blend­ing in though it did, would ulti­mate­ly prove to be the project’s last­ing legacy.

Build­ing up to the Bush Cri­sis Line

Sal­ly John­son and Vic­ki Gor­don dance with Tiwi Island fam­i­ly at the 1995 Dar­win Conference.

In 1994, the remote area nurs­ing work­force suf­fered a series of rever­sals. The Locum Sup­port and Relief Pilot Project was not re-fund­ed or expand­ed. CRANA’s sec­re­tari­at fund­ing itself appeared to be at risk of non-renew­al. 21-year-old nurse San­dra Hoare was also trag­i­cal­ly mur­dered in out­back New South Wales.

CRANA kept in the fight. By 1995, the not-for-prof­it had man­aged to extend its sec­re­tari­at fund­ing arrange­ment, and Sal­ly John­son was induct­ed as a Mem­ber of the Order of Aus­tralia for her con­tri­bu­tion to remote area nurs­ing and Abo­rig­i­nal health in a move that seemed to point to wider recog­ni­tion of RAN practice.³

This year also saw the pub­li­ca­tion of the Con­text of Silence report which includ­ed Janie Smith, then EO, and Jen­ny Klotz among the research team. The report set down on paper the real­i­ty of occu­pa­tion­al violence.

Janie Smith at the 1994 Con­fer­ence in Cairns.

An old Bush Cri­sis Line poster.

It found that RANs were liv­ing with fre­quent threats to their per­son­al safe­ty while on and off call and duty, and that a major­i­ty did not feel ade­quate­ly pre­pared for their cur­rent work. A quar­ter of respon­dents were the only health pro­fes­sion­als in their com­mu­ni­ty; a third no longer felt con­fi­dent in report­ing vio­lent inci­dents to their employ­ers based on pre­vi­ous report­ing expe­ri­ences; over a third were in fear of their per­son­al safe­ty; and more than half had no access to a secu­ri­ty escort when on call.⁴

The real­i­ty faced by RANs could no longer be denied, and there was a sud­den urgency to the report’s rec­om­men­da­tions, which includ­ed the following:

Fed­er­al, State and Ter­ri­to­ry Gov­ern­ment and employ­ing bod­ies… devel­op for­mal and infor­mal mech­a­nisms to pro­vide appro­pri­ate and ade­quate 24-hour debrief­ing and post-trau­ma ser­vices for RANs and oth­er health staff.

The sup­port line asso­ci­at­ed with the Locum Sup­port and Relief Pilot Project had con­tin­ued even after the project ter­mi­nat­ed, but on skele­ton fund­ing. Dur­ing this phase it was up to the Exec­u­tive Offi­cer, not a trained psy­chol­o­gist, to answer these calls and pro­vide support.

This all changed when the Bush Cri­sis Line was fund­ed to com­mence in 1997 by the Office of Abo­rig­i­nal and Tor­res Strait Islander Health Ser­vices. It was offi­cial­ly launched at the Launce­s­ton con­fer­ence of that year. CRANA began pro­mot­ing the ser­vice and rapid­ly dis­trib­uted 1,000 fridge mag­nets, 8,000 tele­phone stick­ers, and 3,500 flyers.

The need for the ser­vice quick­ly made itself appar­ent. Dur­ing the first six years, the ser­vice pro­vid­ed over 1,500 hours of coun­selling, across more than 2,000 calls and deliv­ered well­be­ing work­shops in the likes of Bro­ken Hill, Cook­town and Alice Springs.

The line would sub­se­quent­ly be rebrand­ed to the Bush Sup­port Line in the ear­ly 2000s, in recog­ni­tion of the fact peo­ple can and should access help before they reach cri­sis point. It con­tin­ues to this day.

Safe­ty and security

The ful­fil­ment of the 24-hour sup­port rec­om­men­da­tion was not the Con­text of Silence report’s only lega­cy. It also played a hand in pro­pelling fund­ing for CRANA’s edu­ca­tion­al offer­ings, reduc­ing sin­gle-nurse posts, improv­ing accom­mo­da­tion and facil­i­ty safe­ty, and shap­ing employ­er attitudes.

How­ev­er, in 2016, any sense of progress came to a halt with the trag­ic mur­der of well-respect­ed and ded­i­cat­ed remote area nurse Gayle Wood­ford in Fre­gon, South Aus­tralia. Janie Smith was pres­i­dent of CRANAplus at the time.

The whole remote work­force was griev­ing and there were peo­ple who were so angry and who feared their safe­ty and start­ed leav­ing remote areas,” she recalls. It was an unset­tling time for the whole remote workforce.”

In the wake of the tragedy, the sec­tor began to crit­i­cal­ly reflect on its long-held prac­tices and chal­lenge its accep­tance of risks that were rou­tine­ly con­sid­ered just part of the job’.

CRANA rep­re­sen­ta­tives trav­elled to Can­ber­ra for a round­table with Fiona Nash, then Min­is­ter for Rur­al Health. In-line with its long-term pol­i­cy, CRANA mount­ed calls that RANs should not go out on call by them­selves, but always be accom­pa­nied by anoth­er person.

CRANAplus soon received fund­ing from the Com­mon­wealth Depart­ment of Health to under­take the Remote Area Work­force Safe­ty and Secu­ri­ty Project. It con­sult­ed exten­sive­ly with the work­force and con­vened an expert advi­so­ry group con­tain­ing senior nurs­ing rep­re­sen­ta­tives from around the coun­try, and pub­lished Safe­ty and Secu­ri­ty Guide­lines for Remote and Iso­lat­ed Health, the Work­ing Safe in Remote and Iso­lat­ed Health Hand­book, a risk assess­ment tool and var­i­ous train­ing materials.⁵

Emma Bug­den, the 2018 recip­i­ent of the Gayle Wood­ford Memo­r­i­al Schol­ar­ship with mem­bers of Gayle’s family.

Flinders Uni­ver­si­ty and CRANAplus also ini­ti­at­ed the Gayle Wood­ford Memo­r­i­al Schol­ar­ship in mem­o­ry of Gayle.

In 2019, the SA Gov­ern­ment intro­duced new leg­is­la­tion known as Gayle’s Law, that states health prac­ti­tion­ers in remote areas of South Aus­tralia must be accom­pa­nied by a sec­ond respon­der when attend­ing an out of hours or unsched­uled call­out. How­ev­er, there is still much work to be done, includ­ing the full nation­al imple­men­ta­tion of an Always Accom­pa­nied’ approach to practice.

Diver­si­fi­ca­tion

On the eve of expan­sion, CRANA cel­e­brates its 25th anniver­sary in Bro­ken Hill.

CRANA’s biggest growth spurt may have occurred in the late 1990s, but a sec­ond spurt fol­lowed in 2008.

CRANA was in name an organ­i­sa­tion for remote area nurs­es, but actions speak loud­er than words, and they sug­gest­ed that CRANA rep­re­sent­ed the entire remote health work­force. For exam­ple, health pro­fes­sion­als from many dis­ci­plines taught, and were taught, on its courses.

CRANA found itself in a posi­tion where its name did not reflect its activ­i­ties, nor its con­sti­tu­tion its ambi­tions.

As Janie Smith put it at the time, While being a nurse’ and being reg­is­tered’ may have been the ide­al’ 25 years ago when CRANA was estab­lished [these con­sti­tu­tion­al require­ments] no longer [reflect] the real­i­ties of the cur­rent work­force envi­ron­ment, the mul­ti­dis­ci­pli­nary nature of remote work and the nation­al push towards a more inter­pro­fes­sion­al prac­tice”.

This, and the need to be remote’ (which left out iso­lat­ed pro­fes­sion­als), was result­ing in the exclu­sion of health pro­fes­sion­als who oth­er­wise sub­scribed to the cause.⁶

The front gate of the Alice Springs CRANAplus office in 2009.

This was when CRANA was sit­ting in Alice Springs in this gor­geous lit­tle rock build­ing,” Janie Smith says of the Bath Street head office CRANA had at the time.

CRANA was like a lit­tle cot­tage indus­try, doing its thing, strug­gling for fund­ing. It was at the stage of need­ing to move itself into more of a cor­po­rate enti­ty. It was tee­ter­ing on being some­thing big­ger. There was huge poten­tial to expand and gov­ern­ment good will to make that happen.”

CRANA decid­ed it was time to make the bold move. Under Pres­i­dent Chris Cliffe and CEO Car­ole Tay­lor, the organ­i­sa­tion incor­po­rat­ed itself in the NT in 2008 to become CRANAplus’, and tran­si­tioned from a remote-area-nurse-only organ­i­sa­tion to one that wel­comed a wider Mem­ber­ship and rep­re­sent­ed all peo­ple work­ing in and for the health indus­try in remote Australia

With­in two years, around 14% of CRANA’s Mem­bers were para­medics, doc­tors, Abo­rig­i­nal health work­ers, and oth­er non-nurs­ing health professionals.

Ongo­ing growth

The Hon Tanya Plibersek MP cut­ting the rib­bon at the open­ing of the CRANAplus Cairns Office, with Christo­pher Cliffe and Car­ole Taylor.

For­mer Board Chair Paul Stephen­son with the Hon Michael Kir­by AC CMG, CRANAplus’ Patron through the 2010s.

CRANAplus has con­tin­ued to mature and diver­si­fy fol­low­ing this impor­tant con­sti­tu­tion­al change. It opened an office in Ade­laide in 2008 and in Cairns in 2012; the lat­ter became the head office short­ly there­after. In 2013, it took on its first Patron, human rights expert and For­mer Jus­tice of the High Court of Aus­tralia, Michael Kirby.

Mem­ber­ship struc­tures have changed over the years. In the begin­ning, CRANA had state rep­re­sen­ta­tives who report­ed back to CRANA on key issues and sought to grow Mem­ber­ship in their state. This con­nec­tion with the grass­roots per­sists in the mod­ern day through the CRANAplus’ Nurs­ing and Mid­wifery Round­table, as well as the annu­al Mem­ber Survey.

Thanks to the his­to­ry doc­u­ment­ed here, CRANAplus has estab­lished itself as a well-respect­ed author­i­ty on remote health. Gov­ern­ments, health ser­vices, Pri­ma­ry Health Net­works, rur­al work­force agen­cies, uni­ver­si­ties, com­mit­tees and steer­ing groups val­ue its collaboration.

Despite its 40 years, CRANAplus still has the quick reflex­es that enabled its rapid response to the Inter­ven­tion. Per­haps two of the most sig­nif­i­cant nation­al events of recent years have been COVID-19 and bush­fires, and CRANAplus has been involved in both the COVID-19 Clin­i­cal Evi­dence Task­force and the deliv­ery of work­shops and resources for health pro­fes­sion­als in drought and bush­fire-affect­ed areas.

In 2017, CRANAplus con­sult­ed com­mu­ni­ties in NT and SA while devel­op­ing safe­ty resources for the Com­mu­ni­ty Night Patrol (CNP) Workforce.

Mul­ti­ple land­marks in CRANAplus’ jour­ney walk­ing along­side Abo­rig­i­nal and Tor­res Strait Islander Peo­ples demon­strate its progress. In the ear­ly 1990s, CRANA’s Toni Dowd and Sal­ly John­son were involved in the devel­op­ment of Binang Goonj, a sem­i­nal cross-cul­tur­al edu­ca­tion­al mod­el that is still influ­en­tial today.

CRANA was a fierce advo­cate for Con­gress of Abo­rig­i­nal and Tor­res Strait Islander Nurs­es (now CATSI­NaM) in its ear­ly years, and the two organ­i­sa­tions con­tin­ue to collaborate.

In 2008, Bun­jalung woman Jo Appoo was the first Abo­rig­i­nal appointee to CRANAplus’ Board of Direc­tors. In 2015, CRANAplus launched its first Rec­on­cil­i­a­tion Action Plan. This was fol­lowed in 2020 by its First Peo­ples’ Strat­e­gy, which has pro­vid­ed new ways to priv­i­lege and ampli­fy First Peo­ples’ voic­es as we move towards gen­uine rec­on­cil­i­a­tion and justice.

CRANAplus staff at the 39th Con­fer­ence in 2022.

40 years on, CRANAplus’ sto­ry con­tin­ues to unfold. It remains a sto­ry of peo­ple, unit­ed in recog­ni­tion of their shared inter­ests and con­cerns, and the knowl­edge that their voic­es are stronger as one.

As Sabi­na Knight said dur­ing her pre­sen­ta­tion at the 40th CRANAplus Con­fer­ence, Some [peo­ple] have stayed a long time, oth­ers have had an intense and short expe­ri­ence, but each of those con­tri­bu­tions has been vital to the devel­op­ment of our organ­i­sa­tion, the pro­fes­sion and the remote health landscape”.

Which real­ly brings home one of CRANAplus’ best traits. The organ­i­sa­tion is not an abstract, anony­mous enti­ty. It’s the sum its peo­ple – its Board, its staff, its vol­un­teers and its Members.

And what bonds these peo­ple togeth­er into a com­mu­ni­ty is the desire to improve remote health, to give back to the pro­fes­sion, and the ques­tion: what can I do to make a difference?”

Foot­notes

  1. CRANAplus’ main­tains its vol­un­teer roots to this day. A pas­sion­ate group of over 130 vol­un­teer facil­i­ta­tors con­tin­ue in the spir­it of CRANA’s ear­ly vol­un­teers and make it pos­si­ble for the organ­i­sa­tion to deliv­er con­tex­tu­alised edu­ca­tion on a nation­al scale.
  2. Addi­tion­al copies were avail­able for $1. The Fly­er would even­tu­al­ly become CRANAplus Magazine.
  3. Order of Aus­tralia hon­ours are usu­al­ly bestowed ear­ly in the year, but CRANA nego­ti­at­ed for Sally’s investi­ture to occur at the Dar­win con­fer­ence. It has been said that this is the first time the Tiwi Islands flag (adopt­ed in July 1995) was flown on the mainland.
  4. Fish­er, J., Brad­shaw, J., Cur­rie, B.A., Klotz, J., Robins, P., Reid Searl, K. and Smith, J. (1995), Con­text of Silence”: vio­lence and the remote area nurse, Cen­tral Queens­land University.
  5. Advi­so­ry group mem­bers includ­ed Geri Mal­one (Direc­tor Pro­fes­sion­al Ser­vices), Rod Menere (Project Offi­cer), and Christo­pher Cliffe (CEO), who had all had long­stand­ing involve­ment with CRANAplus.
  6. These themes and quot­ed phras­es emerged in an organ­i­sa­tion­al eval­u­a­tion car­ried out by Janie Smith, through RhED Con­sult­ing, and pub­lished in 2008.