More­over, remote area nurs­es were a pre-dom­i­nant­ly female pro­fes­sion­al group with­in a patri­ar­chal soci­ety, and pre­vail­ing val­ues of reli­gious duty, bush sto­icism and ser­vice to coun­try often sug­gest­ed one should qui­et­ly ​‘get on with the job’.

But beneath the sur­face, the work­force was stir­ring, recalls remote area nurse Sal­ly John­son, who was work­ing as a nurse in the Gulf Coun­try at the time.

“I was sit­ting on a beach in the Gulf of Car­pen­taria not far from Nor­man­ton,” she says, ​“con­tem­plat­ing the real­i­ty and the fair­ness of this situation.”

The year was 1982 and she was with fel­low remote area nurse, Jen­ny Klotz. Jen­ny had recent­ly been asked to relieve an RN at a near­by clin­ic. The nurs­es’ flat was occu­pied and her request to stay in a motel was at first refused because there was a ​“per­fect­ly good” hos­pi­tal trol­ley in the clin­ic for her to sleep on. She suc­cess­ful­ly protest­ed for bet­ter accom­mo­da­tion with the help of the Queens­land Nurs­es Union (QNU), but this was just the tip of the ice­berg. RANs in the area were find­ing them­selves under-pre­pared and equipped to respond to car crash­es, pre­ma­ture births, and oth­er com­plex presentations.

“What we were think­ing at the time was: we are out here expect­ed to have skills that we have nev­er been taught,” Sal­ly says.

“And we are learn­ing on patients and that is not fair to them or to us. So, what to do? Well, this type of nurs­ing had taught us to find a way to fix things.”

The pair com­piled a list of clin­i­cal and gen­er­al nurs­ing skills required by remote area nurs­es, and Jen­ny, who was active with­in the QNU, devel­oped a spe­cial inter­est group called the Queens­land Iso­lat­ed Nurs­es Association.

The group soon attract­ed a mem­ber­ship of 31. This was a light­bulb moment for Jen­ny and Sal­ly; clear­ly, fel­low Queens­lan­ders shared their plight. But did nurs­es in oth­er states and ter­ri­to­ries feel the same?

“I recall two ladies – one was a reg­is­tered nurse (RN) – who were trav­el­ling the out­back with the Iso­lat­ed Children’s Par­ents’ Asso­ci­a­tion,” Jen­ny says. ​“They were deliv­er­ing books and social sup­port to out­ly­ing and remote sta­tions and small com­mu­ni­ties.

“[These ladies] were a god­send. They had con­nec­tions… In Queens­land we had a step ahead, but now word was spread­ing across Aus­tralia through their infor­mal network.”

The RN in ques­tion was Ter­ri Ormis­ton who lived in Mt Isa and worked for the Unit­ing Church Fron­tier Ser­vices. In 1982, she flew into Syd­ney for the Roy­al Prince Alfred Hos­pi­tal Cen­te­nary celebrations.

The day marked 100 years for this urban health­care insti­tu­tion, but Ter­ri dis­cussed the plight of remote area nurs­es. Her pre­sen­ta­tion attract­ed a stand­ing ovation.¹ June Cochrane, Exec­u­tive Direc­tor of Col­lege of Nurs­ing Aus­tralia, took note.

June offered the College’s annu­al con­fer­ence as a forum to gauge the inter­est in estab­lish­ing a net­work of RANs from all states and territories.

The inter­im com­mit­tee that formed fol­low­ing this event includ­ed Mary Barr from Alice Springs, Jen­ny Cramer from NSW, Bil­lie Scott from WA, and Stephanie Muir from the Top End. They suc­cess­ful­ly applied for Gov­ern­ment fund­ing of $4,000 and start­ed to pro­mote the event through their new­found net­works, while nurs­es in Alice Springs includ­ing Mary, Doris Kubisch and Sandy Wer­chon worked tire­less­ly on planning.

“We col­lect­ed all the Aus­tralian tele­phone books from the post office at Nor­man­ton and looked for the addressees of any remote clin­ics, send­ing each of them an invi­ta­tion to come and dis­cuss our sit­u­a­tion in Alice Springs,” Sal­ly says.

​“We didn’t ask them to reply because it was all snail mail and we were busy with our jobs out there. We just thought, we’ll throw it out there and if nobody comes that’s alright, but if 30 or 50 come, we can talk about it.”

Ral­ly­ing togeth­er in 1983 and 1985

Over 100 nurs­es arrived in Alice Springs on 27 Octo­ber for the two-day event. The pre­cise attendee count is lost to time, with 110, 130 and 150 com­mon­ly quot­ed, but the import of the num­ber remains. To accom­mo­date the group, the com­mit­tee had to change the venue three times (final­ly set­tling on a room at the Memo­r­i­al Club) and bor­row cut­lery, glass­es, cups and saucers from Alice Springs Hospital.

The theme was ​‘Remote area nurs­ing – myth or real­i­ty?’ At this time, there was min­i­mal under­stand­ing of the role, even among oth­er nurs­es. RANs were at times even viewed as drop-outs from the main­stream sys­tem. Now, sud­den­ly, the Min­is­ter for Health Neal Blewett was on the stage, acknowl­edg­ing their reality.

“[Pyra­mid struc­tures with doc­tors at the top, para­medics in the mid­dle, and nurs­es at the bot­tom] are prob­a­bly inap­pro­pri­ate in any health set­ting,” he said. ​“For the RAN they are sim­ply irrel­e­vant. He, or she, has to be a doc­tor, para­medic and nurse rolled into one.” It must have come as a pleas­ant surprise.

The first few con­fer­ences were like releas­ing the valve on a pres­sure cook­er, Sal­ly says.

“There was so much pent-up ener­gy, frus­tra­tion and pas­sion among remote area nurs­es. They need­ed a safe place to air their griev­ances, a place they knew they would be heard and under­stood, a place where they could gain sup­port from their peers.”

Jen­ny agrees. ​“The oppor­tu­ni­ty of final­ly being able to dis­cuss and share our com­mon inter­ests and con­cerns was like a seed that was plant­ed in our hearts and minds. [The con­fer­ences] gave us a sense of belong­ing, sol­i­dar­i­ty and pow­er in our own shared knowl­edge and experience.”

In 1985, the group had its break­through con­fer­ence in Townsville. Its suc­cess hinged on gen­er­ous exter­nal sup­port; the Gov­ern­ment pro­vid­ed enough grant mon­ey to cov­er con­fer­ence costs, includ­ing repa­ra­tion of trav­el expens­es for atten­dees who did not receive finan­cial sup­port from their employ­er. In Jenny’s words, they were recog­nis­ing that ​“we as a group of feisty women and men were jus­ti­fied in our right­eous quest to improve the edu­ca­tion and sup­port of RANs”.

The organ­i­sa­tion set­tled on its name, with ​‘CRANA’ suc­ceed­ing over alter­na­tives such as ​‘Remote Area Nurs­es Cor­po­ra­tion’ or ​‘Organ­i­sa­tion of Remote Area Nurs­es Aus­tralia’. It inau­gu­rat­ed Jen­ny Klotz as Pres­i­dent, Sabi­na Knight as Vice Pres­i­dent, Mar­garet Daw­son as Sec­re­tary, Ber­nice Blain as Assis­tant Sec­re­tary, Jen­ny Cramer as Trea­sur­er, and Ann Kreger as Assis­tant Treasurer.

“We did lots of work at that [1985] con­fer­ence in small groups, high­light­ing our most promi­nent issues,” Jen­ny remembers.

“At the end of the day, when oth­er par­tic­i­pants left to find some recre­ation and relax­ation, we, the core group, col­lat­ed all the infor­ma­tion that had been writ­ten on mul­ti­ple, mul­ti­ple pieces of butch­ers paper, and came up with the final key con­cepts that as an organ­i­sa­tion we wished to address.”

These issues were crys­tallised into the famous 1985 con­fer­ence report and includ­ed edu­ca­tion, legal issues, occu­pa­tion­al health and safe­ty, and the ​“spe­cial prob­lems of liv­ing and work­ing in remote areas” (such as iso­la­tion, com­mu­ni­ty ten­sions and high­er lev­els of pover­ty) which meant that ​“straight­for­ward dupli­ca­tion” of urban ser­vices would be inap­pro­pri­ate. Jen­ny Klotz, in glass­es and pearl neck­lace, stares out from the pages of this small, glossy book­let, her gaze serene­ly but calm­ly demand­ing a fair go for RANs. CRANA dis­trib­uted the report wide­ly, to state and fed­er­al Gov­ern­ment, oppo­si­tion, union and non-gov­ern­ment organisations.

Though the book­let focus­es on the issues faced by RANs, this was a means to an end; CRANA’s goal was always to improve health out­comes in remote Aus­tralia. Oth­er details have been lost to time, but this uni­fy­ing pur­pose can be traced back across four decades.

CON­TIN­UE THE HISTORY

• Part 2: Prepar­ing the work­force: the push for education
• Part 3: The fight for iden­ti­ty: val­i­dat­ing RAN practice
• Part 4: From cot­tage indus­try to cor­po­rate enti­ty (includ­ing the for­ma­tion of the Bush Sup­port Line)

Foot­notes

1. Ter­ri also famous­ly called for a year of the remote area nurse in the Aus­tralian Nurs­es Jour­nal in ear­ly 1983.