There are four RFDS remote clin­ics across South Aus­tralia – Andamooka, Innam­inc­ka, Mar­la and Mar­ree. This April marks two years since Melis­sa intro­duced a new mod­el of enrolled nurs­ing to these clin­ics, and she has found it to be a ​“resound­ing success”. 

“After doing a bit of gap analy­sis across the teams in the clin­ics and hear­ing what their pain points were, we decid­ed to imple­ment the EN mod­el,” Melis­sa explains.

“It was pri­mar­i­ly to be a sec­ond posi­tion to meet the Gayle’s Law require­ments, but it was also to sup­port the remote area reg­is­tered nurs­es in their deliv­ery of emer­gency care and out of hos­pi­tal emer­gency trans­port, as well as the deliv­ery of the pri­ma­ry health care and chron­ic dis­ease management.”

The Rur­al and Remote Nurs­ing Gen­er­al­ist Frame­work was an impor­tant tool in this process. Melis­sa has inter­pret­ed from it that to cre­ate a sup­port­ive envi­ron­ment for RANs to prac­tice to their full scope, clin­ics need to pro­vide a posi­tion that can assist them with the more task-ori­ent­ed nurs­ing roles, to encour­age space for big­ger-pic­ture thinking.

“If we want to free up the RAN to do com­plex clin­i­cal deci­sion-mak­ing and com­plex care plan­ning, then the EN could be tak­ing on roles and duties that are with­in their scope of prac­tice to take that bur­den off,” Melis­sa says.

“It gives RANs the head­space to be think­ing about all the oth­er things they are want­i­ng to do in a remote com­mu­ni­ty that you can’t nec­es­sar­i­ly give the ded­i­cat­ed time to when you’re busy doing the core clin­i­cal care.

“Now with the ENs assist­ing, there is time to be think­ing through those things and plan­ning strate­gi­cal­ly, rather than always being in reac­tive mode.”

ENs are not wide­ly sought after for remote area roles across Aus­tralia, but Melis­sa has seen that when they are, they bring many ben­e­fits to a clin­ic, and the wider community.

“We’re in a posi­tion now where nurs­es aren’t suf­fer­ing as much cog­ni­tive fatigue bur­den as they were before, because when they’re in high-pres­sure sit­u­a­tions of emer­gency response, there’s an imme­di­ate sec­ond brains trust who’s a clin­i­cian who they can talk through clin­i­cal rea­son­ing with.”

“And of course with the short­age of RANs in the mar­ket cur­rent­ly, open­ing it up to ENs has real­ly assist­ed us with ensur­ing that our com­mu­ni­ties and our clin­ics oper­ate with a con­tin­u­um of care, our patients are feel­ing more sup­port­ed, and our staff are nev­er work­ing alone.”

The remote area clin­ics are a great place for first-hand learn­ing for ENs too.

“In our clin­ics, most of our ENs are actu­al­ly study­ing to be RNs,” Melis­sa says.

“In their tra­di­tion­al uni­ver­si­ty clin­i­cal place­ment, they might not get the lev­el of access to think­ing through the clin­i­cal rea­son­ing in an advanced, com­plex way. They’re see­ing the RNs doing this, and they’re shad­ow­ing them and unpack­ing what they’re learn­ing in their stud­ies in the course of their work.

“From where I stand as an old nurse in the pro­fes­sion in Aus­tralia, I think that’s a great thing because the nurs­es that we will turn out into the future nurs­ing gen­er­a­tions of Aus­tralia will hope­ful­ly have had access to a whole lot more experience.”

To join an RFDS remote area clin­ic as an EN, at least two-and-a-half years of post­grad­u­ate expe­ri­ence is required, and that has to include at least six months of pri­ma­ry health care or cor­rec­tion­al ser­vices nurs­ing, and/​or at least six months in an acci­dent emer­gency type envi­ron­ment. Expe­ri­ence in mul­ti-pur­pose health ser­vices where there has only been one RN and one EN is also looked upon favourably.