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In a context of high stress, high levels of work engagement and moderate levels of job satisfaction do not obviate high workforce turnover for this population. There is a need to reduce job demands and increase job resources in order to foster long-term work engagement and reduced emotional exhaustion. This might subsequently decrease remote area nursing workforce turnover.

a b s t r a c tBackground: Nurses in very remote areas of Australia (RANs), work in complex and isolated settings for which they are often inadequately prepared, and stress levels are high. This paper, based on the 'Back from the edge' project, evaluates the development and implementation of an intervention to reduce and prevent the impact of occupational stress in the RAN workforce in the Northern territory. Methods: The methods involved a combined participatory action research/organisational development model, involving seven steps, to develop and implement system changes within the (then) Northern Territory Department of Health and Families (NTDH&F). The development, implementation and evaluation was informed via information from participants collected during workshops and interviews. Pre and post surveys were undertaken to evaluate the study. Results: Occupational stress interventions developed by the workgroups were categorised into four main groups: (1) remote context, (2) workload and scope of practice, (3) poor management, and (4) violence and safety concerns. The main interventions centred on promoting a well educated, stable workforce. There were very few measurable changes as a result of the interventions as many were not able to be implemented in the time period of the study, but implementation is continuing. Conclusion: While the outcome evaluations showed few effects, the study through consensus approaches, provides a blueprint for reducing stress among remote area nurses and evidence which should inform policy and practice with respect to service delivery in remote areas.

The development and validation of the RANSS is a significant advancement in remote area nursing research. The RANSS should be administered on an ongoing basis to monitor occupational stress among nurses working in very remote Australia. The RANSS should also be administered internationally in countries that also accommodate remote health care facilities. This would determine whether the RANSS is a psychometrically valid stress measure beyond the context of very remote Australia.