Nursing in a different world: Remote area nursing as a specialist–generalist practice area

Abstract

Objective: Remote area nurses provide primary health care services to isolated communities across Australia. They manage acute health issues, chronic illness, health promotion and emergency responses. This article discusses why their generalist scope of practice should be formally recognised as a specialist nursing practice area.Design: Constructivist grounded theory, using telephone interviews (n = 24) with registered nurses and nurse practitioners.Setting: Primary health care clinics, in communities of 150-1500 residents across Australia.Participants: A total of 24 nurses participated in this study.Results: Nurses' perceived their clinical knowledge and skill as insufficient for the advanced, generalist, scope of practice in the remote context, especially when working alone. Experience in other settings was inadequate preparation for working in remote areas. Knowledge and skill developed on the job, with formal learning, such as nurse practitioner studies, extending the individual nurse's scope of practice to meet the expectations of the role, including health promotion. Conclusion:Remote area nursing requires different knowledge and skills from those found in any other nursing practice setting. This study supports the claim that remote area nursing is a specialist-generalist role and presents a compelling case for further examination of the generalist education and support needs of these nurses. Combined with multidisciplinary collaboration, developing clinical knowledge and skill across the primary health care spectrum increased the availability of health resources and subsequently improved access to care for remote communities. Further research is required to articulate the contemporary scope of practice of remote area nurses to differentiate their role from that of nurse practitioners.

The National Rural and Remote Nursing Generalist Framework 2023–2027

“…They are often required to work in diverse cultural and geographical contexts, responding to emergencies and a wide range of acute and chronic health conditions in isolation, or with the local health care workers including Aboriginal Health Practitioners and nonclinical staff to support the people they care for. 6,7 To practice in rural and remote Australia, RNs are required to be multiskilled and practice as an extended generalist when delivering primary health care. 7,8 Therefore, it is important that RNs have the core capabilities and clinical skills to provide care to rural and remote Australians.…”

“…Furthermore, registered nurses (RNs) are often the first point of call for patient consultations where there are no other health professionals available such as general practitioners. They are often required to work in diverse cultural and geographical contexts, responding to emergencies and a wide range of acute and chronic health conditions in isolation, or with the local health care workers including Aboriginal Health Practitioners and nonclinical staff to support the people they care for 6,7 …”

Models of clinical supervision of relevance to remote area nursing & primary health care: A scoping review

“…24,25 Furthermore, the development of skills and knowledge in generalist settings may assist in overcoming issues related to working in a resource-poor environment. 7 It has been suggested that to assist RANs to work within their scope, support and supervision are required when transitioning from an acute care setting to the remote health setting. 7 Clinical supervision aims to improve quality, safety and challenge standards of care 26 and is not considered performance management or managers providing direction.…”

“…7 It has been suggested that to assist RANs to work within their scope, support and supervision are required when transitioning from an acute care setting to the remote health setting. 7 Clinical supervision aims to improve quality, safety and challenge standards of care 26 and is not considered performance management or managers providing direction. 27 'Mentoring' and 'preceptorship' are often used interchangeably for 'clinical supervision' in rural and remote nursing practice.…”

“…5 In terms of nursing care, the more remote a nurse works the increased amount of generalism and advanced practice is required for clients that have a higher burden of disease. [5][6][7] Remote area nurses (RANs) are 'a registered nurse/midwife whose scope of practice encompasses broad aspects of Primary Health Care and requires a generalist approach. The practice most often occurs in an isolated or geographically remote location.…”