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The terms‘ rural’ and‘ remote’ refer to the 34 per cent of Australians who live outside a major city. The core difference between rural and remote nursing practice and its urban equivalent is the generalist advanced-practice role. 136
Bushy & Bushy( 2001) 137 describe the role of the rural nurse as an‘ expert generalist’ who is often expected to be a Geriatric Nurse, a Trauma Nurse and an Acute Care Nurse simultaneously, and who often functions without the immediate support of a medical practitioner.
Rural and remote emergency departments / services
It is appreciated that rural and remote triage may occur with very different levels of available resources from those available to an urban ED. Despite this, the principles of triage still apply. It may be, however, that the rural and remote Triage Nurse has a greater reliance on local practice and treatment guidelines.
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Within major urban EDs there is a multidisciplinary team available to provide the skill-mix required to ensure that each patient receives adequate assessment and care, and to support the novice Triage Nurse. In rural and remote areas, such support may not exist, and the Triage Nurse may need to provide immediate assessment and care without any support from other health professionals.
One way to define a rural or remote ED is to describe it as one without on-site medical staff. 138-40 Current practice within rural facilities often involves patient care initiated by nurses. Therefore, a number of work practices have developed in response to local circumstances. These may include extension of the nursing role to initiate patient management while the doctor is en route. Some rural EDs have an arrangement with the local doctor whereby patients with non-urgent problems are asked to return at a later time. These practices rely heavily on the assessment skills, judgement and experience of the nurses in the rural facility. Some rural and remote EDs have developed local clinical guidelines for such situations; however, this is still the exception rather than the rule. 139
It is important to note that while the volume of patients in a rural ED is generally lower than that of an urban setting, and the caseload also varies, the range of presenting complaints is the same as that seen in urban EDs. 141
The ATS is applicable in rural and remote settings; however, the emphasis is on time until treatment is initiated, rather than time until seen by a doctor. 139
Triage in the rural context, therefore, does not just involve assessment of acuity; it may also involve early management decisions and treatment. The important principle to remember, however, is that although the boundaries or scope of triage practice may be different between rural and urban triage environments, these differences should not impact upon the consistent and accurate application of the ATS.
Department of Health and Ageing – Emergency Triage Education Kit