Rural and remote nursing issues
Although the ATS is applicable in the rural and remote triage contexts, and the expectation is of consistent and accurate application Australia wide, many factors impacting upon rural and remote nursing practice must be understood in order to ensure that this occurs. These factors may include access to continuing education, recruitment and retention issues, isolation and educational preparation for the generalist role.
Rural Triage Nurses face unique issues that need to be recognised and considered. Features of the rural environment, and of the community and small local hospital services, may exacerbate these issues, and need to be considered as influencing factors for rural triage. Some of the issues confronting rural Triage Nurses are listed below. 30
• Multiple jobs: Due to the spasmodic nature of the need for triage, rural Triage Nurses often have other jobs as well. Unlike their metropolitan counterparts, rural nurses do not dedicate their time to the triage desk. This can impact upon their opportunities for learning and maintaining skills through consistent practice.
• Lack of a‘ safety net’: The Triage Nurse in a rural or remote environment may well be alone in the facility, with no one around to provide support or advice.
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• Lack of other options for care: Patients in this environment cannot easily be triaged elsewhere in the immediate term. When the decision to triage elsewhere is made, consideration must include the distance, and the safest way for the patient to travel.
• Time issues: The initial‘ wait’ time for patients is often not the key issue in this environment; rather, it may be the time it takes to get them to the hospital, and, once they have arrived, how to get them the most appropriate care in the fastest possible time.
• Delivery of initial emergency care: This can be a source of anxiety for staff. Dealing with the unexpected, with limited support or specialised back-up, means that the rural Triage Nurse needs a broad range of knowledge and skills.
• Personal and departmental safety: This can be a potential problem. Triaging without security, often without even another nurse, or a local police station, is a major source of anxiety in rural and remote triage practice.
• The triage process may occur outside the hospital setting: For example, the triage process may occur as part of a district nursing community health care role, or via telephone, as patients try to avoid the inconvenience of travelling long distances to access health care advice or treatment. However, it must be emphasised here that the ATS is a face-to-face tool, and local protocols must guide other triage types.
Department of Health and Ageing – Emergency Triage Education Kit