specialty focus
specialty focus
Isolation intervention
Remote area nurses sound off on ways to reduce occupational stress.
Sue Lenthall interviewed by Dallas Bastian
Nurses are often inadequately prepared for work in remote, isolated settings, and stress levels can be high. To combat this, Australian researchers have developed a roadmap for occupational stress intervention that targets the key concerns of remote area nurses( RANs) and health centre managers.
An earlier study that forms part of the project found that RANs experience high levels of occupational stress and emotional exhaustion. However, they also reported high levels of work engagement and moderate levels of job satisfaction.
“ The job demands most strongly associated with increased levels of occupational stress … were emotional demands, responsibilities and expectations, social issues, workload, staffing issues, poor management, isolation, safety concerns, violence, the remote context, culture shock, difficulties with equipment and infrastructure, and lack of support,” researchers said.
Following this study, the research team held workgroups with RANs and health centre managers to find out what interventions for occupational stress they felt were needed.
Four common themes emerged: remote context and the resulting emotional demands, workload and scope of practice, poor management, and violence and safety concerns.
Nursing Review sat down with Flinders University associate professor Sue Lenthall to discuss the changes that need to be implemented across remote health centres to start to reduce occupational stress and improve RAN safety.
NR: You ran a series of work groups with RANs and health centre managers working in remote Aboriginal communities in Central Australia and the Top End. What were some of the key stressors or areas for improvement that participants identified? SL: Participants identified four main areas of stress. The first one is just a remote context. It’ s physically, personally, professionally
isolating and it’ s a very emotional, demanding role. That particular area is not something we can do so much about.
The second one is the workload and the scope of practice. Most RANs work in a very broad scope of practice. It’ s an advanced practice role where they often have to diagnose, prescribe medications, act in a public health manner, health promotion, all sorts of things which nurses working in a hospital probably wouldn’ t have to do. With the advanced practice, many nurses identified that the levels of responsibilities and expectations by the health service and by the communities were too high to be met and that caused quite a deal of stress.
The third area is basically poor management. The managers sometimes, I think, are an easy target, in that if something goes wrong, management is the broad group that gets blamed, but in remote Australia there’ s a habit of putting people in management without very good management skills or with no management experience. It’ s sometimes the last person standing who becomes the clinic manager. That causes a lot of stress on various people.
The fourth main area was the level of violence and safety concerns. Unfortunately, that was highlighted last year when a nurse in a remote area of nursing in South Australia was murdered, and that has really raised the emphasis on looking at the issues about the violence and safety of RANs.
From those work groups, you created a roadmap for occupational stress intervention. What did that entail? Many of the interventions focused on trying to establish a better education, particularly orientation, and education for RANs so that they are properly prepared for the advanced practice role. We found that about 35 per cent of RANs in the Northern Territory had not received any orientation whatsoever to their roles, and of those who had received an orientation, less than half thought it was adequate. So that was a big area, and it’ s complicated by the fact that there is an enormous turnover rate among RANs all over Australia, not just the Northern Territory. But in the Northern Territory, a recent research project showed the turnover rate for RANs was a 146 per cent, which is extraordinary. It’ s very hard to do a proper orientation for that. There was what we came to call orientation burnout for many people that were there for more than a few months.
10 | nursingreview. com. au