specialty focus
The numbers of RANs coming through that they had to
orientate was just completely burning them out. The other key
part was trying to establish a more stable workforce, and that’s
very difficult with a turnover rate like that, and it’s very difficult
to really reduce levels of occupational stress when you have
such a turnover rate and an unstable workforce like that.
One of the other major areas was trying to reduce the
sense of isolation by increasing the use of internet in all
the accommodation. In the Territory health department,
there is internet available in the clinic but not in most of the
accommodation, which is not ideal. There is a program now
to increase the internet access in accommodation where
people can email, video conference or FaceTime with friends
and families, as well as accessing the internet for educational
purposes and for professional development.
I think another major area was to try to increase the number
of permanent relievers. The relievers that are employed by the
health department go back to the same communities, so it’s
not a new person all the time and decreases the need for that
orientation of everybody that comes through. There have been
some situations where one nurse might be in the clinic and has
seen 136 RANs go through the clinic in 12 months and has had
to orientate each of them.
The other area was trying to increase the education and
performance of managers, to require managers to do some
education around management. With the violence and
safety, the main strategy was to increase the use of second
responders, and since that horrible murder of a RAN in South
Australia, it has become a real issue, the Northern Territory
health department has made it mandatory now for RANs – if
they go out on call at night – to be escorted with a second
responder.
Some of the interventions laid out weren’t implemented in
the 12-month study timeframe. What obstacles were there
in terms of implementation?
The main obstacles were the time period, for one. For real
organisational change, the literature suggests you need at least
three years, and we ran the work groups and tried to make
changes within 12 months, which probably wasn’t realistic. We
had found even though the project is technically finished, a lot
of the interventions are still happening, so they’re still being
implemented within the health department. We do hope to
be able to repeat this survey in a couple of years’ time and see
what the changes have been.
The other main area is the unstable workforce – it’s a bit of
a vicious circle. Until we can do something about stabilising
the workforce a little bit and reducing the turnover, it makes it
very difficult to introduce most of the other interventions and
actually reduce the stress.
I’m not sure exactly how that’s going to happen.
The Commonwealth government’s intervention in the
Northern Territory in Aboriginal communities occurred around
the same time as the start of this project, before we did the
interventions, and really created a limitation as to what we
could do. They also put quite a bit of money into agency staff
to try and increase the number of nurses from the east coast
coming to remote Indigenous communities in the Northern
Territory. We need those people, but they didn’t put money or
strategies into developing a more semi-permanent workforce.
The use of agency staff has increased dramatically in the
Northern Territory and has greatly increased the turnover
rate. There were some unexpected consequences around the
intervention that wasn’t positive for the workforce.
At the moment, it’s still a major issue that it’s easier and often
more financially rewarding to work for an agency than it is to
work for a health department. That’s partly why the turnover
rate is so high. Until we can bring down that turnover rate, I
don’t think there’s very much we can do with really reducing
stress levels, but we have been able to have some real wins on
the board with this project. One of the things we identified was
that there were a number of single nurse clinics, particularly in
Central Australia, and the Northern Territory government had
already made the decision to reduce those, or even get rid of
single nurse posts. I think there’s no single nurse post left in
Central Australia. Through this project, we managed to bring in
better orientation and education.
The other thing that’s needed to try and develop a more
permanent workforce, or semi-permanent, is a career structure
for RANs, which the Northern Territory government has done.
There are areas where nurses can come in at a lower level, a
Level 2 or a Level 3, and not be expected to go on calls straight
away and have an educational process that would lead them to
a Level 4, which is the normal level of RANs. So it allows nurses
to be learners, which in the old structure really wasn’t there.
People were expected to hit the ground running and know
everything, which was totally unrealistic.
Moving forward, what would you say are some of the high
priority changes that need to be implemented across all
remote health centres to start to reduce occupational
stress and improve the safety of RANs?
One of them is to try and reduce the turnover rate. I think there
has to be some creative strategies developed to make it a good
option to work for a health department rather than to work for
an agency. I know people are looking at that and they’re trying
to introduce that.
They have also introduced some more relievers employed
by the health department that would go back to the same
community. The huge turnover rate doesn’t just impact on RANs.
I mean, it’s hugely problematic and it creates a lot of stress on
various people, but it also isn’t great for the community or the
delivery of health services.
So, strategies that will go towards a more stable workforce?
The education and orientation – everybody needs an
orientation before they go out and work in the remote
community. That needs to include agency staff and that needs
to be mandatory for everyone. The standard of education
should be increased.
To reduce the sense of isolation, I think it’s important that
internet is provided in all the accommodation so that people
can access professional development by the internet after
hours, and they can also talk to friends or email family. It’s
about reducing personal/professional isolation.
I think in many communities there is also a need to employ
more Indigenous health staff. That’s an ongoing option.
As far as safety and on-call, the main thing is that there needs
to be a second responder for every call-out. Most people in
cities, with doctors and nurses, don’t go on call-outs on their
own, and RANs were one of the last groups who still went out
on their own at night on call. Now, it’s just not acceptable. That
needs to be implemented across the board. ■
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