Capacity building in rural and remote nursing workforce

Rural and remote communities throughout Australia experience inequalities in the delivery of health services. This is consistent with the international context, where a major contributing factor is a shortage of available, appropriate and motivated health workers. With 70 per cent of the world’s poor living in rural areas, the impact of COVID-19 exacerbated the need to address nursing skills shortages for more vulnerable communities.

The delivery of healthcare services in rural and remote locations in Australia is reliant on a sustainable healthcare workforce, including nurses and midwives. The Queensland Health (QH) Rural and Remote Generalist Nurse Project is one of the QH workforce initiatives that aims to build capacity in the rural and remote nursing workforce to meet community needs.

In October 2019, funding was provided from the Queensland Office of the Chief Nursing and Midwifery Officer (OCNMO) to consider the elements that would be required in developing a statewide career pathway for rural and remote generalist nurses. The project found a wide range of factors impact the delivery of healthcare services in rural and remote locations including:

• an ageing workforce
• difficulties with the provision of an appropriate skill mix with the right training
• safety concerns for staff in these locations
• difficulties related to staff attraction, recruitment and retention
• a lack of suitable leadership programs, professional development opportunities and succession planning.

In 2021, QH made a further commitment to provide funding to five participating Hospital and Health Services (HHS) to recruit 20 FTE registered nurses (RNs) for a supernumerary period to pilot a rural and remote generalist nurse program. The participating HHS are Central West, Darling Downs, North West, South West and Torres and Cape.

The COVID-19 surge impacted Queensland in January 2022, resulting in emergency responses from HHS. This meant the program commencement was delayed. The project team saw this as an opportunity to engage extensively with stakeholders to develop a robust and comprehensive program to be piloted in the 2022–23 financial year.

The project team engaged an external consultant to facilitate a workshop with key stakeholders. Representatives came from the participating HHS, statewide networks, interprofessional streams, along with a health consumer. This was a successful event where the energy level in the room was high, with an obvious appetite for change. Discussions were rich and productive, generating momentum to continue the work with a shared vision. The key topics discussed were:

• What is a rural and remote generalist nurse and what is not?
• What is the context of practice – geographical, social, professional and personal?
• What are the common and unique clinical skills, knowledge and abilities of a nurse working in a rural and remote location?
• What is currently working well in developing the rural and remote generalist nurse role? What are the gaps?

Following the workshop, the project team worked extensively with the QH Executive Directors of Nursing and Midwifery and the Nursing and Midwifery Directors of Education from the five HHS to develop the role and profile of the rural and remote generalist nurse, and to develop a rural and remote generalist nurse program to pilot at the sites. The finalised program consists of:

• core modules to address essential skills, knowledge and abilities
• elective modules to meet the learner’s needs and address local community needs
• support processes to foster clinical, professional and organisational development.

The next stage of the project is to support the implementation of this program and evaluate its outcomes. Findings will inform future work required to continue development of a statewide rural and remote generalist nurse program for RNs.