Rural generalist nursing careers in Western NSW

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I came here as a new grad and I've stayed on since. I've always  enjoyed working here - one of the other reasons is that I met my husband in my new grad year - and the team environment here and getting the things I get to do is second to none - you can't get to do it anywhere else.

You can Triage our here, you can canulate, venepuncture, IDCs, SPCs you name it - we can do it out here.

I am a ward nurse generally but obviously in a rural facility I am also an accident and emergency nurse, when there's a trauma or there's a need for it. 

I also do community nursing, we also have dialysis here at this facility, I've also done dialysis nursing and obviously we have palliative patients.  We have a lot of post rehab patients, so we do a lot of wound care.

The variety is on the of the things I enjoy the most about working here, also you have aged care, you have emergency and you have your normal everyday ward work, so every day is something different and you get to experience things you wouldn't see in the city as they would be swept away to a specialist unit.

I have so many more skills my friends wish they would have but don't, they don't get the opportunity with all the junior Doctors down there in the city.

My role is virtual outreach support to the nursing staff in the district, education sessions through the video conference we support the staff because they may have a question about a medication or a procedure.   For this month in May we have approximately a hundred virtual sessions offered.

When I started working here, they supported me for triage, like how to work in a rural ED. First of all if anything comes through the ED, how to handle that, I've done a vaccination course, advanced life support, so if something happens we can administer drugs.

We have excellent support from vCare which is the speciality emergency team based in Dubbo, and all the retrieval teams they can connect us with.

Here in Nyngan we are very lucky - we have the support of our managers and usually on call RN overnight.  

Because of the diverse nursing that I do I've always been able to do those extra courses whether it be palliative care, community nursing, dialysis.

We're using this technology and this education to improve, to help our nurses, support our nurses.

I've done lots of emergency courses through the district with training days on site here or just in Dubbo or in other towns and they've help further my skills give me that confidence to be in charge.

We do have more registered nurses starting, here - New Grads - which is also very enjoyable as you get to  help them and  you learn new things off them, things they are learning at uni or they have learned in other facilities, so the team is quite diverse but in a way it is very experienced and very strong.

Working in a small rural facility again, the team is not just the nurses on the ward, its actually the whole facility. I might ring a community nurses today to get an assessment with a patient that's being discharged tomorrow, I might actually speak to the front office staff about something particular about that patient, so actually everyone is involved because it is such a small community and a small facility so my whole team is everyone including the ambulance officers who walk through the door.

They're beautiful out here, I couldn't ask for a better team, they're all lovely, all supportive, you just couldn't find any, any team like it.

In a small rural facility everyone is dependent on eachother , its teamwork - if someone comes in ED everyone comes and helps you, they know what is there role and they support us in those situations, in every situation.

I had some free accommodation over at the units for 12 months and then I brought myself a house here in town - so I'm a permanents stayer.

There s no reason not to even if you don't stay out here forever the skills you'll learn in Western LHD will be transferable back in the city and the things you'll see you'll never see anywhere else.

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[Sonia Bonham - Gilgandra Hospital, Regional Nurse Education Western NSW LHD]

The modules, uh it's a framework so if someone entered into our facility and was starting the ARGN program, they would enrol online through My Health Learning and get access to a workbook and some learning modules and some videos and when they were happy that they understood the content then an educator like myself or a CNE would come out to the sites and we'd work one-on-one and just go through their understanding of that and do a verification to make sure that they're at a standard a level of adept, that then provided them with these skills to be able to work autonomously in our facilities, but part of a team.

[Isabella Dark - Registered Nurse, Gilgandra Hospital]

It's an amazing change. I didn't think that I would like it at the beginning but moved out here and within a month I knew that I wanted to stay and not go home, so just branch out and have a go. It's easy to make friends, get involved in the community. It's great, everyone's welcoming, it's a great change so if you're considering it, do it.

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[Music] The rural generalist nurse education program was developed through some identified gaps that were found in the onboarding process and then transitioning nurses from new staff all the way through to advanced clinicians.

In collaboration with the organisational development unit from the workforce and culture directorate, the quality clinical safety and nursing directorate and the virtual rural generalist service -  11 key areas were identified to be addressed through this program.

The resources were developed in collaboration with the rural generalist nurse education team, virtual doctors and other clinical experts within the district. 

Initially the resources developed included a workbook and powerpoint presentations that were delivered locally at facilities.

Through evaluation and feedback we were able to evolve the program to now include e-learning workbooks in my health learning, videos of the assessments taking place and quick reference guides available on the intranet.

As part of this process we developed qr codes for staff to easily access the information 24 hours a day. Staff can easily scan the qr codes and be taken to the rural generalist nurse education pages on the district's intranet.

Those intranet pages contain all the modules and information that is taught in the program. 

An example of this would be using the qr code to access the RGnet pages on plastering and there they have a number of videos showing a number of different plaster of paris backslabs that are relevant, appropriate and safe for the rural generalist nurse to apply. 

Additionally, they can access all the assessment videos in one location -  they scan the appropriate qr code and this takes them to an external youtube channel that is private for the district where they can see all these assessment videos in one go.

As part of the program evolution we now have virtual education available for staff by moving the resources online. We have freed up time from the clinical nurse educators to be able to provide support and coaching in real time, and this is done at the bedside.

The rural generalist nurse education program has been really beneficial to me as a new grad it has really helped broaden my scope and practice my assessment skills.

I think I'll be able to better communicate with everybody in the team and use the skills that I've learned through bedside coaching and through the program to be able to communicate with the doctors about my findings through the assessment and using the handover tool, so can confidently and effectively communicate information.

If you have the opportunity to get into the program, take everything that is been provided, because it for me i found it really beneficial to be able to develop new skills and also use these in everyday nursing practices and has provided me lots of opportunity to grow and develop.

This program has been a great example of the collaboration that can be achieved across groups within the district it has allowed us to develop a program that has set a foundation for new staff into our rural and remote facilities and start them on their journey to become a rural generalist nurse