The National Rural and Remote Nursing Generalist Framework 2023-2027.

Abstract

About seven million people (28% of the population) live in regional, rural and remote Australia.1, 2 Rural and remote Australians have a higher incidence of injury, chronic disease, mental health issues and smoking rates.1, 3 They are also less able to access primary health care than those living in a metropolitan area.1 Furthermore, they experience reduced life expectancy because rural and remote people have poorer access to available health care, including specialist care and are often required to travel long distances compared with their metropolitan counterparts.1, 3, 4 It is important that all Australians, no matter where they live, have access to the health care they need. One way to address the limited access to health care is the greater utilisation of nursing and midwifery health care professionals. As of 2021, there were 333 413 registered nurses and midwives (excluding those on leave) employed in Australia.5 This is the largest group of registered health care professionals and are available in higher numbers in rural and remote areas.3 In 2021, there were 1210 registered nurses and 169 midwives full-time equivalent (FTE) per 100 000 people in very remote areas, as compared with 1114 registered nurses and 89 midwives (FTE) in major cities.3 Furthermore, registered nurses (RNs) are often the first point of call for patient consultations where there are no other health professionals available such as general practitioners. They are often required to work in diverse cultural and geographical contexts, responding to emergencies and a wide range of acute and chronic health conditions in isolation, or with the local health care workers including Aboriginal Health Practitioners and nonclinical staff to support the people they care for.6, 7 To practice in rural and remote Australia, RNs are required to be multiskilled and practice as an extended generalist when delivering primary health care.7, 8 Therefore, it is important that RNs have the core capabilities and clinical skills to provide care to rural and remote Australians. Up until now, there has been no nationally consistent framework to provide nurses with the professional and practical guidance about nursing skills, and attributes required to safely and confidently work and provide health care for those living in rural and remote regions of Australia. In 2023, the Australian Government released the National Rural & Remote Nursing Generalist Framework 2023–2027 (the Framework) for registered nurses working, or seeking to work, in rural and remote locations across Australia.8 The development was led by ‘Deputy Rural Health Commissioner – Nursing and Midwifery, Adj. Prof Shelley Nowlan, and was guided by an expert Steering Committee comprised of peak nursing representatives and rural and remote nursing leaders’.8 The Framework's aim is to support and strengthen the contribution and influence of nursing practice to improve rural and remote health outcomes. It is a contemporary Framework that articulates the registered nurse skill set required to work in rural and remote Australia, or if using the Modified Monash Model (MM) 3–7.9 Educators and employers can use the Framework as a tool to inform curriculum and support nurses to develop the skills required to practice to their capacity.8 It provides nurses with clarity about the unique professional and clinical skills required for rural or remote nursing practice.8 When using the Framework, registered nurses can map their own professional development, clinical knowledge and skills required to practice and improve rural and remote health outcomes. Culturally safe practice; Critical analysis; Relationships, partnerships and collaboration; and Capability for practice are the four domains comprising the Framework.8 Capabilities and statements that reflect the unique requirements for RN practice in rural and remote health care settings support the framework. In addition, the Framework has a self-assessment tool outlining three levels of practice (Formative, Intermediate and Proficient) to support RNs navigate the professional knowledge and skills required to provide person-centred care. This Framework will benefit nurses and the people they care for.8 Although it will not induce a more equitable distribution of health workforce, the Framework will enhance nurse's preparedness. This will enable them practice to their full scope of practice as a nurse generalist in order to provide effective and culturally safe health care in rural and remote Australia.8 While noting that there needs to be an increase in the health workforce generally in rural Australia, including nursing, the National Rural Health Alliance notes that RNs frequently have to practice at an advanced level delivering health care, often with reduced clinical support and assistance when compared to their urban colleagues.10 The Framework is a promising initiative to provide RNs, educators and employers guidance about the skills and support needed for RNs wanting to practice in rural and remote Australia. Improving access to health care in rural and remote Australia will improve patient health and well-being and reduce the existing disparity in health care and health outcomes. More information on the Framework for nursing rural generalist framework can be found at The Department of Health and Aged Care website: https://www.health.gov.au/resources/publications/the-national-rural-and-remote-nursing-generalist-framework-2023-2027. Marnie Connolly: Writing – original draft; writing – review and editing. Heather Keighley: Reviewing and editing.