If you drive long enough through regional or remote Australia, you’ll eventually come across one of the health system’s quiet achievers: the small multipurpose service (MPS) or remote hospital. Often tucked between a general store, a pub and a single main road, these facilities provide emergency care, aged care, subacute services and chronic disease management to communities that may otherwise have no access to healthcare at all. They run 24 hours a day, seven days a week — but often with only a tiny workforce juggling multiple roles.

The realities inside these small facilities are unlike anything found in metropolitan hospitals. They require a level of adaptability, clinical breadth and calm problem solving that defines remote practice.

A Hospital Where Every Clinician Wears Multiple Hats

Most rural and remote hospitals operate with a combination of registered nurses, enrolled nurses, a small number of visiting medical officers (VMOs), and, in some locations, an on-call GP who may cover both the local practice and the hospital’s emergency presentations. According to the Australian Institute of Health and Welfare, health workforce distribution varies sharply across the country, with Remote and Very Remote areas having significantly fewer clinical staff per capita compared with Major Cities. This disparity is felt acutely in multipurpose service (MPS) settings, where small teams must stretch across emergency care, inpatient care, aged care and community work — often within the same shift.

For the nurses working in these facilities, the job is all-encompassing. They may be:

• Managing an emergency case in the resus bay
• Taking phone advice from the on-call GP
• Providing wound care, community outreach or medication management
• Supporting aged care residents
• Preparing a patient for retrieval by the Royal Flying Doctor Service (RFDS)

There’s no “that’s not my role” in a remote hospital — everything is your role when resources are limited.

The Pressure of Being the First and Only Point of Care

In urban areas, a person with chest pain can expect an ambulance within minutes and a cardiologist within an hour. In remote areas, the nearest cardiac unit may be hundreds of kilometres away, and the hospital’s sole registered nurse may be stabilising the patient alone until backup arrives.

According to the RFDS Annual National Report 2023–24, the service delivered 345,136 patient contacts in the past year, underscoring how often rural and remote clinicians rely on retrieval support. For many small hospitals, retrieval teams are essential partners. But retrievals take time: weather delays, long distances, competing emergency priorities and limited landing zones all play a part.

This means remote teams must excel in the “golden hours” — keeping patients alive long enough for specialist care to reach them.

Building a Clinical Picture Without the Luxury of Specialists

Remote hospitals rarely have onsite radiologists, pathologists or specialists. Some have basic X-ray and point-of-care testing, but many operate with limited diagnostics. As a result, nurses often rely on:

• Comprehensive clinical assessment
• Telehealth support through state/territory health networks
• Escalation pathways with district hospitals
• Clinical decision tools designed for low-resource settings

In Western Australia, the Emergency Telehealth Service (ETS) provides 24/7 real-time video support to rural emergency departments. Independent evaluations have shown that ETS reduces unnecessary transfers and strengthens clinical decision-making for remote clinicians. It also gives staff greater confidence when managing complex cases without on-site specialist support.

The Emotional Load: “You’re Not Just Their Nurse, You Know Their Family Too”

In small communities, patients aren’t anonymous. Nurses often care for people they see at the supermarket, whose children go to school with theirs, or who helped them during bushfires or floods. That closeness builds trust, but it also adds emotional weight.

Clinicians describe the challenge of:

• Treating friends and neighbours
• Handling traumatic events that affect the whole town
• Being “always on” in a community that knows where they live
• Managing grief when local tragedies occur

Rural workforce studies consistently highlight the emotional isolation of remote clinicians, emphasising the need for strong peer networks, clinical supervision and structured debriefing.

Keeping the Doors Open: Staffing, Accommodation and Retention

Workforce instability is one of the biggest threats to remote hospitals. The AIHW notes that recruitment and retention remain chronically difficult in remote regions, with far fewer health professionals per capita than in major cities.

To keep services running, many hospitals rely on:

• Short-term locums, sometimes rotating every 2–6 weeks
• Fly-in/fly-out (FIFO) nurses and allied health clinicians
• Shared roles with local GP practices
• Internationally trained staff, who now make up a significant part of the rural workforce

High turnover affects continuity of care and places additional stress on the small number of long-term staff who continue to anchor the service.

Innovation Out of Necessity

Despite these pressures, remote hospitals are often hubs of innovation:

• Telehealth ED consults and after-hours video support
• Advanced practice nurses expanding their scope to meet local needs
• Integrated care models where aged care, acute care and community services operate under one roof
• Simulation training in small teams, allowing nurses to practise everything from neonatal resuscitation to trauma management
• Cross-sector partnerships with RFDS, Aboriginal health services and regional hospitals

These innovations aren’t optional — they are survival strategies that keep services safe and sustainable.

What Remote Teams Want City Clinicians to Know

Every remote clinician has a version of this message:

“We’re not under-skilled. We’re under-resourced.”

Working in a remote hospital means developing extraordinary breadth:

• Managing diverse emergencies
• Practising autonomously
• Learning to work without immediate backup
• Problem-solving with what you have, not what you wish you had

Far from being a “stepping stone,” remote practice is a sophisticated, broad-scope environment that requires advanced clinical judgement and resilience.

Why These Hospitals Matter More Than Ever

With Australia’s regional population growing — and climate events placing more pressure on health systems — remote hospitals are becoming increasingly important. They are the only emergency care for thousands of people, the safety net in disasters and the heartbeat of
many small towns.

Closing one of these facilities, even temporarily, can mean hours of extra travel for urgent care — and increased risk for rural residents.