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Remote nurse practitioners

Photo: Remote nurse practitioner Lyn Byers
What does it take to become a remote Nurse Practitioner? The path is filled with dust and logistical challenges but it’s also one of the most professionally and personally fulfilling journeys, writes Karen Keast.

Working as a Nurse Practitioner in outback Australia, Lyn Byers has the responsibilities of a nurse, a doctor, a pharmacist, a pathology staff member, a driver, a cleaner and a receptionist.

Ms Byers may be thousands of kilometres away from where she grew up in Bairnsdale, Victoria, but she wouldn’t have it any other way.

The nurse and midwife of 13 years, who became a Nurse Practitioner four years ago, loves that she can deliver an advanced level of nursing practice, across the lifespan, to Indigenous people living in one of the most remote and disadvantaged communities in the nation.

“You are a specialist generalist in remote,” she says.

“The populations I work with have extremely complex and psycho-social needs in very poor socio-economic circumstances.

“Being able to offer an extended level of care, in the community, enables individuals to have more control over their health needs.”

Ms Byers works in a clinic, alongside two nurses and several casual-employed Aboriginal health workers, where she cares for families with young children, who often require child health checks and immunisations, while other patients require monitoring for high blood pressure, diabetes and cholesterol.

“Growth faltering and anaemia are big issues in the younger ones however the older children are suffering overweight and obesity - we’re monitoring for diabetes in 10 to 12-year-olds,” she says.

“The older members of the population need assistance with activities of daily living - I’m working out a strategy so a 70-year-old can go away for a specialist appointment, when he is the sole carer for his severely demented wife.”

There are scripts that need to be updated, patients need to be referred to other agencies for support, the ambulance needs to be re-fuelled and there are flu vaccinations to be provided.

And in the midst of it all, the equipment may stop working due to dust or power failure.

“There is no administration person, driver or cleaner - oops, the floor needs mopping,” Ms Byers says.

“The challenges are generally logistic…Nurse Practitioners need to be proficient in detective work and problem solving to ensure all equipment continues to function and best care is provided.”

What are Nurse Practitioners?

Nurse Practitioners are highly educated, skilled and experienced registered nurses who can prescribe medications, order and interpret X-rays and blood tests, and refer to medical specialists.

In 2001, the first Nurse Practitioner was appointed to work in a remote area in Australia, where there was no practising doctor.

A little over a decade later and Australia is now home to 1000 Nurse Practitioners - and it’s estimated 100 of those are working in rural and remote areas.

Nurse Practitioners are highly educated, skilled and experienced registered nurses (RN), who work at an advanced level in a variety of clinical practice settings.

Australian College of Nurse Practitioners (ACNP) vice president Leonie Burdack, who works in a clinical  Nurse Practitioner role in emergency, says Nurse Practitioners play a vital health care role, particularly in rural and remote regions.

“In a rural and remote setting, Nurse Practitioners require excellent generalist skills and knowledge,” she says.

“They are often one of a very small team and it is not uncommon for the Nurse Practitioner to be the sole clinician with a general practitioner available by phone and/or visiting weekly or monthly.”


Ms Burdack says, in many cases, pathology and imaging services are not often regularly available in rural and remote settings.

“There is a far higher reliance on advanced clinical assessment for diagnosis,” she says.

“Particularly in the more remote communities, for patients that are acutely unwell, there is also the need to assess and weigh up whether the patient can be treated and monitored, with a view to transfer out if they are not improving, or whether immediate transfer is required while initial treatment is commenced.

“In addition to excellent generalist skills, the majority of rural and remote Nurse Practitioners also have emergency and/or critical care skills and midwifery qualifications.”

Making the transition

Ms Burdack says Registered Nurses wanting to become Nurse Practitioners should develop a good “generalist” grounding that consolidates undergraduate education coupled with specialist skills and knowledge.

“This usually includes further post graduate study and qualifications in a specialty or generalist area, working in senior clinical nursing roles before completing a Masters degree that is recognised by the Australian Health Practitioner Regulation Authority (AHPRA),” she says.

ACNP figures show 64 per cent of Nurse Practitioners have more than 18 years’ experience working as a RN before becoming an Nurse Practitioner, while 84 per cent have more than 12 years’ experience as a RN.

Ms Burdack says the journey to become a Nurse Practitioner is challenging, and involves commitment and hard work.

“Find a good mentor or mentors and establish good professional networks, set high standards and lead clinically by example, ensure you have the support of your employer - this is essential for your clinical supervision and learning.

“Most of all be resilient and don’t give up.”

Ms Byers says while Nurse Practitioners need a broad range of clinical skills across the lifespan, they must also be able to adapt those skills to the setting.

“You need good hands-on clinical skills to perform thorough assessments which inform your treatment,” she says.

“From my experience, it’s the clinical assessment most Nurse Practitioner candidates really need to work on and it takes practice.

“Practice your assessment skills whenever you have the chance and don’t rely on machines - can you look, listen and feel to give you enough information to inform your treatment?”

A rewarding career

Ms Byers says for many it’s a major culture shock moving to remote nursing.

Sometimes Ms Byer’s clinic uses interpreters or sign language to communicate with patients, there is no mobile phone reception, while many white people find they are often living for the first time as the minority population.

“Remote populations are one of the sickest in Australia, so a remote clinician has the opportunity to see and manage a huge range of conditions not seen in urban settings,” Ms Byers adds.

“Even the parameters of normal change - what you accept in the remote setting wouldn’t be tolerated in an urban setting.”

One of Ms Byer’s more memorable experiences involved providing palliative care to a 54-year-old Aboriginal woman who refused dialysis.

“She was a strong senior, very traditional woman for the community and she had seen her sister die in Alice Springs on dialysis,” she recalls.

“As her health deteriorated, she continued hunting, engaging in traditional ceremonies, involved in community activities, playing cards and caring for grandchildren.”

The woman repeatedly talked with Ms Byers about how she didn’t want dialysis but well-meaning health service providers wanted the woman to receive treatment.

“I received a call from the patient - she didn’t want to be in hospital, she was homesick and didn’t want dialysis. I suggested she come back to her community,” she says.

“It was after this, the specialist services seemed to come to an understanding that she wanted palliative care rather than intervention.”

Ms Byers says the woman’s last days were spent peacefully, sleeping in her bed at home while Ms Byers monitored for pain, provided pain relief and assisted the family’s needs.

“Her husband was caring for her, still hunting rabbits and kangaroos for their meals and washing her.

“She finally went into a coma and slipped away peacefully, surrounded by the sounds, smells, tastes and sensations she had had around her all her life,” Ms Byers says.

“I felt privileged to be invited into her care and feel she had a good death in the way she and her family wanted.”

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Karen Keast

Karen Keast is a freelance health journalist who writes news and feature articles for HealthTimes.

Karen regularly writes for some of Australia’s leading health news websites and magazines.  In a media career spanning 20 years, Karen has worked as a senior journalist in newspapers and television. She has covered the grind of daily news and worked as a politics reporter at countless state and federal elections.

Since venturing into freelance writing five years ago, Karen has found her niche in writing about the health sector for editors, businesses and corporations.

Karen has interviewed the heads of peak health organisations in Australia and overseas, and written hundreds of news and feature articles covering the dedicated work of health professionals who tread the corridors of hospitals and health services, universities, aged care facilities and practices, day in and day out.

Follow Karen Keast on Twitter @stylemywords