Rosemary Cadden reports from the CRANAplus conference in Darwin:

Remote area nursing is famously stressful, but new research suggests that these practitioners are a resilient bunch, and this helps them cope with the occupational stress.

Dr Tess Opie, from Flinders University in Adelaide, has been investigating how stress levels amongst remote area nurses compare with those of hospital-based nurses.

She told the CRANAplus conference in Darwin yesterday that her findings were not what she had expected. The study explored stresses such as emotional demands,  workplace responsibilities and expectations, social issues, isolation and workplace violence.

“We administered two waves of surveys comparing remote area nurses with hospital-based nurses, one in 2008 and one in 2010, and what I expected and what was actually happening were quite different,” Dr Opie explained.

She said:

“Existing data showed that stress levels for remote area nurses were higher than human service workers, police officers and psychiatric nurses.

Throughout my research, I attended numerous conferences and visited remote clinics and I could see first-hand it was a very stressful job: remote area nurses report being incredibly stressed.

I didn’t want to be an armchair researcher so I also did a stint myself as an allied health worker in the Anangu Pitjantjatjara Yankunytjatjara (APY) lands in South Australia.

So we were convinced that we were going to demonstrate that remote area nurses were more stressed than the hospital-based nursing sample. 

However, when we compared remote area nurses and nurses working in hospitals, the remote area nurses did have high levels of stress – but hospital-based nurses reported significantly higher levels than that.

We were shocked.”

Dr Opie outlined some factors that could be contributing to this result.

“Firstly, remote area nurses also reported high levels of work engagement and job satisfaction. They enjoyed their work and felt motivated to work. They were engaged, felt energised and looked forward to going to work. 

In other words, remote area nurses feel stressed and burned out – but also passionate about what they are doing.

We also had to acknowledge that another possible explanation was that remote area nurses do have a tendency to under-report. We do know, from previous research, that they are reluctant to complain about their job conditions through fear of drawing unwanted negative media attention to the communities in which they live and work. This is recognised as a significant phenomenon.

But I was also hearing them talking about how they feel the need to be strong and not to whinge. And I wanted to explore this avenue.

Perhaps there was a process of self-selection in here: with people with high resilience choosing to work in these extreme and unique situations.

So the 2010 survey included a measurement of resilience. And the findings were very interesting, demonstrating possibly why their stress levels are not as high as hospital nurses.

It is that remote area nurses use their resilience as a buffer to reduce their levels of stress. 

Hospital nurses are also resilient, but for them, resilience doesn’t play a role in the relationship between job demands and occupational stress.”

Dr Opie explained that resilience includes such traits as perseverance, sense of humour, the ability to adjust to stressful circumstances and transform adversity into opportunity, and to move forward positively.

While it was once thought that resilience was an innate trait, it is now known that it is a skill that can be taught and learned.

“We want to put that challenge to mentors, managers and RAN educators: that they more adequately prepare nurses for remote health practice, and help them develop robust professional resilience that they can apply to cope more effectively with adversity in the workplace,” she said.

Dr Opie’s PhD was titled Nursing in the Bush: Occupational Stress in Very Remote Australia and her latest publication from her thesis describes the development and validation of the Remote Area Nursing Stress Scale (RANSS) – a new self-report instrument designed specifically to measure occupational stress in this context, and which takes the personal quality of ‘resilience’ into account.

Through this new scale, which will adequately and sensitively measure stress levels for remote area nurses, organisations and governments will be able to track how well or how poorly work interventions are succeeding in reducing stress levels.

Dr Opie’s research over the past few years into occupational stress among remote area nurses has already provided a great deal of knowledge on a previously under-investigated topic.

Her findings have been used by the Centre for Remote Health based in Alice Springs, CRANAplus and the remote health workforce in general to lobby governments and health services for funding and improved conditions.

• Freelance journalist Rosemary Cadden and editor of the quarterly CRANAplus magazine is covering the conference for Croakey readers. Thanks also to photographer Rosey Boehm.

• You can track the CRANAplus conference coverage here.







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