Nursing graduates face 'trial by fire' during rural program, study finds

Graduate nurses overwhelmed by workload pressures in rural health facilities, report finds In short: Nurses undertaking post-graduate programs feel underprepared when providing emergency care in highly complex cases in rural health facilities. Advocates are calling for more investment in education programs focused on the experiences of nurses working in remote communities. What’s next? A Queensland Health spokesperson says incentives for professional development opportunities are available for post-graduate nurses. Danielle Rogers did not know what to expect when she moved to Monto — more than 400 kilometres north-west of Brisbane — to complete her graduate nursing program in 2010. "I think I cried all the way there," she said. But her three-year stint in the rural town inspired the Hervey Bay researcher's post-doctoral study. While Dr Rogers learned a lot through her experience, she discovered newly graduated nurses were underprepared for the medical challenges common in rural and remote health facilities. A CQUniversity report, authored by Dr Rogers and released last month, found rural and remote nurses were expected to provide medical assistance for a range of highly complex health issues with limited training and resources. Advocates believe funding for programs designed to prepare nurses for remote work is key to retaining people in areas with chronic staff shortages. 'Sink or swim' For her report, Dr Rogers interviewed more than 60 nurses and medical experts about their experiences working at health services in Australia's remote regions. Roughly half of these respondents completed nursing programs in rural Queensland. A key concern identified was the onboarding process for new nurses, which involved senior staff explaining the new responsibilities and how the service operated. Dr Rogers said rural nurses must be equipped to respond to "a diverse range of [medical] presentations" not often seen in metropolitan areas, such as farming accidents, with limited support. But multiple participants reported feeling overwhelmed by their new workload because it did not always align with their skill level or prior training. "There were a lot of comments about [how] they were sent in to sink or swim or felt it was a trial by fire," Dr Rogers said. Queensland Nurses and Midwives Union secretary Sarah Beaman said it was tricky for new nurses to make the transition into rural health centres. "Any clinician entering these sites are job ready but if they've come from a metropolitan environment, they feel underprepared particularly when faced with emergency presentations and limited on-site support," Ms Beaman said. Most interviewees were forced to use their professional development leave to attend essential courses about improving their existing skills. But they said the sessions largely focused on the experience of metropolitan nurses. "One person said they did a course [about] advanced life support and the instructor told them to hit a button and the team would come," Dr Rogers said. "They asked, 'Well, there's only two nurses, what do we do in a situation like that?' And the instructor said, 'Oh well, that's not what we're teaching today'." Minimal support available Nurses were told the best place to voice concerns was with their direct line managers. But staffing constraints meant it was not always practical to seek guidance from veteran workers. "Because senior nurses were so tired and burnt out, the education and support which may have been available was difficult to access," Dr Rogers said. "They [graduates] felt like they had to learn and debrief from each other." Many nurses said that, over time, their mental health declined due to geographic isolation, growing caseloads and financial insecurity. "The increased pressure to look after patients with persistent shortages can lead to burnout and stress," Ms Beaman said. The report found the ongoing pressures often resulted in nurses moving to metropolitan areas upon completing their graduate program. Support options are available for rural nurses in Queensland, including a 24/7 crisis hotline and grants to cover initial accommodation and travel costs. But Ms Beaman said more incentives were desperately needed. More training opportunities needed Queensland Health's 2025 Workplace Gap Analysis found more than 17 per cent of nurses in rural facilities were entry-level employees. A separate statistic from the Wide Bay Health and Hospital Service revealed about 5 per cent of the 234 nurses currently working at rural health services across the region were newly graduated nurses. Despite the negative experiences uncovered in Dr Rogers's study, Ms Beaman said rural placements were an incredible training ground for prospective graduates. "You get to work to an optimised scope of practice and provide high-level care when needed," she said. But she said prospective workers were deterred from accepting rural nursing programs due to inequitable access to learning and limited professional development options. Ms Beaman said the current curriculum should be updated to include "transition programs specific to the daily experience of rural and remote nurses". "They need to look at low-cost staff housing options and training support to entice people to work in communities with low staffing numbers," she said. A Queensland Health spokesperson said the department was "building more staff accommodation and providing incentives such as paid professional-development leave, relocation costs and bonus payments". [Image text:] UnisC Hasing Student