Examining workplace safety for remote area nurses in Australia: a cross-sectional descriptive study

Area of Science:

• Public Health
• Occupational Health and Safety
• Rural Health

Background:

• Australia's remote health sector faces chronic understaffing and serves a diverse population with a high disease burden.
• Poor workplace health and safety (WHS) in remote primary health clinics contributes to burnout, high staff turnover, and reduced quality of care.
• The murder of remote area nurse (RAN) Gayle Woodford in 2016 prompted WHS recommendations for the sector, but their implementation is unclear.

Purpose of the Study:

• To identify the extent to which WHS recommendations have been implemented in Australian very remote primary health clinics.
• To assess WHS from the perspective of RANs working in these settings.

Main Methods:

• A cross-sectional online survey was conducted with 173 RANs working in very remote (MM 7) Australian primary health clinics between December 2020 and January 2021.
• The survey used specific safety criteria derived from validated tools and remote-specific WHS recommendations, clustered into domains: staff preparation, safe work environment, and safe work practices.
• Descriptive statistics were used to calculate national and regional workplace safety scores.

Main Results:

• The average national workplace safety score was 53% of recommendations met, with significant variation across domains (staff preparation: 38.5%, safe work environment: 59.4%, safe work practices: 50.0%).
• Significant regional variations in safety scores were observed, notably between the Northern Territory and Queensland, and South Australia and Queensland.
• Many RANs (35.9%) still reported being expected to attend after-hours call-outs alone, indicating a lack of 'never alone' policies or processes.

Conclusions:

• Despite some implemented safety strategies, significant gaps persist in staff preparation, fatigue management, and infrastructure safety for RANs.
• The observed regional variations in safety scores suggest a fragmented approach to WHS in the remote health sector.
• Establishing and enforcing national minimum standards for WHS is crucial to address persistent high turnover and improve healthcare quality and continuity in remote communities.