What the Office of the National Rural Health Commissioner does

This framework is for registered nurses who want to work in rural and remote areas where no two days are the same, and where nurses are required to work to their full scope of practice. It identifies the capabilities needed to deal with any type of presentation and supports the development of nurses in rural and remote settings. If you are a rural or remote nurse, use it to strengthen your own practice. If you're an educator, use it to inform curriculum. If you're an employer, use it to support your employees to practice with confidence.

RUTH: I’m Ruth Stewart, I’m the National Rural Health Commissioner and I’ve been a rural generalist for over 35 years now. It’s the best job in the world.

Rural generalists are equipped to work in rural and remote settings. We really need very skilled clinicians working in remote communities. The National Rural Generalist Pathway is a training program for doctors so that they can end with the skills and competence – and confidence – to work in a rural or remote community, anywhere in Australia. So that governments and health departments, hospitals and clinical practices will recognise the scope of practice and those qualifications as being the signifier that you have the skills to work here.

In setting up the pathway, we’re seeking recognition of rural generalism as a specialised field within general practice. That’s a bit the same as cardiology is a specialised field within internal medicine. So, you’re still a physician with an expertise in internal medicine, but your specialised field is cardiology. Well, I’m still a general practitioner, but I have a specialised field of rural generalism.

PRESTON: I’m Preston Cardelli. I’m one of the provisional senior medical officers working here at Thursday Island. I work as a trainee rural generalist and my skillset is that I’m a training GP registrar with an advanced skill in anaesthetics. I’m able to provide support in a critical care situation and also help out with aeromedical retrievals if needed.

I grew up in a rural area. I always knew that I was going to live in a rural and remote area as much as I could. I knew that I wanted to be a rural doctor because it meant that I could return back to where I felt like my foundations were. And through my medical student rotations, I was able to meet people who were working in the role of a rural generalist. Just fascinated and inspired by the stuff that they do day-to-day because it’s amazing, they do such a wide scope of practice. That’s why I wanted to be a doctor that could manage lots of things, that’s why I chose rural medicine.

RUTH: Rural generalists work in what we often refer to as a resource-poor environment. We don’t have CT scans, MRI scans, we don’t have a coronary catheter lab just onsite. If someone has a heart attack, we need to be able to stabilise them, to consult with our specialist colleagues who are at a distance, not just down the corridor, and deliver the care that’s needed now and decide whether this patient needs to be transferred for further care. And that’s a really important thing about rural generalist training – if you turn up in that environment, you train for it, you know what to do when stuff happens because stuff happens. And if you are a person living in a rural and remote community, you want to know that the doctor who you’re just about to meet knows what to do when stuff happens.

PRESTON: The days in the life of a rural generalist up here, probably very different to a lot of other places. My role, I could be doing anything from adjusting a medication on someone for a long-term treatment plan to retrieving someone and putting someone in a coma in an outer island or delivering a baby. You know, it’s just such a wide scope.

RUTH: Yes, some of those emergency situations that I intervened and saved a life, and you know they come but it’s those times where it’s not as easy as just doing one thing. Where it’s being with someone through the course of their illness and the management of it that can only occur if you provide continuity of care.

PRESTON: I think some of the most rewarding parts about being a rural generalist are the fact that you get to be involved in the community. Torres Strait Islander people are very cultural and very family-based and to be invited into someone’s wedding or funeral is a really big deal, and I don’t think that I would get a chance to be involved in something like that if I wasn’t living and working in a remote area. What I would tell myself 6 or 7 years ago when I first embarked on the journey when I first signed up, it’s everything that you’re expecting it to be plus a whole lot more.

RUTH: Innovation, when you approach it as a rural generalist, you can enable the delivery of care in your community that is equal to what anybody in Australia can get. It just looks different. I never have to wonder whether the work I’m doing is helpful. I know every night when I go to sleep that I have made a difference to people’s lives and that is such, such a wonderful and privileged experience.