Professor of Nursing Julian Grant (pictured, inset) and her colleagues in the the Charles Sturt School of Nursing, Paramedicine and Healthcare Sciences call for investment in structured, tailored specialist education and professional structures for the biggest and most consistent workforce in regional Australia - the knowledgeable, skilled, flexible, adaptable, reflective, innovative and resilient rural generalist nurses.

In Australia, rural generalist nurses are staying the distance with courage and care to attend to the approximately 30 per cent of Australians who live outside major cities.

These rural and regional Australians are sicker and older than their metropolitan peers, and they are more likely to die earlier than their city-dwelling counterparts from diseases such as heart disease, diabetes, suicide and motor vehicle accidents.

They are also more likely to have chronic health conditions including arthritis, asthma, back problems, deafness, diabetes, heart attack, stroke, and vascular disease according to the Australian Institute of Health and Welfare (2019).

People in rural areas struggle to access the same level of health care as their city friends. This means the gap in health care between city and rural Australians continues to grow.

As exciting medical innovations are discovered and delivered in cities, people living in rural areas go without or suffer long periods away from home and family in order to access health care.

There is a chronic shortage of health care professionals in regional Australia, as illustrated by the current NSW parliamentary inquiry into rural healthcare. Yet despite all of the challenges, nurses remain the largest primary health care workforce in regional Australia. They are the stalwarts of courage and care when no-one else is there to assist.

Nurses working in rural settings require advanced skills in generalist practice because these are unique positions with limited access to medical officers, allied health support and investigative services.

Rural nurses work across the human lifespan and across clinical issues that are otherwise afforded specialist care in cities, such as emergency care when a semi-trailer collides with a camper van on the highway in remote areas.

As another example, the next person who might present at a rural health service clinic is the old man who is waiting to die because his wife died last year, his dog died last month and his daughters live in the city and are struggling to get there in time.

Rural generalist nurses are knowledgeable, skilled, flexible, adaptable reflective, innovative and resilient and they work in advanced and extended clinical roles to ensure continuous comprehensive care with limited resources (CRANA Plus).

Rural generalist nurses are staying the distance with courage and care and we call for increased investment at federal levels and from Local Health Districts to keep them there.

We must ensure that these nurses are well-supported operationally and educationally to take up the full scope of their roles.

The Charles Sturt School of Nursing, Paramedicine and Healthcare Sciences is leading the way by working closely with the Western NSW Local Health District to ensure that postgraduate courses for rural and remote nurses will fit current professional pathways and meet the advanced nursing needs of rural generalists.

We need greater understanding of these roles and ‘fit for purpose’ educational models that are flexible and build on the existing needs of the experienced nurse and enable expansion of practice based on the specific needs of the community in which they live, work and play.

On International Nurses Day, while we celebrate the work of nurses working in rural and remote Australia, we call for investment in structured, tailored specialist education and professional structures for the biggest and most consistent workforce in regional Australia ─ nurses.

It’s time to celebrate and grow the ranks of our rural generalist nurses.