Everything you need to know about rural and remote nursing and travel nurse contracts in Australia
And what the Monash Modified Model means
Rural and remote nursing in Australia plays a critical role in providing healthcare services to populations living in geographically isolated areas. These regions often face unique healthcare challenges, including limited access to healthcare facilities, shortages of healthcare professionals, and diverse healthcare needs. Nurses are often the only primary healthcare provider in rural and remote communities, and the care they provide is with fewer resources.
In order to service these communities, nurses with extensive experience typically gained in metropolitan areas in busy tertiary hospitals, will often temporarily relocate to regional, rural or remote areas to fill short-term contracts or long-term vacancies. These nurses may refer to themselves as travel nurses or rural and remote nurses.
Here’s everything you need to know about travel nursing and rural and remote nursing in Australia, and how to get a job as a travel nurse or a rural and remote nurse.
Common Terminology in Rural and Remote Nursing
RAN = Remote Area Nurse
RIPRN or RIPERN = Rural and Isolated Practice Registered Nurses or Rural and Isolated Practice Endorsed Registered Nurse – an endorsement for registered nurses practising in rural, isolated and remote areas in Australia. These nurses are entitled to hold the post-nominal RIPRN. (Victoria & Queensland) RIPRNs have additional training and accreditation and can supply and administer medicines from Schedules 2, 3, 4 and 8 in accordance with the health management protocols in the latest edition of the Primary Clinical Care Manual (PCCM).
Travel Nurse: an American term coined in the 70’s, the concept of travel nurses emerged to support short-term shortages in hospitals, and to support disaster relief efforts and global aid projects. While not frequently used to define nurses in Australia, there is an emerging trend for nurses, especially those on working holiday visas for Australia, to seek opportunities that allow them to work their way around the country, visiting various regions while gaining invaluable work and travel experiences.
MPHS = Multi-Purpose Health Service
LAFHA = Living Away From Home Allowance
FIFO = fly in fly out – usually related to jobs on mining sites and in the oil and gas, and construction industries. Increasingly used by nurses seeking roles in rural and remote nursing where a hospital may enable the nurse to fly in for the duration of their roster before flying home again. Roster variations are extensive. Examples include the 2:1 Roster: In a 2:1 roster, employees work for two weeks straight at the remote site (eg. a mine or an offshore oil rig) and then have one week off before their next rotation. This is often referred to as a “two weeks on, one week off” schedule. 3:1 Roster: Similar to the 2:1 roster, but employees work for three weeks on-site before having one week off. 4:2 Roster: Employees work for four weeks on-site and then have two weeks off.
DIDO = drive in drive out – usually related to rural and remote nursing on mining sites
HHS = Hospital and Health Service (Queensland, Victoria & Tasmania)
LHD = Local Health District (New South Wales)
LHN = Local Health Networks (South Australia)
WACHS = Western Australian Country Health Service
ACCHOs = Aboriginal Community Controlled Health Organisations, of which there are ~145 nationally, supporting ~300 healthcare clinics.
Overview of regional, rural and remote nursing
28% of the population (~7 million Australians) live in regional, rural and remote areas according to the Australian Bureau of Statistics (2022). Australians living in these areas experience lower life expectancies compared to those in metropolitan areas, as reported by the Australian Institute of Health and Welfare (AIHW, 2022). Additionally, they face higher rates of hospitalisations, deaths, injuries, and encounter inequitable access to, as well as lower use of primary healthcare services. These statistics emphasize just how important it is that rural and remote area nurses have generalist skills to navigate the diverse and unique practice contexts they encounter to serve patients in these areas.
What is Rural and Remote in Australia, and what the Monsh Modified Model means
In Australia, the Department of Health uses a national classification system called the Monash Modified Model (MMM) to determine if a healthcare location is a city, rural, remote or very remote. The model measures remoteness and population size on a scale of 1 to 7.
- MM 1 – Metropolitan areas – Major cities which account for 70% of Australia’s population. (eg: St George Hospital, Sydney).
- MM 2 – Regional centres – Inner and Outer Regional areas that are in, or within a 20km drive of a town with over 50,000 residents.
- MM 3 – Large rural towns – Inner and Outer Regional areas that are not MM 2 and are in, or within a 15km drive of a town between 15,000 to 50,000 residents.
- MM 4 – Medium rural towns – Inner and Outer Regional areas that are not MM 2 or MM 3, and are in, or within a 10km drive of a town with between 5,000 to 15,000 residents.
- MM 5 – Small rural towns – All remaining Inner and Outer Regional areas.
- MM 6 – Remote communities – Remote mainland areas AND remote islands less than 5kms offshore.
- MM 7 – Very remote communities – Very remote areas
The MMM of a facility has a direct impact on the skills, experience, and qualifications of the nurse required to fill a vacancy, as well as the rate of pay on offer, incentives, benefits, and bonuses, including transport and accommodation. It’s fair to work on the basis that the more remote the location, the more extensive the experience and qualifications required, and the higher the rate of pay will be.
The Role of Rural and Remote Nurses
The majority of healthcare providers in rural and remote locations are nurses. Rural and remote nurses provide primary healthcare services and play a multifaceted role that includes health promotion, disease prevention, assessment, diagnosis, treatment, and ongoing management of various health conditions. They often work autonomously and collaborate with other healthcare professionals to deliver comprehensive care.
To be considered for a Rural and Remote role in Australia, most, if not all facilities and locations require nurses to have at least 2 years’ post-graduate (but preferably 4 years) acute care nursing (including critical care and emergency) experience before placement in a rural or remote role. Post-graduate experience is also preferred in areas such as chronic disease management, women’s health, and child health.
When nursing agencies state that they require at least 2 years of experience (or more) for a particular role, it’s not the agency that makes this a requirement – it is the hospital or healthcare facility that requests this level of experience.
Nurses will generally require knowledge and understanding of Primary Health Care principles (with knowledge and understanding meaning that a nurse may not have yet acquired that practical experience yet, but will likely have observed this and have a thorough knowledge and understanding in order to conduct the duties required in the role).
Many nurses who have transitioned to rural and remote advise that peers work in a regional environment first.
For any role, nurses must be eligible to work in Australia, hold AHPRA Registration with no restrictions and meet all employment checks, vaccination and mandatory training and compliance requirements. You can learn more about the basic nursing requirements here
Scope of Practice
Rural and remote nurses have a broad scope of practice, as they are typically the primary healthcare providers in their communities.
Rural and remote nurses operate within an extensive and comprehensive scope of practice, applying advanced generalist skills to deliver essential healthcare services to their communities across all stages of life. Their responsibilities encompass a broad range of settings, including preventive and emergency management, acute care, aged care, chronic disease management, child health, maternity and antenatal care, mental health support, palliative care, Indigenous health, community education, and health promotion. Through their planning and provision of care, these dedicated RNs address the diverse healthcare needs of their communities across various healthcare domains.
Rural nurses often provide care with reduced clinical support and are frequently called to respond to a broader range of emergency and health needs. Rural nurses work in varied settings such as small hospitals, Aboriginal Community Controlled Health Organisations, primary health care services, outreach, and community health in multidisciplinary teams, including aged care and mental health.
Remote nurse’s scope of practice encompasses broad aspects of primary health care and requires a generalist approach to delivering care. Remote area nurses are responsible for continuous, coordinated, and comprehensive health care for community members, including after-hours emergency care. RNs working in remote locations offer a full scope of practice to meet the diverse needs of their entire community. They often work in settings that often lack physical resources, specialists, general pharmacy, allied health, and retrieval services.
Rural and remote nursing in Australia comes with several challenges. These include professional isolation, limited access to resources and support, long distances between healthcare facilities, workforce shortages, and the need to adapt to diverse cultural practices and contexts.
Continuous professional development is crucial for rural and remote nurses to stay updated with the latest evidence-based practices, and to address the unique healthcare needs of their communities. Professional organizstions, such as the Australian College of Rural and Remote Medicine (ACRRM) and CRANAplus (the peak professional body for the remote and isolated health workforce) which offers training, workshops, and resources for healthcare professionals in isolated health or remote health who seek work as a clinical nurse, care nurse, midwife, nurse manager while working in Aboriginal and Torres Strait Islander health, men’s health, maternal health, mental health care, children’s health, primary health, and aged care,
Recognising the challenges faced by rural and remote nurses, various support networks and programs are in place. For example, the Nursing and Allied Health Scholarship and Support Scheme (NAHSSS) provides scholarships and support for health professionals working in remote areas. Telehealth services and online communities also offer opportunities for networking and peer support.
Australia’s rural and remote areas are home to diverse populations, including Indigenous communities. Rural and remote nurses need to be culturally sensitive and aware of the unique health needs and cultural practices of the communities they serve.
Indigenous Peoples and Communities
The Aboriginal population in Australia is estimated to be 745,000 individuals (3% of the total population). 18% of Indigenous Australians live in remote and very remote areas.
According to the National Aboriginal Community Controlled Health Organisation (NACCHO), the national peak body for all Aboriginal Community Controlled Health Organisations (ACHHOs), Aboriginal health means not just the physical well-being of an individual, but refers to the social, emotional and cultural well-being of the whole Community in which each individual is able to achieve their full potential as a human being thereby bringing about the total well-being of their Community. It is a whole-of-life view and includes the cyclical concept of life-death-life.
Primary health care services initiated and operated by ACHHOs deliver holistic, comprehensive, and culturally appropriate health care to the community and support the social, emotional, physical and cultural well-being of Aboriginal and Torres Strait Islander peoples, families, and communities.
Recruitment and Retention
Recruitment and retention of healthcare professionals in rural and remote areas is an ongoing challenge. The Australian Government and healthcare recruitment agencies (nursing agencies) may offer incentives such as relocation assistance, travel cost reimbursement, scholarships, grants, and financial incentives to attract and retain healthcare professionals in these regions. These will usually be linked to minimum placement terms – for example, a rural and remote nurse may need to complete a minimum 6-week contract in order for travel costs to be reimbursed.
Incentives and Allowances
Incentives and allowances may extend to:
Living Away From Home Allowance (LAFHA) – paid directly by an employer to an employee to compensate for their additional non-deductible expenses because of a requirement to live away from their usual place of residence to do their job. LAFHA may range from $50 to as much as $150 per day worked and may be dependent on the level of remoteness of the role.
Travel costs may cover fuel or return economy flights from the nearest airport to the nurses’ usual place of residence, or via public transport, or taxi fares, or a combination of all modes. Travel entitlements are not necessarily paid for every rural and remote placement and may be via negotiation only.
Excess baggage costs may be offered in certain situations for longer-term contracts, but keep in mind that some very remote locations may only be serviced by a light aircraft which limits the amount of baggage can be transported. We’ve heard of excess baggage costs being covered for $50 – $80.
Accommodation may be offered (single, shared, shared single room in nurse’s quarters, subsidised local accommodation, family home). There is huge variety in the living conditions across rural and remote locations – most places advise that there is no expectation of luxury. Most accommodation will be adequate and meet basic requirements, so it’s important to clarify with whoever offers you a contract what you require or what is on offer, so expectations are clear. It’s also important to understand that some areas may experience difficulty in supplying well-functioning accommodation, so be prepared to rough it.
Meals may be provided in some situations (such as on mine sites).
Please note that if a placement is not successfully completed because a nurse chooses to leave the contract prior to completion, or the nurse is terminated from the contract, most agencies, healthcare facilities, and health services will require any travel costs outlaid to be paid back. This is because these conditions on the placements are made by the hospital or healthcare facility as part of an agreement with the agency.
For a comprehensive list of rural and remote nursing incentives, benefits, entitlements, and allowances that may be offered or negotiated, check out our checklist here.
Telehealth and Technology
Telehealth services have been increasingly used in rural and remote healthcare, allowing nurses to connect with patients and other healthcare professionals remotely. Technology, such as electronic health records and telemedicine, plays a vital role in improving access to healthcare and communication in these areas. In much the same way as agencies may only have agreements in place with particular facilities to connect them to nurses, Telehealth works the same way – there are a limited number of Telehealth providers nationwide and a limited number of agencies or providers who offer Telehealth work (uPaged being one of them!).
Despite the challenges, rural and remote nursing can be highly rewarding. Nurses in these areas often develop strong relationships with their patients and become integral members of their communities. The opportunity to make a real difference in people’s lives and contribute to improving health outcomes can be personally fulfilling.
The flip side of this is professional and personal isolation. Rural and remote nursing jobs are not for everyone. Long periods of time away from family and friends can lead to homesickness and feelings of isolation.
A big challenge is having to travel to remote locations with some rural and remote nurses working on a fly-in fly-out (FIFO) or drive-in drive-out (DIDO) basis. There may also be limited equipment and resources on site. However, most health services provide a full induction or orientation and offer ongoing support to nurses working in remote areas.
Rural and remote nursing can provide unique and rewarding career opportunities. It offers the chance to make a significant impact on the health and well-being of underserved populations, work closely with communities, and develop a diverse skill set.
The Role of the Nursing Agency
Australia is served by over 250 nursing recruitment agencies (known as agencies), operating in metropolitan, regional, rural and remote locations.
Nursing agencies are the intermediary between the Nursing Agency consultants and the hospitals, healthcare facilities and communities that need short term contracts and nursing vacancies filled. They work hard to ensure nurses get the best offer for a term contract. They may negotiate allowances, benefits and incentives on the nurse’s behalf, and arrange travel and accommodation. They are also responsible for ensuring compliance, employment checks, training, mandatories and compliance is current and retain liability for these for the duration of the placement. Agencies must adhere to a raft of regulatory requirements, and will usually hold a labour hire licence in order to provide their services. They will also usually belong to a professional organisation such the Recruitment, Consulting & Staffing Association (RCSA), which is the peak body for the recruitment, staffing and workforce solutions industry across Australia and New Zealand.
Typically, agencies secure a fee for placement for up to 13 weeks of placement after which time fee options lapse.
Rural and Remote Locations
Where a nurse can secure a placement or term contract will depend on which locations are served by each agency. Agency’s selection by a supplier to be a member of their preferred supplier panel, and these are usually obtained after participating in a competitive tender to supply locations.
Clever healthcare facilities and health districts list term contracts directly on uPaged, removing the need for the agency middleman. What this means is that the rates on offer to the nurse will usually be higher than those from agencies, while benefits and allowances are the highest level on offer for that facility.
uPaged has won the right to supply a number of organisations, including the whole of Queensland Health, Western Sydney Local Health District, South East Sydney Local Health District, Northern New South Wales Local Health District, as well as private hospital and healthcare operations including Macquarie Health, Nexus Hospitals, Sydney Adventist Hospital and Chris O’Brien Lifehouse Hospital.
Leaving a contract or placement prior to completion can lead to penalties that mean that a nurse may be banned from working within a particular State, Territory, LHD, LHN, HHS or other health service for a period of time after leaving that role prior to completion. Again – this is not an agency thing – but rather related to the terms and conditions imposed on the agency by the hospital, healthcare facility or health district.
The agency or service that facilitated the placement will usually incur a hefty financial penalty that may be passed on to the nurse if a contract is canceled or not fulfilled, so before a contract is agreed upon, it’s critical to ensure that the terms and conditions of the contract are fully understood by the nurse. Leniency on any financial penalties may be granted for extenuating circumstances, but this will always be at the discretion of the agency and healthcare facility.
Rural and Remote Mandatories
In addition to the standard vaccination protocols and mandatory competencies, rural and remote nurses also usually require current:
- Advanced Life Support (ALS)
- Remote Emergency Care (REC) certification or equivalent
- Maternity Emergency Care (MEC)certification or equivalent
- Immunisation Providers Certificate or working towards same, to be completed within 12 months of employment
- Tertiary qualifications in Remote Health Practice, Midwifery, Child health, Community Health, Mental Health etc, or working towards same
Some contracts may require evidence of the completion of a 4-wheel driving (4WD) course, and a full clean C class manual driver’s licence (in order to drive the local Ambulance).
Working as a nurse in rural and remote Australia requires a unique set of skills and attributes. In addition to the essential medical knowledge and clinical nursing skills, the following soft skills are important:
Adaptability: Nurses working in rural and remote areas must be adaptable and flexible due to limited resources, varying patient demographics, and challenging working conditions. They need to quickly adjust to changing circumstances and be open to new approaches and procedures.
Strong communication: Effective communication is crucial for nurses working in any setting, but it becomes even more vital in rural and remote areas where healthcare professionals may need to work closely with a small team or communicate with patients from diverse cultural backgrounds. Clear and empathetic communication is essential to establish trust and provide quality care.
Problem-solving: Nurses in rural and remote areas often face unique challenges, such as limited access to specialised equipment or medical expertise. They need to be resourceful, creative, and skilled at problem-solving to find alternative solutions and provide the best possible care within the available resources.
Independence and self-reliance: Working in remote areas often means being part of a small healthcare team or even being the sole healthcare provider in the region. Nurses should be comfortable working independently, making critical decisions, and taking initiative when necessary. They need to be self-reliant and confident in their abilities.
Cultural sensitivity: Rural and remote areas in Australia may have diverse populations with different cultural backgrounds, including indigenous communities. Nurses should demonstrate cultural sensitivity, respect for cultural practices, and a willingness to learn from and collaborate with people from various backgrounds.
Emotional resilience: Providing healthcare in rural and remote areas can be emotionally challenging. Nurses may face unique situations, including limited resources, long working hours, and witnessing the impact of social and economic disparities on patients’ health. Emotional resilience is vital to cope with these challenges and maintain mental well-being.
Teamwork and collaboration: While nurses in rural areas may have more independence, teamwork and collaboration are still crucial. They must work closely with other healthcare professionals, including doctors, allied health providers, and community support services, to deliver comprehensive care to patients.
Community engagement: Nurses working in rural and remote areas often develop strong connections with the community. Building trust and engaging with the local population is important for promoting health education, preventive care, and understanding the unique healthcare needs of the community.
Overall, nurses working in rural and remote Australia need a combination of clinical skills, adaptability, effective communication, problem-solving abilities, cultural sensitivity, emotional resilience, teamwork, and community engagement to provide quality care in challenging environments.
Study to be a Rural and Remote Nurse
While not critical to pursue a rural and remote career, it is highly recommended that training is undertaken to prepare for life as a rural and remote nurse.
CRANAplus provides rural and remote health courses here: https://crana.org.au/learning-opportunities/overview
There are two programs of study of up to 12 months duration that prepare registered nurses with additional training to work as RIPRNs:
- the Rural and Isolated Practice (Scheduled Medicines) Registered Nurse Course at Queensland Health’s Cunningham Centre, or
- the Graduate Certificate of Health (Scheduled Medicines) at the University of Southern Queensland;
Rates of Pay for Rural and Remote Nurses
According to talent.com, the average rural and remote salary is $117,500, which equates to an hourly rate of ~$60 per hour before any incentives, allowances, entitlements, benefits or bonuses are accounted for. It’s not unheard of to hear of rural and remote nurses earning up to $220K a year.
Support for Career Progression in Rural and Remote Nursing
There are a number of organisations that support nurses in rural and remote areas. These include:
- Office of the National Rural Health Commissioner
- Remote Area Health Corps
- Australian College of Nurse Practitioners (ACNP)
- Australian Nursing and Midwifery Federation (rural members) – ANMF
- Australian College of Nursing (Rural Nursing and Midwifery Faculty) – ACN (RNM)
- Australian Primary Health Care Nurses Association (APNA)
- Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM)
- Council of Remote Area Nurses of Australia (CRANAplus)
- National Rural Health Alliance
- Australian Rural Health Education Network (ARHEN)
- National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners (NAATSIHWP)
- National Aboriginal Community Controlled Health Organisation (NACCHO)
- National Rural Health Student Network (NRHSN)
- Rural Workforce Agency Network (RWA Network)
- CRANA’s Guide to working rural and remote in the Northern Territory
It’s important to note that the information provided here is a general overview, and specific details and opportunities will vary depending on the region, the nursing agency or facility that work is secured through, and the healthcare context within rural and remote Australia.
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